PM and ozone, indicators of air quality, and acute deaths in California, 2004-2007.

Since the London Great Smog of 1952 was estimated to have killed over 4000 people, scientists have studied the relationship between air quality and acute mortality. Currently, the association between air quality and acute deaths is usually taken as evidence for causality. As air quality has markedly improved since 1952, do contemporary datasets support this view? We use a large dataset, eight air basins in California for the years 2004-2007, to examine the possible association of ozone and PM with acute deaths after statistically removing seasonal and weather effects. Our analysis dataset is available on request. We conducted a regression-corrected, case-crossover analysis for all non-accidental deaths age 75 and older. We used stepwise regression to examine three causes of death. After seasonal and weather adjustments, there was essentially no predictive power of ozone or PM for acute deaths. The case-crossover analysis produced odds ratio very close to 1.000 (no effect). The very narrow confidence limits indicated good statistical power. We study recent air quality in both time-stratified, symmetric, bidirectional case-crossover and time series regression and both give consistent results. There is no statistically significant association between either ozone or PM and acute human mortality. In the absence of an association, causality is in question.