Touloumi G, Pocock S J, Katsouyanni K, Trichopoulos D
Department of Hygiene and Epidemiology, University of Athens Medical School, Greece.
Int J Epidemiol. 1994 Oct;23(5):957-67. doi: 10.1093/ije/23.5.957.
Athens has a serious air pollution problem which became evident in the early 1970s. Studies for the years 1975-1982 have indicated a positive association of sulphur dioxide (SO2) with total daily mortality. Since 1983 the pollution profile in Athens has gradually changed but the levels of smoke, SO2 and carbon monoxide (CO) remain relatively high.
The association of air pollution with daily all-cause mortality in Athens for the years 1984-1988 was investigated using daily values of SO2, smoke and CO. Autoregressive models with log-transformed daily mortality as the dependent variable, were used to adjust for temperature and relative humidity (both lagged by 1 day), year, season and day of week, as well as for serial correlations in mortality.
Graphic analysis revealed non-linear monotonically increasing relationships between total mortality and SO2, smoke and CO, with steeper exposure-response slopes at lower air pollution levels. Air pollution data lagged by 1 day had the strongest association with daily mortality. In three separate autoregression models for log(SO2), log(smoke) and log(CO) the regression coefficients for each were highly statistically significant (P < 0.001). Further multiple regression modelling showed that SO2 and smoke are both independent predictors of daily mortality, though to a lesser extent than temperature and relative humidity. The inclusion of CO in the model did not further improve the prediction of daily mortality. The magnitude of association is small, for instance, a 10% reduction in smoke is estimated to decrease daily mortality by 0.75% (95% confidence interval [CI]: 0.51-0.99). However, it cannot be accounted for by climatic and seasonal effects, so that a causal influence of air pollution on daily mortality seems plausible.
These findings suggest that current air pollution levels in Athens (and many other industrialized cities) may be responsible for substantial numbers of premature deaths, and hence remain an important public health issue.
雅典存在严重的空气污染问题，这在20世纪70年代初就已显现。1975 - 1982年的研究表明，二氧化硫（SO₂）与每日总死亡率呈正相关。自1983年以来，雅典的污染状况逐渐发生变化，但烟尘、SO₂和一氧化碳（CO）的水平仍相对较高。
利用SO₂、烟尘和CO的日值，对1984 - 1988年雅典空气污染与每日全因死亡率之间的关联进行了调查。以对数转换后的每日死亡率为因变量的自回归模型，用于调整温度和相对湿度（均滞后1天）、年份、季节和星期几，以及死亡率的序列相关性。
图形分析显示，总死亡率与SO₂、烟尘和CO之间存在非线性单调递增关系，在较低空气污染水平下暴露 - 反应斜率更陡。滞后1天的空气污染数据与每日死亡率的关联最强。在分别针对log(SO₂)、log(烟尘)和log(CO)的三个自回归模型中，每个模型的回归系数均具有高度统计学意义（P < 0.٠001）。进一步的多元回归建模表明，SO₂和烟尘都是每日死亡率的独立预测因子，尽管程度低于温度和相对湿度。将CO纳入模型并未进一步改善对每日死亡率的预测。关联程度较小，例如，估计烟尘减少10%可使每日死亡率降低0٠75%（95%置信区间[CI]：0.51 - 0.99）。然而，这不能用气候和季节效应来解释，因此空气污染对每日死亡率的因果影响似乎是合理的。
这些发现表明，雅典（以及许多其他工业化城市）目前的空气污染水平可能导致大量过早死亡，因此仍然是一个重要的公共卫生问题。
