[The EMECAS Project: Spanish multicentre study on short-term health effects of air pollution]. / El proyecto EMECAS: protocolo del estudio multicéntrico en España de los efectos a corto plazo de la contaminación atmosférica sobre la salud.

UNLABELLED: The EMECAM Project demonstrated the short-term effect of air pollution on the death rate in 14 cities in Spain throughout the 1990-1995 period. The Spanish Multicentre Study on Health Effects of Air Pollution (EMECAS) is broadening these objectives by incorporating more recent data, information on hospital disease admissions and totaling 16 Spanish cities. This is an ecological time series study in which the response variables are the daily deaths and the emergency hospitalizations due to circulatory system diseases and respiratory diseases among the residents in each city. Pollutants analyses: suspended particles, SO2, NO2, CO and O3. Control variables: meteorological, calendar, seasonality and influenza trend and incidence. STATISTICAL ANALYSIS: estimate of the association in each city by means of the construction of generalized additive Poisson regression models and metanalysis for obtaining combined estimators. The EMECAS Project began with the creation of three working groups (Exposure, Epidemiology and Analysis Methodology) which defined the protocol. The average levels of pollutants were below those established under the current regulations for sulfur dioxide, carbon monoxide and ozone. The NO2 and PM10 values were around those established under the regulations (40 mg/m3). This is the first study of the relationship between air pollution and disease rate among one group of Spanish cities. The pollution levels studied are moderate for some pollutants, although for others, especially NO2 and particles, these levels could entail a problem with regard to complying with the regulations in force.

El Proyecto EMECAS: protocolo del estudio multicéntrico en España de los efectos a corto plazo de la contaminación atmosférica sobre la salud / The EMECAS project: spanish multicentre study on short-term health effects of air pollution

El proyecto EMECAM constató el efecto a corto plazo de la contaminación atmosférica sobre la mortalidad en 14 ciudades españolasentre 1990 y 1995. El Estudio Multicéntrico Español de Contaminación Atmosférica y Salud (EMECAS) amplía estos objetivosincorporando al análisis datos de morbilidad hospitalaria, utilizainformación más reciente y suma un total de 16 ciudades. Se trata deun estudio ecológico de series temporales, siendo las variables respuestalas defunciones diarias y los ingresos hospitalarios urgentespor enfermedades del aparato circulatorio y enfermedades respiratoriasen los residentes de cada ciudad. Contaminantes analizados: partículas en suspensión, SO2, NO2, CO y O3. Variables de control:meteorológicas, de calendario, estacionalidad y tendencia e incidenciade gripe. Análisis estadístico: estimación de la asociación en cadaciudad mediante la construcción de modelos de regresión de Poissonaditivos generalizados, y meta-análisis para la obtención de estimadoresconjuntos. Los niveles medios de contaminantes se situaronpor debajo de los establecidos por la normativa actual para el dióxidode azufre, el monóxido de carbono y el ozono. Los valores de NO2y PM10 se situaron alrededor de los establecidos en la normativa (40mg/m3). Se trata del primer estudio de la relación entre contaminación atmosférica y morbilidad en un conjunto de ciudades españolas.Los niveles de contaminantes estudiados son moderados para algunoscontaminantes, aunque en otros, especialmente NO2 y partículas,podrían representar un problema para el cumplimiento de la normativavigente

The EMECAM Project demonstrated the short-term effect of airpollution on the death rate in 14 cities in Spain throughout the 1990-1995 period. The Spanish Multicentre Study on Health Effects of AirPollution (EMECAS) is broadening these objectives by incorporatingmore recent data, information on hospital disease admissionsand totaling 16 Spanish cities. This is an ecological time series studyin which the response variables are the daily deaths and the emergencyhospitalizations due to circulatory system diseases and respiratorydiseases among the residents in each city. Pollutants analyses:suspended particles, SO2, NO2, CO and O3. Control variables:meteorological, calendar, seasonality and influenza trend and incidence.Statistical analysis: estimate of the association in each city bymeans of the construction of generalized additive Poisson regressionmodels and metanalysis for obtaining combined estimators. TheEMECAS Project began with the creation of three working groups(Exposure, Epidemiology and Analysis Methodology) which definedthe protocol. The average levels of pollutants were below thoseestablished under the current regulations for sulfur dioxide, carbonmonoxide and ozone. The NO2 and PM10 values were around thoseestablished under the regulations (40 mg/m3). This is the first studyof the relationship between air pollution and disease rate among onegroup of Spanish cities. The pollution levels studied are moderate forsome pollutants, although for others, especially NO2 and particles,these levels could entail a problem with regard to complying with theregulations in force

[Short-term relationship between air pollution and mortality in 13 Spanish cities]. / Relación a corto plazo de la contaminación atmosférica y la mortalidad en 13 ciudades españolas.

