Vigotti M A
Dipartimento di Scienze dell'Uomo e dell Ambiente, Università di Pisa.
Epidemiol Prev. 1999 Oct-Dec;23(4):408-15.
During the '80s, evidence was collected that air pollutants concentrations close to, or lower than, air quality standards could negatively influence public health at short term, i.e. within a few days. The European Union financed, between 1993 and 1995, the study "Short term effects of Air Pollution on Health: a European Approach using epidemiological time-series data" (APHEA-1 project), involving more than 25 millions inhabitants in 15 cities, investigated between 1977 and 1991. In this paper, the main results, already published in various scientific journals, are reported. The health effects were studied as mortality for natural causes, cardiovascular and respiratory diseases, and as emergency hospital admissions for all respiratory diseases, bronchial asthma, and chronic obstructive pulmonary disease (COPD). The pollutants whose measures were available for the analysis are sulphur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM) measured either as black smoke or total suspended particulate, and ozone (O3). The analysis was carried out by each participating group following a detailed protocol, defined during various workshops, through the construction of Poisson regression models, adjusted for autocorrelation and overdispersion, accounting for variables influencing the daily count of deaths, such as long time trends, season, temperature, day of the week. This paper reports the results of the meta-analysis, performed using the values of each city, as relative risk of dying or being admitted to hospital associated with increases of 50 micrograms/m3 in the 24 hours average concentrations of each pollutant. The daily number of natural deaths was associated with increases in the levels of PM, SO2, O3, and NO2. Cardiovascular and respiratory deaths were associated with increases of the levels of PM, SO2, and O3; cardiovascular deaths were associated also with increases of NO2 concentrations. Emergency hospital admissions for the whole group of respiratory disorders are less consistently associated with PM, SO2, and NO2, whereas there is evidence of association with O3. COPD admissions are related to the air pollutant levels, especially those of O3. Lastly, NO2 levels may play a role in exhacerbating asthma, and SO2 levels can have an effect on asthma in children. A second study is currently going on, involving over 40 millions residents in 34 cities. The aims of this project are: to evaluate the dose-response relationship, to investigate on synergy among pollutants, on the "harvesting" phenomenon, on the geographical differences inside Europe and with the U.S. through the collaboration with a similar American study now in progress. The existence of an association between daily variations in the levels of urban air pollution and adverse health effects was confirmed in Europe. This association is weak, but it involves the whole resident population, so it is a major cause of concern from the public health point of view.
在20世纪80年代，有证据表明，接近或低于空气质量标准的空气污染物浓度可能在短期内（即几天内）对公众健康产生负面影响。欧盟在1993年至1995年资助了“空气污染对健康的短期影响：利用流行病学时间序列数据的欧洲方法”研究（APHEA - 1项目），该研究涉及15个城市的2500多万居民，调查时间为1977年至1991年。本文报告了已在各种科学期刊上发表的主要结果。健康影响被研究为自然原因、心血管和呼吸系统疾病导致的死亡率，以及所有呼吸系统疾病、支气管哮喘和慢性阻塞性肺疾病（COPD）的急诊住院人数。可用于分析的污染物测量值包括二氧化硫（SO₂）、二氧化氮（NO₂）、以黑烟或总悬浮颗粒物测量的颗粒物（PM）以及臭氧（O₃）。每个参与小组按照在各种研讨会上确定的详细方案进行分析，通过构建泊松回归模型，并针对自相关和过度分散进行调整，同时考虑影响每日死亡人数的变量，如长期趋势、季节、温度、星期几。本文报告了荟萃分析的结果，使用每个城市的值作为与每种污染物24小时平均浓度每增加50微克/立方米相关的死亡或住院相对风险。每日自然死亡人数与PM、SO₂、O₃和NO₂水平的增加有关。心血管和呼吸系统死亡与PM、SO₂和O₃水平的增加有关；心血管死亡也与NO₂浓度的增加有关。整个呼吸系统疾病组的急诊住院人数与PM、SO₂和NO₂的关联不太一致，而有证据表明与O₃有关。COPD住院与空气污染物水平有关，尤其是O₃的水平。最后，NO₂水平可能在加重哮喘方面起作用，SO₂水平可能对儿童哮喘有影响。第二项研究正在进行中，涉及34个城市的4000多万居民。该项目的目标是：评估剂量反应关系，研究污染物之间的协同作用、“收获”现象、欧洲内部以及与美国之间的地理差异，通过与一项正在进行的类似美国研究合作进行。欧洲证实了城市空气污染水平的每日变化与不良健康影响之间存在关联。这种关联很弱，但涉及全体居民，因此从公共卫生角度来看是一个主要关注点。
