Annex C. Epidemiology Studies 

Table C-1. Studies of CO exposure and cardiovascular morbidity. 

Study Design Concentrations CO Effect Estimates (95% CI) 

CHANGES IN HEART RATE AND HEART RATE VARIABILITY 

Author: Chan et al. 

(2005, 088988) 

Period of Study:

December 

2001-February 2002 

Location:

Taipei, Taiwan 

Health Outcome: Various measures of HRV 

via ambulatory ECG (Holter system) 

Study Design: Panel 

Statistical Analyses: Linear regression 

(mixed effects) 

Age Groups Analyzed: 

40-75 yr 

Sample Description:

83 patients from the National Taiwan 

University Hospital 

Averaging Time: 

1-h ma 

Mean (SD) unit: 

1.1 ppm 

Range (Min, Max):

0.1, 7.7 

Copollutant: NR 

 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined (-h ma): 1, 2, 3, 4, 5, 6, 7, 8 

CO had no statistically significant effect on SDNN, 

rMSSD, LF, HF. 

Author: Chuang (2008, 

155731) 

Period of Study: NR 

Location: Boston, MA 

Health Outcome: HRV (changes in STsegment) 

Study Design: Panel 

Statistical Analyses: Linear additive 

models; Additive mixed logistic regression 

models 

Age Groups Analyzed: 43-75

Sample Description: 48 patients with 

documented CAD who had undergone 

percutaneous coronary intervention for acute 

coronary syndrome (acute MI or unstable 

angina pectoris) or who had worsened CAD 

Averaging Time: 12 h, 24 h

Mean (SD) unit: 12 h: 

0.48ppm, 24 h: 0.46ppm

Range (Min, Max): 12-h: 

25th percentile- 0.35, 75th 

percentile- 0.62, Max- 1.88; 

24 h: 25th percentile- 0.37, 

75th percentile- 0.62, Max1.56 

Copollutant: NR 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined: NR 

Estimated RR for ST-segment depression ≥0.1 

mm (ppm): 12-h: 0.70 (0.58-0.84) 

24 h: 0.84 (0.68-1.03) 

Estimated ST-segment change, mm (ppm): 12-h 

mean: 0.013 (0.003-0.024) 

24 h mean: 0.007 (-0.004-0.019) 

CO not significantly associated with ST-segment 

depression.

Author: Dales et al. 

(2004, 099036) 

Period of Study: NR 

Location:

Toronto, Canada. 

Health Outcome: Various measures of HRV 

via Holter system 

Study Design: Panel 

Statistical Analyses: Linear regression 

(mixed effects) 

Age Groups Analyzed: 

51-88 yr (mean 65 yr) 

Sample Description: 36 subjects with preexisting CAD 

Averaging Time: 24 h 

Mean (SD) unit:

2.40 ppm (95th percentile) 

Personal monitoring 

Range (Min, Max):0.4, 16.5 

Copollutant: correlation

PM2.5: r = 0.17 

 

Increment: NR 

Regression co-efficient [Lower CI, Upper CI] 

Lags examined: NR 

CO had no statistically significant effect on LF, HF, 

HFLFR, SDNN among those taking beta-blockers, whereas CO had a positive effect on SDNN among 

those not taking beta-blockers. Slope = 0.0111 

(0.002-0.020, p = 0.02) 

 

Note: Hyperlinks to the reference citations throughout this document will take you to the NCEA HERO database (Health and 

Environmental Research Online) at http://epa.gov/hero. HERO is a database of scientific literature used by U.S. EPA in the process of 

developing science assessments such as the Integrated Science Assessments (ISAs) and the Integrated Risk Information System (IRIS). 

January 2010 C-1 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Gold et al. 

(2000, 011432) 

Period of Study: 

June-September 1997 

Location:

Boston, MA 

Health Outcome (ICD9 or ICD10): Heart 

rate and various measures of HRV via Holter 

system 

Study Design: Panel/Cohort 

Statistical Analyses: Linear regression 

(fixed effects/random effects) 

Age Groups Analyzed: 

53-87 yr 

Sample Description: 21 active Boston 

residents observed up to 12 times. 

Averaging Time: 24 h 

Mean (SD) unit: 0.47 ppm 

Range (Min, Max): 0.12, 0.82

Copollutant: NR 

 

Increment: 0.6 ppm 

% Change [Lower CI, Upper CI] 

Lags examined: 24 h 

No significant effect with CO (no results recorded) 

Author: Gold et al. 

(2005, 087558) 

Period of Study: 

June-September 1999 

Location:

Boston, MA 

Health Outcome: ST- segment. 

Study Design: Panel 

Statistical Analyses: Linear regression 

(mixed models) 

Age Groups Analyzed: 

61-88 yr 

Sample Description: 24 active Boston 

residents each observed up to 12 times. 

Averaging Time: 

1 h, 24 h 

Mean (SD) unit: NR 

Range (Min, Max): (ppm) 

(personal monitoring) 

10th = 0.20 

90th = 1.08 

Copollutant: NR 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined: 1 24 h 

Although CO was associated with ST-segment 

depression in single pollutant models, this result did 

not persist in multiple pollutant models. 

Author: Goldberg et al. 

(2008, 180380) 

Period of Study: 

July 2002-October 2003 

Location: 

Montreal, Quebec 

Health Outcome: Oxygen saturation and 

heart rate 

Study Design: Panel 

Statistical Analyses: Mixed regression 

models 

Age Groups Analyzed: 50-85 yr 

Sample Description: 31 subjects with CHF 

and limits in physical functioning in the Heart 

Failure and Heart Transplant Center at the 

McGill University Health Center 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

PM2.5: r = 0.72 

NO2: r = 0.84

SO2 and NO2: r = 0.43 

Increment: NR 

Adjusted Mean Difference [Lower CI, Upper CI] 

Lags examined: 0, 1, 2 

Oxygen Saturation:

Lag 0: 0.004 ppm (-0.060, 0.067) 

Lag 1: -0.001 ppm (-0.066, 0.065) 

3-day: -0.005 ppm (-0.098. 0.088)

Pulse Rate: 

Lag 0: 0.011 ppm (-0.290, 0.312) 

Lag 1: 0.227 ppm (-0.080,0.535) 

3-day: 0.245 ppm (-0.209, 0.700)

Author: Holguin et al. 

(2003, 057326) 

Period of Study: 

February-April 2000 

Location:

Mexico City, Mexico 

Health Outcome: Various measures of HRV 

via ECG 

Study Design: Panel 

Statistical Analyses: GEE 

Age Groups Analyzed: 

60-96 yr (mean age 79 yr) 

Sample Description:

34 patients who were permanent residents of 

a nursing home in the Northeast metropolitan 

area. 

Averaging Time: 24 h 

Mean (SD) unit: 3.3 ppm 

Range (Min, Max): 1.8, 4.8 

Copollutant: NR 

 

Increment: 10 ppm 

Regression Coefficients [Lower CI, Upper CI] 

Lags examined: 0 

Lag 0: 

HF: 0.003 (-0.004 to 0.001) 

LF: 0.001 (-0.006 to 0.008) 

LF/HF: 0.001 (-0.005 to 0.002) 

January 2010 C-2 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Ibald-Mulli et al. 

