BackgroundRecent studies have found that particulate matter (PM) attached radioactivity was associated with certain adverse health effects including increased blood pressure and lung dysfunction. However, there has been no investigation on the direct effect of PM radioactivity on mortality. MethodsExposures to ambient PM gamma activities were determined using U.S. EPA RadNet data. Data on daily deaths were obtained from individual state Departments of Public Health. We used a generalized additive quasi-Poisson model to estimate the associations between two-day average ambient PM gamma activities (gamma2 through gamma9) with all-cause non-accidental and cardiovascular daily deaths for each of 18 US cities, for each season, adjusting for two-day average PM2.5 exposure, temperature, relative humidity, day of week and long-term trends. Subsequently, we used random-effects meta-analysis to estimate the overall effect in the 18 cities for each season. ResultsWe found that all-cause non-accidental daily mortality in spring season was positively associated with two-day average ambient PM gamma activities in spring, with significant results for gamma2, gamma5 and gamma6. Similarly, cardiovascular daily mortality was positively associated with two-day average ambient PM gamma activities, with significant results for gamma2, gamma4, gamma5, gamma6, gamma7 and gamma9. For the spring season, each interquartile range (IQR) increase of two-day averaged ambient PM gamma activity was associated with increase in all-cause daily deaths, ranging from 0.15% (95% Confidence Interval (CI): −0.36%, 0.65%) to 1.03 (95%CI: 0.18%, 1.89%). Each IQR was also associated with increase in cardiovascular daily deaths, ranging from 0.01% (95%CI: −0.89, 0.92) to 2.95% (95%CI: 1.33, 4.59). For other seasons overall we found statistically insignificant associations of PM radioactivity with mortality. ConclusionsOur findings suggest that there are potential systemic toxic effects of inhalation of radionuclides attached to ambient air particles.