BACKGROUND AND OBJECTIVE: EMECAM is a collaborative project that seeks to evaluate the short-term effects of air pollution on mortality in Spain. MATERIAL AND METHOD: We collected data for air pollutants (particles and gases), daily mortality (total except external, cardiovascular and respiratory causes) and co-variables (temperature, humidity, influenza and calendar variables) in 13 Spanish cities. The magnitude of the association in every city was estimated using GAM under a Poisson distribution. Combined estimates for each cause and pollutant were obtained under 'fixed effects' and 'random effects'models. RESULTS: An increase of 10 (g/m3 in the levels of the average of the concurrent and one day lag for black smoke was associated with a 0.8% (CI: 0.4-1.1) increase in mortality. The same increase in the concentration of SO2 was associated with a 0.5% (CI: 0.1-1.0) increase in daily deaths, and a 0.6% (CI: 0.3-0.8) increase in the case of NO2. An increase of 1 mg/m3 in the levels of CO was associated with an increase of 1.5% (CI: 0.5-2.6) in daily deaths. CONCLUSIONS: There is a short-term association between increases of daily levels of air pollutants and the number of daily deaths in Spanish cities.

Relación a corto plazo de la contaminación atmosférica y la mortalidad en 13 ciudades españolas / Short-term relationship between air pollution and mortality in 13 Spanish cities

FUNDAMENTO Y OBJETIVO: EMECAM es un proyecto multicéntrico cuyo objetivo es evaluar la asociación a corto plazo de la contaminación sobre la salud en España. MATERIAL Y MÉTODO: Se obtuvieron los datos sobre contaminación atmosférica (partículas en suspensión y gases), mortalidad (todas las causas excluidas las externas, causas respiratorias y causas del aparato circulatorio) y de covariables para el control de la confusión (temperatura, humedad, gripe, variables de calendario) en 13 ciudades españolas. Los estimadores locales de los efectos de los contaminantes, obtenidos a partir de modelos autorregresivos generalizados aditivos de Poisson, se combinaron mediante modelos de efectos fijos y, cuando existía heterogeneidad, modelos de efectos aleatorios. Se construyeron todos los modelos con uno y con dos contaminantes simultáneamente. RESULTADOS: Un aumento de 10 µg/m3 en el promedio de las concentraciones del día simultáneo y el día anterior de humos negros se asoció con un incremento del 0,8 por ciento (intervalo de confianza [IC] del 95 por ciento, 0,4-1,1) de la mortalidad total. El mismo incremento de dióxido de azufre y de dióxido de nitrógeno se asoció con incrementos del 0,5 por ciento (IC del 95 por ciento, 0,1-1,0) y del 0,6 por ciento (IC del 95 por ciento: 0,3-0,8) de la mortalidad, respectivamente. Un aumento de 1 mg/m3 en los valores de monóxido de carbono se asoció con un incremento del 1,5 por ciento (IC del 95 por ciento, 0,5-2,6) en las defunciones diarias. Los coeficientes obtenidos para los grupos de causas específicas fueron, en general, de mayor magnitud. En los modelos de dos contaminantes las partículas y el monóxido de carbono fueron los contaminantes que mostraron mayor robustez en los estimadores. CONCLUSIONES: Los incrementos diarios en las concentraciones de contaminantes atmosféricos se asocian, a corto plazo, con un aumento en el número de defunciones en las ciudades españolas (AU)

A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project.

In recent years, some epidemiologic studies have attributed adverse effects of air pollutants on health not only to particles and sulfur dioxide but also to photochemical air pollutants (nitrogen dioxide and ozone). The effects are usually small, leading to some inconsistencies in the results of the studies. Furthermore, the different methodologic approaches of the studies used has made it difficult to derive generic conclusions. We provide here a quantitative summary of the short-term effects of photochemical air pollutants on mortality in seven Spanish cities involved in the EMECAM project, using generalized additive models from analyses of single and multiple pollutants. Nitrogen dioxide and ozone data were provided by seven EMECAM cities (Barcelona, Gijón, Huelva, Madrid, Oviedo, Seville, and Valencia). Mortality indicators included daily total mortality from all causes excluding external causes, daily cardiovascular mortality, and daily respiratory mortality. Individual estimates, obtained from city-specific generalized additive Poisson autoregressive models, were combined by means of fixed effects models and, if significant heterogeneity among local estimates was found, also by random effects models. Significant positive associations were found between daily mortality (all causes and cardiovascular) and NO(2), once the rest of air pollutants were taken into account. A 10 microg/m(3) increase in the 24-hr average 1-day NO(2)level was associated with an increase in the daily number of deaths of 0.43% [95% confidence interval (CI), -0.003-0.86%] for all causes excluding external. In the case of significant relationships, relative risks for cause-specific mortality were nearly twice as much as that for total mortality for all the photochemical pollutants. Ozone was independently related only to cardiovascular daily mortality. No independent statistically significant relationship between photochemical air pollutants and respiratory mortality was found. The results in this study suggest that, given the present levels of photochemical pollutants, people living in Spanish cities are exposed to health risks derived from air pollution.