Background Air pollution in cities has been linked to increasedrates of mortality and morbidity in developed and developingcountries. Although these findings have helped lead to a tighteningof air-quality standards, their validity with respect to publichealth has been questioned.
Methods We assessed the effects of five major outdoor-air pollutantson daily mortality rates in 20 of the largest cities and metropolitanareas in the United States from 1987 to 1994. The pollutantswere particulate matter that is less than 10 µm in aerodynamicdiameter (PM10), ozone, carbon monoxide, sulfur dioxide, andnitrogen dioxide. We used a two-stage analytic approach thatpooled data from multiple locations.
Results After taking into account potential confounding by otherpollutants, we found consistent evidence that the level of PM10is associated with the rate of death from all causes and fromcardiovascular and respiratory illnesses. The estimated increasein the relative rate of death from all causes was 0.51 percent(95 percent posterior interval, 0.07 to 0.93 percent) for eachincrease in the PM10 level of 10 µg per cubic meter. Theestimated increase in the relative rate of death from cardiovascularand respiratory causes was 0.68 percent (95 percent posteriorinterval, 0.20 to 1.16 percent) for each increase in the PM10level of 10 µg per cubic meter. There was weaker evidencethat increases in ozone levels increased the relative ratesof death during the summer, when ozone levels are highest, butnot during the winter. Levels of the other pollutants were notsignificantly related to the mortality rate.
Conclusions There is consistent evidence that the levels offine particulate matter in the air are associated with the riskof death from all causes and from cardiovascular and respiratoryillnesses. These findings strengthen the rationale for controllingthe levels of respirable particles in outdoor air.
Source Information
From the Departments of Epidemiology (J.M.S.) and Biostatistics (F.D., F.C.C., I.C., S.L.Z.), School of Hygiene and Public Health, Johns Hopkins University, Baltimore.
Address reprint requests to Dr. Samet at Johns Hopkins University, School of Public Health, 615 N. Wolfe St., Suite 6041, Baltimore, MD 21205, or at jsamet{at}jhsph.edu.
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