Mortality In Madrid Research Articles

Impact of mixing layer height variations on air pollutant concentrations and health in a European urban area: Madrid (Spain), a case study

The occurrence of local high-pollution episodes in densely populated urban areas, which have huge fleets of vehicles, is currently one of the most worrying problems associated with air pollution worldwide. Such episodes are produced under specific meteorological conditions, which favour the sudden increase of levels of air pollutants. This study has investigated the influence of the mixing layer height (MLH) on the concentration levels of atmospheric pollutants and daily mortality in Madrid, Spain, during the period 2011-2014. It may help to understand the causes and impact of local high-pollution episodes. MLH at midday over Madrid was daily estimated from meteorological radio soundings. Then, days with different MLH over this urban area were characterized by meteorological parameters registered at different levels of an instrumented tower and by composite sea level pressure maps, representing the associated synoptic meteorological scenarios. Next, statistically significant associations between MLH and levels of PM10, PM2.5, NO, NO2, CO and ultra-fine particles number concentrations registered at representative monitoring stations were evaluated. Finally, associations between all-natural cause daily mortality in Madrid, MLH, and air pollutants were estimated using conditional Poisson regression models. The reduction of MLH to values below 482m above-ground level under strong atmospheric stagnation conditions was accompanied by a statistically significant increase in levels of NO, NO2, CO, PM2.5 and ultra-fine particle number concentrations at urban-traffic and suburban monitoring sites. The decrease of the MLH was also associated to a linear increase of the daily number of exceedances of the UE NO2 hourly limit value (200μg/m3) and levels of air pollutants at hotspot urban-traffic monitoring stations. Also, a statistically significant association of the MLH with all-natural cause daily mortality was obtained. When the MLH increased by 830m, the risk of mortality decreased by 2.5% the same day and by 3.3% the next day, when African dust episodic days were excluded. They were also higher in absolute terms than the increases in risk of mortality that were determined for the exposition to any other air pollutant. Our results suggest that when the prediction models foresee values of MLH below 482m above-ground level in Madrid, the evolution of high-contamination episodes will be very favourable. Therefore, short-term policy measures will have to be implemented to reduce NO, NO2, CO, PM2.5 and ultra-fine particle emissions from anthropogenic sources in this southern European urban location.

Health impact assessment by the implementation of Madrid City air-quality plan in 2020

ObjectivesAir pollutant concentrations in many urban areas are still above the legal and recommended limits that are set to protect the citizens’ health. Madrid is one of the cities where traffic causes high NO2 levels. In this context, Madrid City Council launched the Air Quality and Climate Change Plan for the city of Madrid (Plan A), a local strategy approved by the previous government in 2017. The aim of this study was to conduct a quantitative health impact assessment to evaluate the number of premature deaths that could potentially be prevented by the implementation of Plan A in Madrid in 2020, at both citywide and within-city level. The main purpose was to support decision-making processes in order to maximize the positive health impacts from the implementation of Plan A measures. MethodsThe Regional Statistical Office provided information on population and daily mortality in Madrid. For exposure assessment, we estimated PM2.5, NO2 and O3 concentration levels for Madrid city in 2012 (baseline air-quality scenario) and 2020 (projected air-quality scenario based on the implementation of Plan A), by means of an Eulerian chemical-transport model with a spatial resolution of 1 km × 1 km and 30 vertical levels. We used the concentration-response functions proposed by two relevant WHO projects to calculate the number of attributable annual deaths corresponding to all non-accidental causes (ICD-10: A00-R99) among all-ages and the adult population (>30 years old) for each district and for Madrid city overall. This health impact assessment was conducted dependant on health-data availability. ResultsIn 2020, the implementation of Plan A would imply a reduction in the Madrid citywide annual mean PM2.5 concentration of 0.6 μg/m3 and 4.0 μg/m3 for NO2. In contrast, an increase of 1 μg/m3 for O3 would be expected. The annual number of all-cause deaths from long-term exposure (95% CI) that could be postponed in the adult population by the expected air-pollutant concentration reduction was 88 (57–117) for PM2.5 and 519 (295–750) for NO2; short-term exposure accounted for 20 (7–32) for PM2.5 and 79 (47–111) for NO2 in the total population. According to the spatial distribution of air pollutants, the highest mortality change estimations were for the city centre – including Madrid Central and mainly within the M-30 ring road –, as compared to peripheral districts. The positive health impacts from the reductions in PM2.5 and NO2 far exceeded the adverse mortality effects expected from the increase in O3. ConclusionsEffective implementation of Plan A measures in Madrid city would bring about an appreciable decline in traffic-related air-pollutant concentrations and, in turn, would lead to significant health-related benefits.

