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Analitis, A.* ; Michelozzi, P.* ; D'Ippoliti, D.* ; de'Donato, F.* ; Menne, B.* ; Matthies, F.* ; Atkinson, R.W.* ; Iñiguez, C.* ; Basagana, X.* ; Schneider, A.E. ; Lefranc, A.* ; Paldy, A.* ; Bisanti, L.* ; Katsouyanni, K.*

Effects of heat waves on mortality: Effect modification and confounding by air pollutants.

Epidemiology 25, 15-22 (2014)
DOI PMC
Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.
Background: Heat waves and air pollution are both associated with increased mortality. Their joint effects are less well understood. Methods: We explored the role of air pollution in modifying the effects of heat waves on mortality, within the EuroHEAT project. Daily mortality, meteorologic, and air pollution data from nine European cities for the years 1990-2004 were assembled. We defined heat waves by taking both intensity and duration into account. The city-specific effects of heat wave episodes were estimated using generalized estimating equation models, adjusting for potential confounders with and without inclusion of air pollutants (particles, ozone, nitrogen dioxide, sulphur dioxide, carbon monoxide). To investigate effect modification, we introduced an interaction term between heat waves and each single pollutant in the models. Random effects meta-analysis was used to summarize the city-specific results. Results: The increase in the number of daily deaths during heat wave episodes was 54% higher on high ozone days compared with low, among people age 75-84 years. The heat wave effect on high PM10 days was increased by 36% and 106% in the 75-84 year and 85+ year age groups, respectively. A similar pattern was observed for effects on cardiovascular mortality. Effect modification was less evident for respiratory mortality, although the heat wave effect itself was greater for this cause of death. The heat wave effect was smaller (15-30%) after adjustment for ozone or PM10. Conclusions: The heat wave effect on mortality was larger during high ozone or high PM10 days. When assessing the effect of heat waves on mortality, lack of adjustment for ozone and especially PM10 overestimates effect parameters. This bias has implications for public health policy.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Pollution Related Deaths ; 15 European Cities ; 9 French Cities ; Particulate Matter ; Time-series ; Us Cities ; Temperature ; Ozone ; Association ; Weather
Language english
Publication Year 2014
HGF-reported in Year 2014
ISSN (print) / ISBN 1044-3983
e-ISSN 1531-5487
Journal Epidemiology
Quellenangaben Volume: 25, Issue: 1, Pages: 15-22 Article Number: , Supplement: ,
Publisher Lippincott Williams & Wilkins
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)
POF-Topic(s) 30202 - Environmental Health
Research field(s) Genetics and Epidemiology
PSP Element(s) G-504000-001
PubMed ID 24162013
DOI 10.1097/EDE.0b013e31828ac01b
WOS ID WOS:000328205200006
Scopus ID 84890126568
Erfassungsdatum 2014-01-02
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