(2004, 087415) 

Period of Study:

1998-1999 

Location: Helsinki, 

Finland 

Erfurt, Germany 

Amsterdam, Netherlands 

Health Outcome: BP and HR via ECG 

Study Design: Panel 

Statistical Analyses: Linear regression 

Age Groups Analyzed: ≥ 50 yr 

Sample Description: 131 nonsmokers with 

coronary heart disease 

Averaging Time: 24 h 

Mean (SD) unit: 

Amsterdam: 0.6 mg/m3 

Erfurt: 0.4 mg/m3

 

Helsinki: 0.4 mg/m3

Range (Min, Max):

Amsterdam: 0.4, 1.6 

Erfurt: 0.1, 2.5 

Helsinki: 0.1, 1.0

Copollutant: 

Amsterdam

PM2.5: r = 0.58 μg/m3 

NO2: r = 0.76 μg/m3

SO2: r = 0.50 mg/m3

UFP: r = 0.22 n/cm3 

ACP: r = 0.60 n/cm3

Erfurt

PM2.5: r = 0.77 μg/m3 

NO2: r = 0.86 μg/m3

SO2: r = 0.68 mg/m3

UFP: r = 0.72 n/cm3 

ACP: r = 0.78 n/cm3

Helsinki

PM2.5: r = 0.40 μg/m3 

NO2: r = 0.32 μg/m3

SO2: r = 0.19 mg/m3

UFP: r = 0.35 n/cm3 

ACP: r = 0.51 n/cm3

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined: 0, 1, 2, 3 

Results presented graphically 

Author: Liao et al. 

(2004, 056590) 

Period of Study: 

1996-1998 

Location:

Forsyth County, NC; 

Selected suburbs of 

Minneapolis, MN; 

Jackson, MI 

Health Outcome: Heart rate & various rates 

of HRV. 

Study Design: Cohort 

Statistical Analyses: Linear regression 

Age Groups Analyzed: 

45-64 yr (mean 62 yr) 

Sample Description:

6,784 study subjects from the atherosclerosis 

risk in communities study 

Averaging Time: 24 h 

Mean (SD) unit: 

0.65 ppm (0.44) 

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: 0.44 ppm 

Regression coefficients Lags examined: 1 

Lag 1: 

HF (log transformed): -0.033

LF (log transformed): 0.006

SDNN: -0.274

Heart rate (bpm): 0.404*

Confidence intervals: not recorded

*p < 0.05 

January 2010 C-3 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Min (2009, 

199514) 

Period of Study:

December 2003 – 

January 2004 

Location: Tae-in island 

community in South 

Korea 

Health Outcome: HRV 

Study Design: Panel 

Statistical Analyses: Time-lag model 

Age Groups Analyzed: 20-87

Sample Description: 986 subjects, 367 with 

metabolic syndrome (MetS), 619 without 

MetS 

Averaging Time: 8 h 

Mean (SD) unit: 0.454 ppm 

(0.560) 

Range (Min, Max): 0.100, 

7.200 ppm 

Copollutant: PM10

Increment: NR 

Estimated % Increase in subjects with MetS

[Lower CI, Upper CI] 

Lags examined: 0-1, 1-2, 2-3, 3-4, 4-5, 5-6 

Single pollutant:

Lag 0-1:

Log(SDNN): -0.29 (-0.59, 0.00), p < 0.1 

Log(LF): -0.34 (-1.02, 0.33) 

Log(HF): -0.67 (-1.41, 0.08), p < 0.1

Lag 1-2:

Log(SDNN): -0.45 (-0.81, -0.10), p < 0.05 

Log(LF): -0.65 (-1.46, 0.17)

Log(HF): -1.04 (-1.94, -0.14), p < 0.05

Lag 2-3:

Log(SDNN): -0.28 (-0.57, 0.02), p < 0.1

Log(LF): -0.19 (-0.87, 0.48)

Log(HF): -0.82 (-1.57, -0.07), p < 0.05

Lag 3-4:

Log(SDNN): -0.18 (-0.47, 0.10)

Log(LF): -0.14 (-0.80, 0.51)

Log(HF): -0.46 (-1.19, 0.27) 

Lag 4-5:

Log(SDNN): -0.20 (-0.49, 0.09)

Log(LF): -0.36 (-1.04, 0.31)

Log(HF): -0.42 (-1.17, 0.33) 

Lag 5-6:

Log(SDNN): 0.13 (-0.18, 0.44)

Log(LF): 0.50 (-0.21, 1.20)

Log(HF): -0.03 (-0.81, 0.76) 

Co-pollutant (with PM10):

Lag 0-1: 

Log(SDNN): -0.25 (-0.56, 0.05)

Log(LF): -0.35 (-1.04, 0.31)

Log(HF): -0.67 (-1.44, 0.10), p<0.1 

Lag 1-2:

Log(SDNN): -0.48 (-0.88, -0.09), p<0.05; Log(LF): 

-0.72 (-1.63, 0.18); Log(HF): -1.09 (-2.09, -0.09), 

p<0.05 

Lag 2-3: 

Log(SDNN): -0.35 (-0.67, -0.03), p < 0.05

Log(LF): -0.17 (-0.90, 0.56) 

Log(HF): -0.78 (-1.59, 0.03), p < 0.1 

Lag 3-4: Log(SDNN): -0.22 (-0.55, 0.11)

Log(LF): -0.11 (-0.86, 0.63)

Log(HF): -0.34 (-1.17, 0.49) 

Lag 4-5:

Log(SDNN): -0.18 (-0.48, 0.12); Log(LF): -0.21 

(-0.89, 0.48); Log(HF): -0.37 (-1.14, 0.40) 

Lag 5-6: 

Log(SDNN): 0.17 (-0.14, 0.49)

Log(LF): 0.54 (-0.18, 1.25)

Log(HF): 0.00 (-0.80, 0.80) 

No significant results for subjects without MetS.

January 2010 C-4 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Park et al. 

(2005, 057331) 

Period of Study: 

2000-2003 

Location:

Boston, MA 

Health Outcome: Various measures of HRV 

via ECG 

Study Design: Panel/Cohort 

Statistical Analyses: Linear regression 

Age Groups Analyzed: 

21-81 yr 

Sample Description:

497 men from the normative aging study in 

Greater Boston area 

Averaging Time: 24 h 

Mean (SD) unit: 0.50 ppm 

Range (Min, Max): 

0.13, 1.8 

Copollutant: NR 

 

Increment: 0.24 ppm 

% Change in HRV [Lower CI, Upper CI] 

Lags examined: 4-h ma, 24-h ma, 48-h ma 

Lag 4-h ma: 

SDNN (Log10): 2.0 (-2.9 to 7.3) 

HF (Log10): 8.8 (-4.6 to 24.1) 

LF(Log10): 3.2 (-7.0 to 14.6) 

LF:HF(Log10): -5.1 (-13.5 to 4.1) 

Lag 24-h ma: 

SDNN (Log10): -2.2 (-7.7 to 3.6) 

HF (Log10): -13.2 (-25.4 to 1.0) 

LF(Log10): -0.6 (-11.9 to 12.1) 

LF:HF(Log10): 14.5 (2.9-27.5) 

Lag 48-h ma: 

SDNN(Log10): -3.4 (-10.2 to 3.9) 

HF (Log10): -13.8 (-.28.9 to 4.4) 

LF (Log10): -2.4 (-16.2 to 13.6) 

LF:HF (Log10): 13.2 (-1.1 to 29.6) 

Author: Peters et al. 

