Daily mortality and air pollution in the Netherlands

We studied the association of daily mortality with short-term variations in the ambient concentrations of major gaseous pollutants and PM in the Nethe rlands. The magnitude of the association in the four major urban areas was compared with that in the remainder of the country. Daily cause-specific mo rtality counts, air quality, temperature, relative humidity, and influenza data were obtained from 1986 to 1994. The relationship between daily mortal ity and air pollution was modeled using Poisson regression analysis. We adj usted for potential confounding due to long-term and seasonal trends, influ enza epidemics, ambient temperature and relative humidity, day of the week, and holidays, using generalized additive models. Influenza episodes were associated with increased mortality up to 3 weeks l ater. Daily mortality was significantly associated with the concentration o f all air pollutants. An increase in the PM,, concentration by 100 mu g/m(3 ) was associated with a relative risk (RR) of 1.02 for total mortality. The largest RRs were found for pneumonia deaths. Ozone had the most consistent , independent association with mortality. Particulate air pollution (e.g., PM10, black smoke [BS]) was not more consistently associated with mortality than were the gaseous pollutants SO2 and NO2. Aerosol SO4-2, NO3-, and BS were more consistently associated with total mortality than was PM10. The R Rs for all pollutants were substantially larger in the summer months than i n the winter months. The RR of total mortality for PM10 was 1.10 for the su mmer and 1.03 for the winter. There was no consistent difference between RR s in the four major urban areas and the more rural areas.