Differences in the impact of heat waves according to urban and peri-urban factors in Madrid.

Aside from climatic factors, the impact of heat waves on mortality depends on the demographic and socio-economic structure of the population as well as variables relating to local housing. Hence, this study's main aim was to ascertain whether there might be a differential impact of heat waves on daily mortality by area of residence. The study is a time-series analysis (2000-2009) of daily mortality and minimum and maximum daily temperatures (°C) in five geographical areas of the Madrid region. The impact of such waves on heat-related mortality due to natural causes (ICD-10: A00- R99), circulatory causes (ICD-10: I00-I99) and respiratory causes (ICD-10: J00-J99) was obtained by calculating the relative risk (RR) and attributable risk (AR), using GLM models with the Poisson link and controlling for trend, seasonalities and the autoregressive nature of the series. Furthermore, we also evaluated other external variables, such as the percentage of the population aged over 65years and the percentage of old housing. No heat-related mortality threshold temperature with statistical significance was detected in the northern and eastern areas. While the threshold temperatures in the central and southern areas were very similar and close to the 90th percentile, the threshold in the western area corresponded to the 97th percentile. Attributable mortality proved to be highest in the central area with 85 heat wave-related deaths per annum. External factors found to influence the impact of heat on mortality in Madrid were the size of the population aged over 65years and the age of residential housing. Demographic structure and the percentage of old housing play a key role in modulating the impact of heat waves. This study concludes that the areas in which heat acts earliest are those having a higher degree of population ageing.

System dynamics for predicting the impact of traffic noise on cardiovascular mortality in Madrid

The impact of road traffic noise on health is an important issue worldwide. In Madrid (Spain), the existing high daily noise levels all year round have been associated with short-term cardiovascular mortality. A system dynamics model is constructed to estimate the evolution of the traffic noise impact on the population older than 65 in Madrid over the upcoming years. This strategy allows to make predictions based on yearly variations in traffic intensity, population at risk, motor vehicle-related technological advances and lifestyles, and urban planning policies. Madrid harbours a persisting noise epidemic since 1980, which would be eradicated in 2040 at the earliest if significant action for noise abatement were taken.

Short-Term Effects of Ozone on Mortality: Comparative Analysis of Urban and Suburban Zones in Madrid (Spain)

A large number of papers published in the last decades are related to the effect of ozone exposure on mortality worldwide. Several studies have been performed to investigate the effect of ozone on mortality in Madrid (Spain), but the findings of these local reports were focused only on the Madrid city. The association of daily concentrations of ozone with daily mortality was investigated using autoregressive Poisson regression models. This study explores the effects of ozone on all causes except accidents, cardiovascular and respiratory short-term mortality in two areas of the Madrid region: an urban area constituted by the Madrid municipality and an industrial sub-urban area surrounding the city. Using three years of daily data (2003-2005), it was analyzed the all-ages populations and the over-64 age groups. The average ozone concentrations over the study period were 54.07 ± 27.17 µg/m3 in the Madrid municipality and 70.09 ± 32.96 µg/m3 in the sub-urban municipalities surrounding the city.Our results in the all-ages group indicated that 0.69% of all causes except accidents, 1.15% of cardiovascular and 1.56% of respiratory daily deaths, respectively, could be attributed to exposure to ozone in the Madrid city, whereas 11.69% of daily respiratory deaths were attributable to ozone exposure in the Madrid sub-urban surroundings. Our results show a clear association between mortality and ozone exposure. The spatial heterogeneity of ozone effects on short-term mortality throughout the Madrid region may have implications for local environmental policies and also for social and health services planning.

Impact of road traffic noise on cause-specific mortality in Madrid (Spain)

Latest time-series research conducted in Madrid has reported associations of road traffic noise with cause-specific daily mortality. Based on the results from that research, this study presents the health impact of urban noise for the period 2003–2009 as the number of avoidable deaths from various cardiovascular, respiratory, and metabolic diseases. The impact of noise on cardiovascular mortality exceeds that of fine particles (PM2.5) in the two population groups considered: <65 and >65years of age.