(1999, 011554) 

Period of Study: 

1984-1985 

Location:

Augsburg, Germany 

Health Outcome: Heart rate 

Study Design: Cohort 

Statistical Analyses: Linear regression 

(GEE) 

Age Groups Analyzed: 

25-64 yr 

Sample Description:

2681 men and women who participated in 

the MONICA study 

Averaging Time: 24 h 

Mean (SD) unit:

During air pollution episode: 

4.54 mg/m3

Outside air pollution episode: 

4.51 mg/m3

Range (Min, Max):

During air pollution episode: 

2.39, 6.85 

Outside air pollution episode: 

0.91, 11.51

Copollutant: NR 

Increment: 6.6 mg/m3

Mean Change in Heart Rate (beats/min) [Lower 

CI, Upper CI] 

Lags examined: 0, 5-day avg 

All 

Lag 0: 0.97 (0.02-1.91) 

Lag 5-day avg: 0.70 (-0.09 to 1.48) 

Men 

Lag 0: 0.95 (-0.37 to 2.27) 

Lag 5-day avg: 0.91 (-0.25 to 2.07) 

Women 

Lag 0: 0.98 (-0.37 to 2.34) 

Lag 5-day avg: 0.52 (-0.55 to 1.59) 

Author: RiojasRodriguez et al. (2006, 

156913) 

Period of Study:

December 2001-April 

2002 

Location:

Mexico City, Mexico 

Health Outcome: Various measures of HRV 

via Holter system 

Study Design: Panel 

Statistical Analyses: Linear regression 

(mixed effects models) 

Age Groups Analyzed: 

25-76 yr (mean 55 yr) 

Sample Description:

30 patients from the Outpatient Clinic of the 

National Institute of Cardiology of Mexico 

Averaging Time: 24 h 

Mean (SD) unit: 2.9 ppm 

(personal monitor) 

Range (Min, Max): 0.1, 18.0 

Copollutant: NR 

Increment: 1 ppm 

Regression Coefficients [Lower CI, Upper CI] 

Lags examined (per min): 5, 10 

Lag 5 min: 

HF: -0.006 (-0.023 to 0.010)

LF: -0.024 (-0.041 to -0.007)

VLF: -0.034 (-0.061 to -0.007) 

Notes: VLF = Very low frequency 

Author: Schwartz et al. 

(2005, 074317) 

Period of Study: 1999 

Location:

Boston, MA 

Health Outcome: Measures of HRV via 

Holter system 

Study Design: Panel 

Statistical Analyses: Linear regression 

(hierarchical model) 

Age Groups Analyzed: 

 61-89 yr 

Sample Description:

28 subjects living at or near an apartment 

complex located on the same street as the 

Harvard School of Public Health 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max): ppm 

25th = 0.38; 75th = 0.54 

Copollutant: correlation 

PM2.5: r = 0.61 

NO2: r = 0.55 

SO2: r = -0.18 

O3: r = 0.21 

 

Increment: 0.16 ppm 

% Change in HRV [Lower CI, Upper CI] 

Lags examined: 24 h, 1 h 

Lag 1 h: 

SDNN: -2.6 (-5.6 to 0.5); rMSSD: -3.9 (-10.6 to 3.3); 

PNN50: -3.5 (-13.7 to 8.0); LF:HF: 4.5 (-1.2 to10.5) 

Lag 24 h: 

SDNN:

-4.2 (-0.6 to -7.7); rMSSD: -10.2 (-2.4 to 

-17.4); 

PNN50: 

-14.8 (-3.0 to -25.2); LF:HF: 6.2 (-0.6 to 13.4) 

January 2010 C-5 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Tarkiainen et al. 

(2003, 053625) 

Period of Study: 

October 1997-May 1998 

Location:

Kuopio, Finland 

Health Outcome: Various measures of HRV 

via Ambulatory ECG (Holter system) 

Study Design: Panel 

Statistical Analyses: ANOVA for repeated 

errors (GLM) 

Age Groups Analyzed: 

55-68 yr 

Sample Description: 6 male patients with 

angiographically- verified CAD 

Averaging Time: 24 h 

Mean (SD) unit:

4.6 ppm (max of CO episode) 

(personal monitoring) 

Range (Min, Max): 0.5, 27.4 

(max of CO episode) 

Copollutant: NR 

 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined: 5 min prior to CO episode, 5 min 

during CO episode 

CO had no statically significant effect on NN, SDNN 

or rMSSD. However, during high CO exposure 

(>2.7 ppm), CO was associated with an increase in 

rMSSD of 2.4ms (p=0.034). 

Author: Timonen et al. 

(2006, 088747) 

Period of Study: 

1998-1999 

Location:

3 Cities in Europe: 

Amsterdam, 

Netherlands; Erfert, 

Germany; Helsinki, 

Finland 

Health Outcome: 

Stable CAD: Various measures of HRV via 

ambulatory ECG (Holter system) 

Study Design: Panel 

Statistical Analyses: Linear regression 

(mixed model) 

Age Groups Analyzed: Mean age across 3 

cities; 64-71 yr. 

Sample Description:

131 subjects with stable CAD followed for 6 

mo with biweekly clinical visits. 

Averaging Time: 24 h 

Mean (SD) unit:

Amsterdam: 0.6 mg/m3

Erfert: 0.4 mg/m3

Helsinki: 0.4 mg/m3

Range (Min, Max):

Amsterdam: 0.4, 1.6 

Erfert: 0.1, 2.5 

Helsinki: 0.1, 1.0 

Copollutant: correlation 

Amsterdam: 

PM2.5: r = 0.58 

NO2: r = 0.76 

Erfert: 

PM10: r = 0.77 

NO2: r = 0.86 

Helsinki: 

PM10: r = 0.40 

NO2: r = 0.32 

Increment: 1 mg/m3

Regression co-efficient [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3, 5-day avg 

SDNN: 

Lag 0: -1.21 (-4.44 to 2.03); Lag 1: -1.71 (-6.05 to 

2.63); Lag 2: -5.69 (-10.7 to -0.72); Lag 3: 0.66 

(-3.83 to 5.15); 

5-day avg: -3.60 (-9.88 to 2.68) 

HF: 

Lag 0: 5.0 (-15.1 to 25.1); Lag 1: -2.0 (-37.1 to 33.1); 

Lag 2: -30.7 (-59.8 to -1.5); Lag 3: -9.3 (-35.8 to 

-17.3); 

5-day avg: -15.2 (-53.0 to 22.6) 

LF/HF: 

Lag 0: -3.6 (-21.8 to 14.5); Lag 1: -28.6 (-52.0 to 

-5.3); 

Lag 2: -10.1 (-36.9 to 16.7); Lag 3: 7.7 (-16.5 to 

31.9); 

5-day avg: -16.9 (-51.2 to 17.3) 

Author: Wheeler et al. 

(2006, 088453) 

Period of Study: 

1999-2000 

Location:

Atlanta, GA 

Health Outcome: Various measures of HRV 

via Holter system 

Study Design: Panel 

Statistical Analyses: Linear regression 

(mixed effects models) 

Age Groups Analyzed: 

Mean 65 yr;IQR 55-73 yr 

Sample Description:

18 subjects with COPD and 12 subjects with 

recent MI. 

Averaging Time: 1 h 

Mean (SD) unit: 

362.0 ppb 

Range (Min, Max):

25th = 221.5; 75th = 398.1 

Copollutant: correlation 

PM2.5: r = 0.43 

 

Increment: NR 

RR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined (h ma): 1, 4, 24 

No CO results reported. 

