Original Contribution Individual-Level Modifiers of the Effects of Particulate Matter on Daily Mortality

Consistent evidence has shown a positive association between particulate matter with an aerodiameter of less than or equal to 10 lm (PM10) and daily mortality. Less is known about the modification of this association by factors measured at the individual level. The authors examined this question in a case-crossover study of 20 US cities. Mortality events (1.9 million) were obtained for nonaccidental, respiratory, heart disease, and stroke mortality between 1989 and 2000. PM10 concentrations were obtained from the US Environmental Protection Agency. The authors examined the modification of the PM10–mortality association by sociodemographics, location of death, season, and secondary diagnoses. They found different patterns of PM10–mortality associations by gender and age but no differences by race. The level of education was inversely related to the risk of mortality associated with PM10. PM10-related, out-of-hospital deaths were more likely than were in-hospital deaths, as were those occurring during spring/fall versus summer/winter. A secondary diagnosis of diabetes modified the effect of PM10 for res-piratory and stroke mortality. Pneumonia was a positive effect modifier for deaths from all causes and stroke, while secondary strokemodified the effects for all-cause and respiratory deaths. The findings suggest that more attention must be paid to population characteristics to identify greater likelihood of exposures and susceptibility and, as a result, to improve policy making for air pollution standards. air pollution; effect modifiers (epidemiology); mortalit