Comparison of the effects of extreme temperatures on daily mortality in Madrid (Spain), by age group: The need for a cold wave prevention plan

A number of studies have shown that there is a time trend towards a reduction in the effects of heat on mortality. In the case of cold, however, there is practically no research of this type and so there is no clearly defined time trend of the impact of cold on mortality. Furthermore, no other specific studies have yet analysed the time trend of the impact of both thermal extremes by age group.We analysed data on daily mortality due to natural causes (ICD-10: A00-R99) in the city of Madrid across the period 2001–2009 and calculated the impact of extreme temperatures on mortality using Poisson regression models for specific age groups. The groups of age selected coinciding with the pre-existing age-groups analyzed in previous papers. For heat waves the groups of age used were: <10 years, 10–17 years, 18–44 years, 45–64 years, 65–74 years and over-75 years. For cold waves the groups of age used were: <1 year; 1–5 years, 6–17 years, 18–44 years, 45–64 years, 65–74 years and over-75 years. <1, 1–17, 18–44, 45–66, 65–74 and over-75 years. We controlled for confounding variables, such as air pollution, noise, influenza, pollen, pressure and relative humidity, trend of the series, as well as seasonalities and autoregressive components of the series. The results of these models were compared to those obtained for the same city during the period 1986–1997 and published in different studies.Our results show a lightly reduction in the effects of heat, especially in the over-45-year age group. In the case of cold, the behaviour pattern was the opposite, with an increase in its effect. Heat adaptation and socio-economic and public-health prevention and action measures may be behind this amelioration in the effects of heat, whereas the absence of such actions in respect of low temperatures may account for the increase in the effects of cold on mortality. From a public health point of view, the implementation of cold wave prevention plans covering all age groups is thus called for.

Influence of advections of particulate matter from biomass combustion on specific-cause mortality in Madrid in the period 2004-2009.

Approximately, 20 % of particulate and aerosol emissions into the urban atmosphere are of natural origin (including wildfires and Saharan dust). During these natural episodes, PM10 and PM2.5 levels usually exceed World Health Organisation (WHO) health protection thresholds. This study sought to evaluate the possible effect of advections of particulate matter from biomass fuel combustion on daily specific-cause mortality among the general population and the segment aged ≥ 75 years in Madrid. Ecological time-series study in the city of Madrid from January 01, 2004 to December 31, 2009. The dependent variable analysed was daily mortality due to natural (ICD-10:A00-R99), circulatory (ICD-10:I00-I99), and respiratory (ICD-10:J00-J99) causes in the population, both general and aged ≥ 75 years. The following independent and control variables were considered: a) daily mean PM2.5 and PM10 concentrations; b) maximum daily temperature; c) daily mean O3 and NO2 concentrations; d) advection of particulate matter from biomass combustion ( http://www.calima.ws/ ), using a dichotomous variable and e) linear trend and seasonalities. We conducted a descriptive analysis, performed a test of means and, to ascertain relative risk, fitted a model using autoregressive Poisson regression and stratifying by days with and without biomass advection, in both populations. Of the 2192 days analysed, biomass advection occurred on 56, with mean PM2.5 and PM10 values registering a significant increase during these days. PM10 had a greater impact on organic mortality with advection (RRall ages = 1.035 [1.011-1.060]; RR ≥ 75 years = 1.066 [1.031-1.103]) than did PM2.5 without advection (RRall ages = 1.017 [1.009-1.025]; RR ≥ 75 years = 1.012 [1.003-1.022]). Among specific causes, respiratory-though not circulatory-causes were associated with PM10 on days with advection in ≥ 75 year age group. PM10, rather than PM2.5, were associated with an increase in natural cause mortality on days with advection of particulate matter from biomass combustion, particularly in the ≥ 75 year age group.

Short-term impact of particulate matter (PM2.5) on respiratory mortality in Madrid

Objectives: This paper sought to quantify the particulate matter (PM2.5) pollutant's impact on short-term daily respiratory-cause mortality in the city of Madrid. Methods: As our dependent variable, we took daily mortality registered in Madrid from 1 January 2003 to 31 December 2005, attributed to all diseases of the respiratory system as classified under heads J00–J99 of the ICD 10 and broken down as follows: J12–J18, pneumonia; J40–J44, chronic diseases of the respiratory system except asthma; J45–J46, asthma; and J96, respiratory failure. Results: The relative risk (RR) for daily overall respiratory mortality was RR 1.0281 (1.0043–1.0520), with a proportional attributable risk (PAR) of 2.74%. This effect occurred in lag 1; respiratory failure, RR 1.0816 (1.0119–1.1512) and PAR 7.54% at lag 5; and pneumonia, RR 1.0438 (1.0001–1.0875) and PAR 4.19% at lag 6. Conclusions: Our results reflect the association that exists between PM2.5 concentrations and daily respiratory-cause mortality.