January 2010 C-6 
Study Design Concentrations CO Effect Estimates (95% CI) 

ONSET OF CARDIAC ARRHYTHMIA 

Author: Berger et al. 

(2006, 098702) 

Period of Study: 

October 2000-April 2001 

Location:

Erfurt, Germany 

Health Outcome: 

Runs of supraventricular and ventricular 

tachycardia recorded via 24-h ECG. 

Study Design: Panel 

Statistical Analyses: 

Poisson regression (GAM) linear regression 

Age Groups Analyzed: 

52-76 yr (mean 76 yr) 

Sample Description:

57 men with CHD 

Averaging Time: 24 h 

Mean (SD) unit: 0.52 mg/m3

Range (Min, Max): 0.11, 1.93

Copollutant: correlation NR 

 

Increment: 

All: 0.27 mg/m3

5-day avg: 0.22 mg/m3

RR Estimate [Lower CI, Upper CI] 

Lags examined (h): 0, 0-23, 24-47, 48-71, 72-95, 

5-day avg 

Supraventricular extrasystoles: 

Lag 0: 1.18 (1.00-1.38) Lag 0-23: 1.16 (1.02-1.31); 

Lag 24-47: 1.13 (1.00-1.28); Lag 48-71: 1.18 

(1.03-1.36); 

Lag 72-95: 1.08 (0.98-1.20); 5-day avg: 1.18 

(1.04-1.35) 

Mean % Change [Lower CI, Upper CI] 

Hourly Lags examined: 

0, 0-23, 24-47, 48-71, 72-95, 5-day avg 

Ventricular extrasystoles: 

Lag 0: 0.0 (-4.1 to 4.4); Lag 0-23: 1.1 (-3.3 to 5.7); 

Lag 24-47: 1.9 (-2.6 to 6.6); Lag 48-71: 4.2 (-0.3 to 

8.9); 

Lag 72-95: 2.7 (-1.3 to 6.9); 5-day avg: 3.0 (-1.8 to 

8.0) 

Author: Dockery et al. 

(2005, 078995) 

Period of Study: 

1995-2002 

Location:

Boston, MA 

Health Outcome:

Tachyarrhythmias: 

Study Design: Panel 

Statistical Analyses: Logistic regression 

(GEE) 

Age Groups Analyzed: 

19-90 yr; mean 64 yr 

Sample Description:

203 cardiac patients with ICDs within 40km 

of air monitoring site at Harvard School of 

Public Health, Boston 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max):

25th = 0.53; 75th = 1.02 

Copollutant: NR 

Increment: 0.48 ppm 

OR for Ventricular Arrhythmia [Lower CI, Upper 

CI] 

Lags examined (days): 0, 1, 2, 3 

Lag 2-day ma: 1.14 (0.95-1.29) 

Among those who had an arrhythmia:

within 3 days: 1.65 (1.17-2.33)

later than 3 days: 1.04 (0.83-1.29) 

Author: Metzger et al. 

(2007, 092856) 

Period of Study: 

1993-2002 

Location:

Atlanta, GA 

Health Outcome: 

Cardiac arrhythmia, ICD, 

ventricular tachyarrhythmia 

Study Design: Panel 

Statistical Analyses: 

Logistic regression (GEE) 

Age Groups Analyzed: 

15-88 yr 

Sample Description:

518 patients with ICDs with at least one 

ventricular tachyarrhythmic event 

Averaging Time: 1 h 

Mean (SD) unit: 1.7 ppm 

Range (Min, Max): 0.1, 7.7 

Copollutant: NR 

 

Increment: 1 ppm 

OR for Tachyarrhythmic event [Lower CI, Upper 

CI] 

Lags examined (days): 0 

Results for all events 

Lag 0: 0.999 (0.970-1.028) 

Events resulting in cardiac pacing or defibrillation 

Lag 0: 1.008 (0.964-1.054) 

Events resulting defibrillation 

Lag 0: 1.012 (0.925-1.10.7) 

January 2010 C-7 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Peters et al. 

(2000, 011347) 

Period of Study: 

1995-1997 

Location:

Eastern Massachusetts 

Health Outcome:

Defibrillated discharges for ventricular 

tachycardia or fibrillation 

Study Design: Panel 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: 

Mean 62 yr 

Sample Description:

100 patients with ICDs 

Averaging Time: 24 h 

Mean (SD) unit: 0.58 ppm 

Range (Min, Max):

25th = 0.43; 75th = 0.66 

Copollutant: correlation 

PM10: r = 0.51 

PM2.5: r = 0.56 

NO2: r = 0.71 

SO2: r = 0.41 

O3: r = -0.40 

Increment: 

0.65 ppm (Lags 0, 1, 2, 3); 0.42 ppm (Lag 5-day 

mean) 

OR for Defibrillated Discharge [Lower CI, Upper 

CI] 

Lags examined (days): 0, 1, 2 ,3, 5-day mean 

At least one discharge: 

Lag 0: 1.07 (0.62-1.86); Lag 1: 1.06 (0.61-1.85); 

Lag 2: 1.05 (0.62-1.77); Lag 3: 0.09 (0.65-1.83); 

Lag 5-day mean: 1.23 (0.71- 2.12) 

At least 10 discharges: 

Lag 0: 1.12 (0.54-2.32); Lag 1: 1.13 (0.54-2.33); 

Lag 2: 1.62 (0.85-3.09); Lag 3: 1.98 (1.05-3.72); 

Lag 5-day mean: 1.94 (1.01-.75) 

Author: Rich et al. 

(2004, 055631) 

Period of Study: 

February-December 

2000 

Location:

Vancouver, Canada 

Health Outcome: Cardiac arrhythmia via 

patients ICD 

Study Design: 

Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: 

15-85 yr 

Sample Description:

34 patients who experienced at least 1 ICD 

discharge (8,201 person days) 

Averaging Time: 24 h 

Mean (SD) unit: 

553.8 ppb 

Range (Min, Max): 

IQR: 162.7 

Copollutant: correlation 

PM10: r = 0.40 

SO2: r =0.75 

NO2: r =0.68 

O3: r = -0.56 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3 

No significant effect (results not reported in table). 

Author: Rich et al. 

(2005, 079620) 

Period of Study: 

1995-1999 

Location:

Boston, MA 

Health Outcome: Ventricular arrhythmias via 

ICD 

Study Design: Panel/Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

203 patients with implanted ICD at the New 

England Medical Center 

Averaging Time: 

1 h and 24 h 

Mean (SD) unit: NR 

Range (percentiles): 

1 h: 

25th = 0.46 

75th = 1.04 

24 h: 

25th = 0.52 

75th = 1.03 

Copollutant: NR 

Increment: 0.56 ppm; 0.54; 0.51; 0.49 respectively 

for results shown below 

OR Estimate [Lower CI, Upper CI] 

Ventricular arrythmia 

Hours prior to event:

0-2: 1.01 (0.87-1.18)

0-6: 1.00 (0.85-1.17)

0-23: 1.03 (0.84-1.25)

0-47: 1.11 (0.88-1.40) 

Author: Rich et al. 

