Case-Crossover Analysis of Air Pollution Health Effects: A Systematic Review of Methodology and Application

Case-crossover is one of the most used designs for analyzing the health-related effects of air pollution. Nevertheless, no one has reviewed its application and methodology in this context. Objective: We conducted a systematic review of case-crossover (CCO) designs used to study the relationship between air pollution and morbidity and mortality, from the standpoint of methodology and application.Data sources and extraction: A search was made of the MEDLINE and EMBASE databases.Reports were classified as methodologic or applied. From the latter, the following information was extracted: author, study location, year, type of population (general or patients), dependent variable(s), independent variable(s), type of CCO design, and whether effect modification was analyzed for variables at the individual level. Data synthesis: The review covered 105 reports that fulfilled the inclusion criteria. Of these, 24 addressed methodological aspects, and the remainder involved the design’s application. In the methodological reports, the designs that yielded the best results in simulation were symmetric bidirectional CCO and time-stratified CCO. Furthermore, we observed an increase across time in the use of certain CCO designs, mainly symmetric bidirectional and time-stratified CCO. The dependent variables most frequently analyzed were those relating to hospital morbidity; the pollutants most often studied were those linked to particulate matter. Among the CCO-application reports, 13.6% studied effect modification for variables at the individual level.Conclusions: The use of CCO designs has undergone considerable growth; the most widely used designs were those that yielded better results in simulation studies: symmetric bidirectional and time-stratified CCO. However, the advantages of CCO as a method of analysis of variables at the individual level are put to little use

Comparing meta-analysis and ecological-longitudinal analysis in time-series studies: a case study of the effects of air pollution on mortality in three Spanish cities

The objective of this paper is to introduce a diVerent approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. Design—The approach is illustrated by providing quantitative estimates of the short-termeVects of air pollution on mortality in three Spanish cities, Barcelona,Valencia and Vigo, for the period 1992–1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were nonlinear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. Main results—The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 μg/m3 and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 μg/m3 of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant,especially those among air pollutants and meteorological variables. Conclusions—Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities

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 NO2, once the rest of air pollutants were taken into account. A 10 μg/m3 increase in the 24-hr average 1-day NO2 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

Time-series regression models to study the short-term effects of environmental factors on health

Time series regression models are especially suitable in epidemiology for evaluating short-term effects of time-varying exposures on health. The problem is that potential for confounding in time series regression is very high. Thus, it is important that trend and seasonality are properly accounted for. Our paper reviews the statistical models commonly used in time-series regression methods, specially allowing for serial correlation, make them potentially useful for selected epidemiological purposes. In particular, we discuss the use of time-series regression for counts using a wide range Generalised Linear Models as well as Generalised Additive Models. In addition, recently critical points in using statistical software for GAM were stressed, and reanalyses of time series data on air pollution and health were performed in order to update already published. Applications are offered through an example on the relationship between asthma emergency admissions and photochemical air pollutants

Influència de l'ús del biodièsel en les emissions contaminants i en el consum de combustible en vehicles pesants

L’objecte d’aquest estudi consisteix en determinar la influència de l’ús del biodièsel en: 1.- Les variacions en comparació amb el combustible convencional (gasoil A) en les emissions de gasos i partícules contaminants en motors de vehicles pesants de transport de mercaderies. 2.- Les variacions en comparació amb el combustible convencional (gasoil A) en el nivell de so emès per motors de vehicles pesants de transport de mercaderies. 3.- Els canvis en el consum de combustible en vehicles pesants en comparació amb la utilització de gasoil A. 4.- Els problemes tècnics observats en motors de vehicles pesants de transport de mercaderies durant un període de funcionament elevat

Avaluació de les emissions de gasos d’ efecte hivernacle a la ciutat de Girona i propostes de reeducació

En els últims 30 anys, la comunitat internacional ha anat agafant consciència dels efectes que pot tenir l’ increment de les emissions de gasos d’ efecte hivernacle (GEH). És per aquest motiu, entre d’ altres que es fan inventaris d’ emissions de GEH a nivell estatal i a gran escala. Aquest projecte té com a principal objectiu determinar i quantificar les emissions de GEH a escala local del municipi de Girona. Per tal de poder dur a terme aquest treball ha calgut buscar metodologies i softwares, que s’ han hagut d’ adaptar a la singularitat que té Girona, sobretot pel que fa al transport. Finalment es fan propostes que s’ adapten a la problemàtica del municipi

Estudi de l'evolució dels nivells d'immissió dels contaminant emesos per la incineradora de Campdorà (Girona)

L’ objectiu principal d’ aquest treball és l’ anàlisi de l’ evolució de l’ impacte ambiental produït per l’ emissió de gasos contaminants procedents de la incineradora de Campdorà (Girona). Els gasos contaminants objecte d’ estudi són: partícules de suspensió totals, clorur d’ hidrogen, diòxid de nitrogen, monòxid de carboni i diòxid de sofre. S’ ha realitzat la simulació de la dispersió atmosfèrica dels contaminants emesos per la incineradora de Campdorà mitjançant el programa informàtic ISC-AERMOD View. Com a resultat, s’ obtenen una sèrie de mapes de concentració on es mostren els diferents nivells d’ immissió detectats en la zona objecte d’ estudi. Els resultats mostren com la incorporació de noves tecnologies i tractaments de gasos en la incineradora de Campdorà han representat una reducció dels nivells d’ immissió de la zona, millorant la qualitat de l’ aire i disminuint l’ impacte ambiental que produeixen les emissions contaminants

Emissions de N2O i desnitrificació en sòls agrícoles i d'ecosistemes naturals. Factors de regulació

La major conscienciació actual dels problemes de pol·lució que acompanyen les pèrdues de N del sòl cap a l'atmosfera ha reorientat les investigacions cap a un coneixement més profund dels processos implicats en les emissions dels compostos nitrogenats que comporten un major perjudici des d'un punt de vista ecològic així com els seus principals factors reguladors. La creixent preocupació per l'increment de la concentració atmosfèrica de N2O és deguda a les seves interaccions amb la fotoquímica atmosfèrica i el balanç de radiació de la Terra ja que intervé en la destrucció de la capa estratosfèrica d'ozó, contribueix a l'efecte hivernacle i participa de la pluja àcida. Es considera que els sòls són la principal font de N2O atmosfèric. Al voltant del 90% d'aquestes emissions són d'origen biòtic; els principals processos implicats són la desnitrificació i la nitrificació. L'emissió del N2O produït a través d'aquests dos processos es caracteritza pels diferents nivells de regulació que presenta ja que depèn de la taxa dels processos, de la proporció de N canalitzada per cada procés cap a la producció de N2O i del seu consum dins el mateix sòl el qual està relacionat amb les dificultats en el transport cap a l'atmosfera. Això comporta una gran dificultat a l'hora d'aprofundir en el coneixement de les emissions de N2O del sòl cap a l'atmosfera i de la seva regulació. El desconeixement dels nivells d'emissió de N2O i de la importància de la desnitrificació així com de la seva regulació tant en sòls agrícoles com naturals de les nostres contrades és el principal punt de partida dels objectius d'aquest treball.