Short-term effect of fine particulate matter (PM 2.5) on daily mortality due to diseases of the circulatory system in Madrid (Spain)

Introduction Owing to their small size, fine particles, i.e., those having a diameter ≤ 2.5 μm (PM 2.5), have a high alveolar penetration capacity, thereby triggering a local inflammatory process with circulatory repercussion. Despite being linked to respiratory and cardiovascular morbidities, there is limited evidence of an association between this type of particulate matter and short-term increases in mortality. Objective The aim of this study was to analyse and quantify the short-term impact of PM 2.5 on daily mortality due to diseases of the circulatory system, registered in Madrid from 1 January 2003 to 31 December 2005. Methods An ecological longitudinal time-series study was conducted, with risks being quantified by means of Poisson regression models. As a dependent variable, we took daily mortality registered in Madrid from 1 January 2003 to 31 December 2005, attributed to all diseases of the circulatory system as classified under heads I00–I99 of the International Classification of Diseases-10th revision (ICD-10) and broken down as follows: I21, acute myocardial infarction (AMI); I20, I22–I25, other ischemic heart diseases; and I60–I69, cerebrovascular diseases. The independent variable was daily mean PM 2.5 concentration. The other variables controlled for were: chemical pollution (PM 10, O 3, SO 2, NO 2 and NO x); acoustic and biotic pollution; influenza; minimum and maximum temperatures; seasonalities; trend; and autocorrelation of the series. Results A linear relationship was observed between PM 2.5 levels and mortality due to diseases of the circulatory system. For every increase of 10 μg/m 3 in daily mean PM 2.5 concentration, the relative risks (RR) were as follows: for overall circulatory mortality, associations were established at lags 2 and 6, with RR of 1.022 (1.005–1.039) and 1.025 (1.007–1.043) respectively; and for AMI mortality, there was an association at lag 6, with an RR of 1.066 (1.032–1.100). The corresponding attributable risks percent (AR%) were 2.16%, 2.47% and 6.21% respectively. No statistically significant association was found with other ischemic heart diseases or with cerebrovascular diseases. Conclusion PM 2.5 concentrations are an important risk factor for daily circulatory-cause mortality in Madrid. From a public health point of view, the planning and implementation of specific measures targeted at reducing these levels constitute a pressing need.

Ingresos hospitalarios por infecciones meningocócicas en la Comunidad de Madrid (1997–2005)

Neisseria meningitidis infection causes an important morbidity and mortality in Spain. Our study aims to estimate the burden of hospital admissions for meningococcal infection in Spain during a nine-year period (1997-2005) by analyzing the Spanish hospital surveillance system.An epidemiological retrospective study was conducted. Data were obtained from the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos) maintained by the Ministry of Health. Information about hospitalizations, age, length of stay in hospital, mortality and cost per patient was obtained.There were 1137 hospital discharges for meningococcal disease (International Classification of Diseases 9th Clinical Modification: ICD 9 CM code 036 in any listed diagnosis) during the study period. Annual incidence was 2.41 cases per 100,000 individuals. Mortality rate and case-fatality rate were 0.19 cases per 100,000 population and 7.7%, respectively. The average length of hospitalization was 12 days. The youngest age group showed the highest hospitalizations incidence (24.42 hospitalizations per 100,000 population in those under 4 years of age) but the case-fatality rate was higher in the oldest group (11% in patients over 30 years). These hospitalizations imply an annual cost of 592,980 euro to the Madrid Health System.Our study shows that meningococcal infection is still an important cause of hospital admissions and mortality in Madrid, resulting in a high cost to the Health Care System.

Impact of extreme temperatures on daily mortality in Madrid (Spain) among the 45–64 age-group

This paper analyses the relationship between extreme temperatures and mortality among persons aged 45-64 years. Daily mortality in Madrid was analysed by sex and cause, from January 1986 to December 1997. Quantitative analyses were performed using generalised additive models, with other covariables, such as influenza, air pollution and seasonality, included as controls. Our results showed that impact on mortality was limited for temperatures ranging from the 5th to the 95th percentiles, and increased sharply thereafter. During the summer period, the effect of heat was detected solely among males in the target age group, with an attributable risk (AR) of 13.3% for circulatory causes. Similarly, NO(2) concentrations registered the main statistically significant associations in females, with an AR of 15% when circulatory causes were considered. During winter, the impact of cold was exclusively observed among females having an AR of 7.7%. The magnitude of the AR indicates that the impact of extreme temperature is by no means negligible.