(2006, 089814) 

Period of Study: 

2001 & 2002 

Location:

St. Louis, MO 

Health Outcome: Ventricular arrhythmia 

Study Design: Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

60 subjects with at least 1 ICD recorded 

arrhythmia who lived within 40 km of 

St. Louis – Midwest supersite. 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max):

25th = 0.4; 75th = 0.6 

Copollutant: NR 

 

Increment: 0.2 ppm 

OR for Ventricular Arrhythmia [Lower CI, Upper 

CI] 

Lags examined: 0 to 23-h ma: 

0- to 23-h ma: 0.99 (0.80-1.21) 

January 2010 C-8 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Rich et al. 

(2006, 088427) 

Period of Study: 

1995-1999 

Location:

Boston, MA 

Health Outcome: ICD episode of atrial 

fibrillation 

Study Design: Panel/case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

203 patients with ICDs at the New England 

Medical Center 

Averaging Time: 1 h

and 24 h 

Mean (SD) unit: NR 

Range (Min, Max): 

1 h: 

25th = 0.46; 75th = 1.04 

24 h: 

25th = 0.52; 75th = 1.03 

Copollutant: NR 

Increment: 

Lag (hrs) 0: 0.58 ppm 

Lag (hrs) 0-23: 0.51 ppm 

OR for episode of atrial fibrillation [Lower CI, 

Upper CI] 

Lags (h): 0, 0-23 

Lag 0: 0.87 (0.56-1.37) 

Lag 0-23: 0.71 (0.39-1.28) 

Author: Sari et al. 

(2008, 190315) 

Period of Study: June 

2007 

Location: 

Gaziantep, Turkey 

Health Outcome: P-wave dispersion 

(predictors of atrial fibrillation, ventricular 

arrhythmias and sudden death) via ECG 

Study Design: Case control 

Statistical Analyses: Pearson correlation 

analysis 

Age Groups Analyzed: 

Barbecue workers mean age: 33.66 ± 9.43 yr

Control group mean age: 35.15 ± 6.78 yr 

Sample Description: 48 healthy males 

working at various indoor barbecue 

restaurants for at least 3 yr (avg:15.6 ± 7.1 

yr), 51 age-matched healthy men for control 

group 

Averaging Time: NR 

Mean (SD) unit: COHb% 

Indoor barbecue workers: 

6.48% ± 1.43 

Control Group: 

2.19% ± 1.30 

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: NR 

Correlation coefficient for COHb [p-value] 

Lags examined: NR 

Pmin: -0.132 (0.245) 

Pmax: 0.215 (0.057) 

Pd: 0.315 (0.005) 

QTmin: 0.080 (0.454) 

QTmax: 0.402 (<0.001) 

QTd: 0.573 (<0.001) 

cQTd: 0.615 (<0.001) 

Author: Sarnat et al. 

(2006, 090489) 

Period of Study: 

24 wk during the 

summer and fall of 2000 

Location:

Steubenville, OH 

Health Outcome: Arrhythmia via ECG 

measurements 

Study Design: Panel 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: 

53-90 yr (mean age 71) 

Sample Description:

32 nonsmoking older adults 

Averaging Time: 24 h 

Mean (SD) unit: 0.02 ppm 

Range (Min, Max): -0.1, 1.5 

Copollutant: correlation 

PM2.5: r = 0.45 

SO2: r = 0.62 

NO2: r = 0.66 

O3: r = -0.37 

Increment: 0.2 ppm 

RR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined (days): 1, 2, 3, 4, 5, 5-day ma 

Lag 5-day ma: 

Supraventricular ectopy 

SVE: 0.99 (0.76-1.29) 

Ventricular ectopy 

VE: 1.05 (0.75-1.46) 

Author: Vedal et al. 

(2004, 055630) 

Period of Study: 

1997-2000 

Location:

Vancouver, Canada 

Health Outcome: Cardiac arrythmia via 

patients with ICD 

Study Design: Panel 

Statistical Analyses: 

Logistic regression (GEE) 

Age Groups Analyzed: Range from 

12-77 yr (mean age 53 yr) 

Sample Description:

50 patients who experienced 1 or more 

arrhythmia event during the 4yr 

Averaging Time: 24 h 

Mean (SD) unit: 0.6 ppm 

Range (Min, Max): 

0.3, 1.6 

Copollutant: correlation 

PM10: r = 0.43 

SO2: r = 0.62 

NO2: r = 0.74 

O3: r = -0.52 

Increment: 0.2 ppm 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3 

No significant effect for CO (results shown in plots) 

January 2010 C-9 
Study Design Concentrations CO Effect Estimates (95% CI) 

CARDIAC ARREST 

Author: Levy et al. 

(2001, 017171) 

Period of Study: 

1988-1994 

Location:

Seattle, WA 

Health Outcome: Out-of-hospital primary 

cardiac arrest 

Study Design: Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: 25-75 yr 

Sample Description: 

 362 cases 

Averaging Time: 24 h 

Mean (SD) unit: 1.79 ppm 

Range (Min, Max): 

0.52, 5.92 

Copollutant: correlation 

PM10: r = 0.81 

SO2: r = 0.29 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1 

Lag 1: 0.99 (0.83-1.18) 

Author: Sullivan et al. 

(2003, 043156) 

Period of Study: 

1985-1994 

Location:

Washington State 

Health Outcome: 

Out-of-Hospital cardiac arrest 

Study Design: Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

1,542 members of a large health 

maintenance organization 

Averaging Time: 24 h 

Mean (SD) unit: 1.92 ppm 

Range (Min, Max): 

0.52, 7.21 

Copollutant: NR 

Increment: 1.02 ppm 

OR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2

Lag 0: 0.95 (0.85-1.05)

Lag 1: 0.97 (0.87-1.08)

Lag 2: 0.99 (0.89-1.11) 

MYOCARDIAL INFARCTION 

Author: Peters et al. 

(2001, 016546) 

Period of Study: 

1995-1996 

Location:

Boston, MA 

Health Outcome: Onset of MI 

Study Design: Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

772 participants 

Averaging Time: 24 h 

Mean (SD) unit: 1.09 

Range (percentiles): ppm 

5th = 0.49 

95th = 1.78 

Copollutant: NR 

Increment: 2 H-1 ppm; 24 h – 0.6 ppm 

OR Estimate [Lower CI, Upper CI] 

Onset of MI:

2-h prior: 1.22 (0.89-1.67)

24 h prior: 0.98 (0.70-1.36)

Author: Rosenlund et 

al. (2006, 089796) 

Period of Study: 

1992-1994 

Location:

Stockholm, Sweden 

Health Outcome: MI 

Study Design: Case control 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: 

45-70 yr 

Sample Description:

1,397 cases;1,870 controls 

Averaging Time: 

Mean (SD) unit: 

66.8 μg/m3

 

(Estimated 30-yr residential 

exposure) 

Range (percentiles):

5th = 13.9; 95th = 295.7 

Copollutant: NR 

Increment: 300 μg/m3

OR Estimate [Lower CI, Upper CI] ; lag: 

Estimated 30-yr avg exposure 

All cases: 1.04 (0.89-1.21) 

Nonfatal cases: 0.98 (0.82-1.16) 

Fatal cases: 1.22 (0.98-1.52) 

In-hospital death: 1.16 (0.89-1.51) 

Out-of-hospital death: 1.36 (1.01-1.84) 

Author: Rosenlund et 

al. (2009, 190309) 

Period of Study: NR 

Location: Stockholm 

County, Sweden 

Health Outcome: Fatal and nonfatal MI 

Study Design: Case control 

Statistical Analyses: Various multiple 

regression models 

Age Groups Analyzed: 15-79 yr 

Sample Description: 43,275 MI cases 

during 1985-1996; 511,065 controls 

Averaging Time: 1 yr 

Mean (SD) unit: 

