The effects of an air quality alert program on premature mortality: A difference-in-differences evaluation in the region of Paris

Background: Daily exposure to air pollution has been shown to increase cardiovascular and respiratory mortality. While increases in short-term exposure to air pollutants at any daily concentrations has been shown to be associated to adverse health outcomes, days with extreme levels, also known as air pollution peaks based on specific thresholds, have been used to implement air quality alerts in various cities across the globe. Objectives: We aimed at evaluating the potential effects of the Air Quality Alerts (AQA) system on different causes of premature mortality in Paris, France. Methods: Air quality alerts (AQA) based on particulate matter (PM10) levels and related interventions were implemented in the region of Paris in 2008 and were revised to be more stringent in 2011. In this study, we applied a difference-in-differences (DID) approach coupled with propensity-score matching (PSM) to daily mortality data for the period 2000 to 2015 to evaluate the effects of the Paris AQA program on different causes of premature mortality for the entire population and for adults > 75 years old. Results: Overall, results did not show evidence of a reduction in mortality of the PM10 AQA program when first implemented in 2008 with initial thresholds (80 mu g/m(3)); DID estimates were slightly above 1 for cardiovascular and respiratory mortality. However, when evaluating the drastic reduction in revised thresholds in 2011 (50 mu g/ m(3)) to trigger interventions, we identified a reduction in cardiovascular (DID = 0.84, 95% CI: 0.755 to 0.930) mortality, but no change in respiratory mortality was detected (DID = 0.97, 95% CI: 0.796, 1.191). Discussion: Our study suggests that AQA may not have health benefits for the population when thresholds are set at high daily PM10 levels. Given that such policies are implemented in many other metropolitan areas across the globe, evaluating the effectiveness of AQA is important to provide public authorities and researchers a rationale for defining specific thresholds and extending the scope of these policies to lower air pollution levels.

Automated summary

The Air Quality Alerts (AQA) system was implemented in Paris, France in 2008 and revised in 2011 to have more stringent thresholds. The study found that the AQA system did not reduce mortality when thresholds were set at high PM10 levels initially, but did show a reduction in cardiovascular mortality when thresholds were revised to lower levels in 2011.