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Background: Particulate air pollution is associated with increased mortality. There is a need for European results from multicountry databases concerning cause-specific mortality to obtain more accurate effect estimates.

Methods: We report the estimated effects of ambient particle concentrations (black smoke and particulate matter less than 10 [mu]m [PM10]) on cardiovascular and respiratory mortality, from 29 European cities, within the Air Pollution and Health: a European Approach (APHEA2) project. We applied a 2-stage hierarchical modeling approach assessing city-specific effects first and then overall effects. City characteristics were considered as potential effect modifiers.

Results: An increase in PM10 by 10 [mu]g/m3 (lag 0 1) was associated with increases of 0.76% (95% confidence interval = 0.47 to 1.05%) in cardiovascular deaths and 0.58% (0.21 to 0.95%) in respiratory deaths. The same increase in black smoke was associated with increases of 0.62% (0.35 to 0.90%) and 0.84% (0.11 to 1.57%), respectively.

Conclusions: These effect estimates are appropriate for health impact assessment and standard-setting procedures.

(C) 2006 Lippincott Williams & Wilkins, Inc.