Cases: 64.2 μg/m3

Controls: 55.8 μg/m3

Range (percentiles):

Cases: 5th = 7.3; 95th =267.4

Controls: 5th =6.1;95th=261.8

Copollutant: PM10, NO2

Increment: NR 

OR Estimate [Lower CI, Upper CI] 

5-yr avg exposure 

All subjects (n = 301,273) 

All cases: 1.01 (0.97-1.05) 

Nonfatal cases: 0.94 (0.89-1.00) 

Fatal cases: 1.14 (1.07-1.21) 

In-hospital death: 1.00 (0.91-1.10) 

Out-of-hospital death: 1.23 (1.14-1.32) 

Restriction to subjects who did not move between 

population census ( n = 80,155) 

All cases: 1.04 (0.94-1.14) 

Nonfatal cases: 0.96 (0.87-1.06) 

Fatal cases: 2.03 (1.59-2.60) 

In-hospital death: 2.04 (1.35-3.08) 

Out-of-hospital death: 2.03 (1.50-2.74) 

January 2010 C-10 
Study Design Concentrations CO Effect Estimates (95% CI) 

CHANGES IN BLOOD PRESSURE 

Author: 

Ibalde-Mulli et al. (2001, 

016030) 

Period of Study: 

1984-1985 

Location:

Augsburg, Germany 

Health Outcome: BP–SPB 

Study Design: Cohort 

Statistical Analyses: 

Gaussian regression for repeated measures 

Age Groups Analyzed: 

25-64 yr 

Sample Description: 

2,607 men and women 25-64 yr 

Averaging Time: 24 h 

Mean (SD) unit: 

4.1 mg/m3

Range (Min, Max): 

1.7, 8.2 

Copollutant: NR 

Increment: Lag 0: 5.6 mg/m3

5-day prior avg 

Mean Change [Lower CI, Upper CI] 

SPB mmHg 

Lag 0 (days): 

All: 0.53 (-0.66 to 1.72); Men: 0.68 (-0.94 to 2.31); 

Women: 0.51 (-1.31 to 2.19) 

5-day prior avg: 

All: 1.06 (-0.17 to 2.29); Men: 0.92 (-0.87 to 2.70); 

Women: 0.91 (-0.87 to 2.70) 

Author: Zanobetti et al. 

(2004, 087489) 

Period of Study: 

1999-2001 

Location:

Boston, MA 

Health Outcome: BP 

Study Design: Cohort/Panel 

Statistical Analyses: Random effects 

Age Groups Analyzed: 39-90 yr 

Sample Description:

62 subjects with 631 total visits 

Averaging Time: 

1 h and 120 h avg 

Mean (SD) unit:

Same h: 0.81 ppm 

120-h avg: 0.66 ppm 

Range (Min, Max):

Same h: 

10th = 0.48; 90th = 1.22 

120-h avg: 

10th = 0.48; 90th = 0.86 

Copollutant: NR 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

CO had no significant effect on BP 

CHANGES IN BLOOD MARKERS OF COAGULATION AND INFLAMMATION 

Author: Baccarelli et al. 

(2007, 090733) 

Period of Study: 

1995-2005 

Location:

Milan, Italy 

Health Outcome: Prothrombin time (PT) and 

activated partial thromboplastin time (APTT) 

Study Design: Panel 

Statistical Analyses: GAMS 

Age Groups Analyzed: 

11-84 yr (mean 43 yr) 

Sample Description:

1,218 healthy individuals who were partners 

or friends of patients with thrombosis who 

attended the thrombosis center of the 

University of Milan. 

Averaging Time: 1 h 

Mean (SD) unit: NR 

Range (percentiles):

Sept-Nov: 

25th = 1.36; 75th = 3.52 

Dec-Feb: 

25th = 2.00; 75th = 4.31 

Mar-May: 

25th = 1.03; 75th = 2.14 

Jun-Aug: 

25th = 0.73; 75th = 1.58 

Copollutant: NR 

Increment: NR 

Regression co-efficient [Lower CI, Upper CI] 

Lags examined (time of blood sampling – avg): 0, 

7, 30 

PT: 

Lag 0: -0.11 (-0.18 to -0.05); Lag 7: -0.07 (-0.14 to 

0.01); Lag 30: -0.05 (-0.13 to 0.02) 

APTT: 

Lag 0: 0.03 (-0.04 to 0.10); Lag 7: 0.04 (-0.04 to 

0.11); Lag 30: 0.06 (-0.01 to 0.14) 

Notes: CO had no effect on fibrinogen, functional 

antithrombin, functional protein C, protein C antigen, 

functional protein S, or free protein S for all lag 

periods. 

January 2010 C-11 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Delfino et al. 

(2008, 156390) 

Period of Study:

2005-2006 

Location: Los Angeles, 

CA 

Health Outcome: Biomarkers of systemic 

inflammation 

Study Design: Panel 

Statistical Analyses: 

Linear mixed-effects models 

Age Groups Analyzed: 

≥ 65 yr (mean 85.7 yr) 

Sample Description: 29 nonsmoking 

subjects with history of CAD living in 

retirement communities 

Averaging Time: 24 h 

Mean (SD) unit:

0.78 ± 0.30 ppb

Range (Min, Max): 

0.22, 1.97

Copollutant (Outdoor): 

EC: r = 0.84

OC: r = 0.69

OCprimary: r = 0.73

NO2: r = 0.78

O3: r = -0.35

PM0.25: r = 0.84

PM0.25-2.5: r = 0.14

PM2.5-10: r = 0.51

Increment: NR 

Estimated coefficient 

Relationship to outdoor air pollutants: 

CRP (ng/mL): Lag 0: 847.52; 3-day avg: 728.79; 9-

day avg: 236.51 

IL-6 (pg/mL): Lag 0: 0.52; 3-day avg: 0.51; 9-day 

avg: 0.50 sTNF-RII (pg/mL): Lag 0: 154.05; 3-day 

avg: 139.45; 9-day avg: 225.60 

Relationship to indoor air pollutants: 

CRP (ng/mL): Lag 0: 695.39; 3-day avg: 527.37; 9-

day avg: 760.15 

IL-6 (pg/mL): Lag 0: 0.54; 3-day avg: 0.47; 9-day 

avg: 0.77 sTNF-RII (pg/mL): Lag 0: 114.22; 3-day 

avg: 107.95; 9-day avg: 273.38 

Relationship of sP-selction (ng/mL) to: 

Indoor air pollutants: Lag 0: 0.77; 5-day avg: 1.40; 

9-day avg: 2.19 

Outdoor air pollutants: Lag 0: 0.84; 5-day avg: 1.23; 

9-day avg: 4.29

Relationship of Cu, Zn-SOD (U/g Hb) to: 

Indoor air pollutants: Lag 0: -145.54; 5-day avg:

 -238.72; 9-day avg: -70.10 

Outdoor air pollutants: Lag 0: -105.73; 5-day avg: 

-176.72; 9-day avg: -41.92

January 2010 C-12 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Delfino et al.