Impact of temperature and air pollution on the mortality of children in Madrid.

This work analyzes the impact of temperature and air pollution on infant mortality in Madrid. Daily values of mortality of children younger than 10 years, maximum and minimum temperatures, and air pollutants were considered for an 11-year period. In winter, mortality was mostly associated with very low temperatures and high total suspended particles (TSP) concentrations, whereas summer mortality depended crucially on the occurrence of high TSP and nitrogen oxides concentrations. In winter, the temperature effect increases dramatically for daily maximum temperature values lower than 6degreesC. This pattern is rather different from the one obtained for older age groups in the same location, which show the well-known V relationship between temperature and mortality. The association with TSP shows 2 linear branches without threshold and a strong increase in mortality for concentrations more than 100 microg/m3.

Mortality impact of extreme winter temperatures.

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986-1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature (T(max)) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occurred 7-8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4-5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect.

Air pollution and mortality in Madrid, Spain: a time-series analysis.

To assess the relationship, if any, between air pollutant (sulfur dioxide and total suspended particulate) levels and mortality in the city of Madrid during the period 1986-1992, controlling for weather, season, and influenza epidemics. Daily death counts were obtained from the Regional Mortality Registry. Pollution data were supplied by the Municipal Monitoring Network. Time-series analysis methodology was used to assess the link between non-accidental as well as circulatory- and respiratory-disease mortality, on the one hand, and mean daily concentrations of SO2 and total suspended particulate (TSP), on the other. Multivariate autoregressive integrated moving-average (ARIMA) models were used to adjust for season, temperature, relative humidity, and influenza. A sensitivity analysis was run to assess the robustness of the estimators. Graphical analysis revealed a linear relationship between mortality and TSP. The relationship was logarithmic in the case of SO2. TSP lagged 1 day and SO2 lagged 3 days with an independent effect on mortality. This relationship was produced without the detection of a minimal threshold in emission values. These results support the hypothesis of an association between pollution levels and mortality between 1986-1992 in Madrid. Additional measures designed to reduce pollution levels without compromising thermal comfort should be implemented.

Asociación entre la contaminación atmosférica por dióxido de azufre y partículas totales en suspensión y la mortalidad diaria en la ciudad de Madrid (1986–1992)

The aim of the study is to quantify the relationship between sulphur dioxide (SO2), total suspended particulate (TSP) and daily mortality in Madrid. Data were plotted to exhibit the functional relationship between SO2, TSO and mortality. Box-Jenkins prewhitening method was used to detect lags and weights from the transfer function. Multivariate ARIMA models were built to control for confounding variables (air temperature and influenza epidemics). Graphic analysis suggested a logarithmic relationship between SO2 and mortality, and lineal relationship with TSP. No evidence of a threshold was found for each pollutant. Cross-correlation functions showed a statistically significant relationship between daily mortality caused by organic, cardiovascular and respiratory diseases and air pollution. The first lag was statistically significant for TSP and the third lag for SO2. Multivariate models gave a coefficient beta = 0.039 for TSP and beta = 1.04 for SO2 indicating a 6.6% increase in mortality for each 100 micrograms/m3 increase in TSP and a 2.2% for SO2. The result suggest a causal relationship between daily mortality and air pollution in Madrid.

Mortalidad por cáncer en madrid, 1980-1984

In order to assess whether the exclusion of the province of Madrid from the Spanish areas having a high risk of cancer mortality from most locations (1975-1978)--as opposed to what has been observed in other provinces with similar characteristics--has remained in subsequent years, mortality due to malignant tumors in Madrid in 1980-1984 has been studied. Standardized Mortality Ratios (SMR) yielded values less than 100, which were statistically significant for most locations. The magnitude of the SMR observed under the heading "malignant tumor of unspecified location" must be noted, both in men (206,34) and women (189,61). The evolution of this heading as a percentage of total cancer deaths shows that Madrid has values considerably over the national mean, also in men (11,87%) and women (14,83%). The aspects related to the filling of death certificates that could explain a possible distortion of the pattern of cancer mortality in Madrid are discussed.