(2009, 200844) 

Period of Study: JulmidOct and midOct-Feb 

of 2005-2006 and 

2006-2007 

Location: Los Angeles, 

CA

Health Outcome: Biomarkers of 

inflammation 

Study Design: Panel 

Statistical Analyses: Linear mixed effects 

models adjusted for confounders 

Age Groups: 65+ (84.1 ± 5.60) yr

Sample Description: 60 subjects with 

confirmed CAD history, nonsmoker, 

unexposed to environmental tobacco smoke

Averaging Time: 24 h

Mean (SD) unit: 0.50 (0.25) 

ppm 

Range (min, max): 0.11, 

1.30 

Copollutant: NO2, NOX, O3, 

PM0.25, PM0.25-2.5, PM2.5-10, EC, 

OC, BC, OCpri, SOC, PN/cm3

Increment: NR 

Regression coefficients (95% CI) 

Subjects with positive responses: 

Cu,Zn-SOD (U/g Hb): 1-day avg: 1441 (97, 2786), 

3-day avg: 2634 (1416, 3854), 5-day avg: 4227 

(2078, 6376), 7-day avg: 3474 (914, 6034), 9-day 

avg: 2954 (737, 5172) 

GPx-1 (U/g HB): 1-day avg: -0.97 (-4.45, 2.50), 

3-day avg: -2.21 (-6.48, 2.06), 5-day avg: 4.71 

(-2.90, 12.33), 7-day avg: 4.20 (-3.29, 11.68), 9-day 

avg: 4.76 (-1.58, 11.10) 

Subjects with negative responses: 

Cu,Zn-SOD (U/g Hb): 1-day avg: -195 (-338, -52), 

3-day avg: -242 (-399, -85), 5-day avg: -242 (-440, 

-44), 7-day avg: -315 (-664, 34), 9-day avg: -176 

(-508, 156) 

GPx-1 (U/g HB): 1-day avg: -0.82 (-1.55, -0.08), 

3-day avg: -0.85 (-1.66, -0.04), 5-day avg: -0.84 

(-1.88, 0.21), 7-day avg: -1.04 (-2.85, 0.78), 9-day 

avg: -0.47 (-2.19, 1.26) 

All subjects: 

IL-6 (pg/mL): 1-day avg.: 0.35 (0.17, 0.54), 3-day 

avg.: 0.40 (0.20, 0.61), 5-day avg.: 0.54 (0.27, 0.80), 

7-day avg.: 0.34 (-0.06, 0.74), 9-day avg.: 0.31 (-

0.07, 0.70) 

P-selectin (ng/mL): 1-day avg.: 3.33 (0.94, 5.73), 

3-day avg.: 3.65 (1.02, 6.29), 5-day avg.: 5.28 (1.86, 

8.70), 7-day avg.: 11.2 (5.39, 17.0), 9-day avg.: 10.4 

(4.83, 16.0) 

TNF-RII (pg/mL): 1-day avg: 112 (13, 211), 3-day 

avg: 136 (29, 243), 5-day avg: 229 (88, 371), 7-day 

avg: 132 (-86, 349), 9-day avg: 220 (19, 421) 

TNF-α (pg/mL): 1-day avg: 0.05 (-0.05, 0.16), 3-day 

avg: 0.09 (-0.03, 0.20), 5-day avg: 0.14 (-0.01, 0.29), 

7-day avg: 0.07 (-0.19, 0.33), 9-day avg: 0.14 (-0.11, 

0.39) 

CRP (ng/mL): 1-day avg: 780 (343, 1217), 3-day 

avg: 739 (255, 1222), 5-day avg: 1117 (485, 1749), 

7-day avg: 126 (-800, 1052), 9-day avg: 41 (-840, 

923) 

SOD (U/g Hb): 1-day avg: -62 (-231, 108), 3-day 

avg: -53 (-244, 138), 5-day avg: -37 (-285, 211), 

7-day avg: 98 (-314, 509), 9-day avg: 208 (-173, 

590) 

GPx-1 (U/g Hb): 1-day avg: -0.69 (-1.41, 0.03), 3-day 

avg: -0.69 (-1.48, 0.11), 5-day avg: -0.56 (-1.60, 

0.48), 7-day avg: -0.56 (-2.34, 1.21), 9-day avg: 0.05 

(-1.63, 1.72) 

Effect modification by medication use: 

TNF-RII (pg/mL): 1-day avg: All subjects: 125 (11, 

239), Statins: 48 (-105, 201), No Statins: 199 (47, 

352); 3-day avg: All subjects: 161 (39, 283), Statins: 

1 (-170, 171), No Statins: 306 (141, 472) ; 5-day avg: 

All subjects: 257 (100, 413), Statins: 15 (-210, 240), 

No Statins: 445 (240, 649); 7-dayay avg: All subjects: 

176 (-68, 419), Statins: 43 (-297, 382), No Statins: 

283 (-23, 589); 9-dayay avg: 265 (41, 489), Statins: 

160 (-158, 478), No Statins: 355 (65, 646) 

sP-selectin (ng/mL): 1-day avg: All subjects: 1.84 

(-0.62, 4.30), Clopidogrel: 0.00 (-2.80, 2.81), No 

Clopidogrel: 1.72 (-0.42, 3.86); 3-day avg: All 

subjects: 1.90 (-0.79, 4.60), Clopidogrel: -0.67 (-3.95, 

2.60), No Clopidogrel: 1.60 (-0.76, 3.96); 5-day avg: 

All subjects: 2.97 (-0.47, 6.41), Clopidogrel: -0.18 

January 2010 C-13 
Study Design Concentrations CO Effect Estimates (95% CI) 

(-4.38, 4.01), No Clopidogrel: 3.04 (0.06, 6.01); 

7-day avg: All subjects: 6.74 (0.75, 12.73), 

Clopidogrel: 2.24 (-4.22, 8.71), No Clopidogrel: 6.78 

(1.60, 3.96); 9-day avg: All subjects: 6.96 (1.20, 

12.72), Clopidogrel: 2.0 (-4.40, 8.48), No 

Clopidogrel: 5.54 (0.46, 10.6) 

Author: Liao et al. 

(2005, 088677) 

Period of Study: 

1996-1998 

Location:

Forsyth County, NC; 

Selected suburbs of 

Minneapolis, MN; 

Jackson, MI 

Health Outcome: Various measures of 

hemostasis/ inflammation 

Study Design: Cohort 

Statistical Analyses: 

Linear regression 

Age Groups Analyzed: 

45-64 yr 

Sample Description:

10,208 subjects from the Atherosclerosis 

Risk in Communities Study 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: 0.6 ppm 

Regression coefficients [SE] 

Lags examined (days): 1 

Lag 1: 

Fibrinogen (mg/dL): -0.16 (0.67) 

Factor VIII –C (%): 0.45 (0.42) 

vWF %: -0.29 (0.50) 

WBC (x 103/mm3): 0.003 (0.017) 

Albumin (g/dL): -0.018 (0.003)** 

** p < 0.01 

Author: Ljungman et al. 

(2009, 191983) 

Period of Study:

May 2003-July 2004 

Location: Athens, 

Greece; Augsberg, 

Germany; Barcelona, 

Spain; Helsinki, Finland; 

Rome, Italy; Stockholm, 

Sweden 

Health Outcome: Plasma Interleukin-6 (IL6), Fibrinogen 

Study Design: Panel/Field 

Statistical Analyses: Linear Mixed Effects 

Model 

Age Groups Analyzed: 35-80 yr 

(mean = 62.2 yr) 

Sample Description: 955 subjects who had 

experienced MI between 4 mo and 6 yr 

before start of the study 

Averaging Time: 24 h 

Mean (SD) unit: 

Individual cities: 

0.29-1.48 mg/m3

 

Mean for all cities: 

0.78 mg/m3

Range (percentiles): 

25th = 0.56; 75th = 0.90 (for 

mean of all cities) 

Copollutant: 

(mean for all cities) 

NO2: r = 0.69 

PM10: r = 0.47 

PM2.5: r = 0.55 

PNC: r = 0.67 

Increment: 0.34 mg/m3

Change of IL-6 

% of overall mean per IQ range increase 

Genotypes: 1 1, 1 2, 2 2 

IL6 rs2069832 

1 1: 2.0 (0.3, 3.6); 1 2: -0.2 (-1.7, 1.3); 2 2: -2.0 

(-4.7, 0.8); p-value: 0.03 

IL6 rs2069840 

1 1: 2.0 (0.3, 3.8); 1 2: 0.4 (-0.9, 1.7); 2 2: -1.2 

(-3.4, 1.1); p-value: 0.04 

IL6 rs2069845 

1 1: 1.9 (0.2, 3.5); 1 2: -0.1 (-1.5, 1.4); 2 2: -1.6 

(-4.3, 1.2); p-value: 0.31 

FGA rs2070011 

1 1: 1.0 (-0.7, 2.7); 1 2: 0.7 (0.6, 2.0); 2 2: 0.4 

(-1.9, 2.7); p-value: 0.64 

FGB rs1800790 

1 1: -0.2 (-1.8, 1.3); 1 2: 2.1 (0.4, 3.8); 2 2: 4.5 

(1.1, 8.0); p-value: 0.02 

Author: Pekkanen et al. 

(2000, 013250) 

Period of Study: 

1991-1993 

Location:

London, England 

Health Outcome: Fibrinogen 

Study Design: Cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: 

35-55 yr 

Sample Description:

7,205 office workers 

Averaging Time: 8 h 

Mean (SD) unit: 

1.4 mg/m3

Range (Min, Max): 

Min = NR, Max = 9.9 

Copollutant correlation: 

PM10: r = 0.57 

NO2: r = 0.81 

SO2: r = 0.61 

O3: r = -0.45 

Increment: 1.6 mg/m3

% Change in fibrinogen concentration [p value] ; 

Lags examined: 0, 1, 2, 3 

Lag 0: 1.43 (<0.01); Lag 1: 1.49 (<0.01); 

Lag 2: 1.59 (<0.01); Lag 3: 1.26 (<0.01) 

OR for having Fibrinogen above 3.19 g/l [p value] 

Lags examined: 0, 1, 2, 3 

Lag 0: 1.17 (0.05); Lag 1: 1.09 (0.31); 

Lag 2: 1.14 (0.11); Lag 3: 1.22 (<0.01) 

January 2010 C-14 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Ruckerl et al. 

(2006, 088754) 

Period of Study: 

2000-2001 

Location:

Erfert, Germany 

Health Outcome: Blood markers of 

inflammation and coagulation 

Study Design: Panel 

Statistical Analyses: 

Linear and logistic regression (fixed effects) 

Age Groups Analyzed: 

51-76 yr (mean = 66 yr) 

Sample Description:

57 male patients with CHD 

Averaging Time: 24 h 

Mean (SD) unit: 

0.52 mg/m3

Range (Min, Max): 

0.11, 1.93 

Copollutant correlation:

NO2: r = 0.82 

 

Increment: 0.27 mg/m3

OR Estimate for blood marker >90th percentile 

[Lower CI, Upper CI]

Lags examined (h): 0-23, 24-47, 48-71, 5-day avg 

CRP (C-reactive protein) 

0-23: 0.9 (0.7-1.2); 24-47: 1.0 (0.7-1.5); 

48-71: 1.5 (1.1-2.1); 5-day avg 1.1 (0.8-1.6) 

ICAM-1 (Intercellular adhesion molecule 1) 

0-23: 0.8 (0.6-1.0); 24-47: 1.5 (1.2-1.9); 

48-71: 1.7 (1.3-2.3); 5-day avg 1.2 (1.0-1.6) 

% of change from the mean of blood marker 

vWF (von Willebrand factor antigen) 

0-23: 4.4 (1.4- 7.5); 24-47: 2.7 (-0.8 to 6.1); 

48-71: 2.0 (-1.7 to 5.8); 5-day avg: 4.9 (1.0-8.8) 

FVII (Factor VII) 

0-23: -1.4 (-3.8 to 1.1); 24-47: -2.6 (-4.8 to 0.3); 

48-71: -2.8 (-5.1 to -0.4); 5-day avg: -3.0 (-5.5 to 

-0.4) 

Author: Ruckerl et al. 

(2007, 156931) 

Period of Study: 

May 2003-July 2004 

Location:

6 cities across Europe: 

Athens, Greece; 

Augsburg, Germany; 

Barcelona, Spain; 

Helsinki, Finland; 

Rome, Italy; 

Stockholm, Sweden 

Health Outcome: Interleukin-6, 

C-reactive protein, Fibrinogen 

Study Design: Panel/Cohort 

Statistical Analyses: 

Linear regression (mixed effects) 

Age Groups Analyzed: 

37-81 yr 

Sample Description:

1,003 MI survivors who had at least 2 valid 

repeated blood samples 

Averaging Time: 24 h 

Mean (SD) unit:

 Athens: 1.48 mg/m3

Augsburg: 0.58 mg/m3

Barcelona: 0.59 mg/m3

Helsinki: 0.31 mg/m3

Rome: 1.40 mg/m3

Stockholm: 0.29 mg/m3

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: 0.34 mg/m3

% Change in mean [Lower CI, Upper CI] 

Lags examined: 0, 1, 2, 5-day avg 

(Pooled estimates) 

Interleukin-6 

Lag 0: 0.57 (-0.63 to 1.79) 

Lag 1: 0.44 (-0.79 to 1.68); 

Lag 2: -2.36 (-4.82 to 0.17) 

5-day avg: -0.28 (-2.53 to 2.02) 

C-reactive protein 

Lag 0: -0.01 (-1.72 to 1.73 

Lag 1: -1.51 (-3.30 to 0.32) 

Lag 2: -2.35 (-6.84 to 2.36); 

5-day avg: -0.85 (-.5.37 to 3.90) 

Fibrinogen 

Lag 0: 0.24 (-0.54 to 0.92) 

Lag 1: 0.32 (-0.35 to 1.00); 

Lag 2: -0.44 (-1.11 to 0.23) 

5-day avg: 0.12 (-0.81 to 1.05) 

January 2010 C-15 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Rudez et al. 

(2009, 193783) 

Period of Study:

January 2005-December 

2006 

Location: Rotterdam, 

the Netherlands 

Health Outcome: Platelet aggregation, 

thrombin generation, Fibrinogen, C-reactive 

protein 

Study Design: Panel 

Statistical Analyses: Linear regression 

Age Groups Analyzed: Mean = 41 yr 

Sample Description: 40 healthy individuals 

Averaging Time: 24 h 

Median (SD) unit: 333 μg/m3

Range (percentiles): 

25th = 276; 75th = 412 

Copollutant: 

PM10: r >0.6 

NO: r >0.6 

NO2: r >0.6 

O3: -0.4 ≥ r ≥ -0.6 

Increment: NR 

Estimated Changes [Lower CI, Upper CI] 

Platelet Aggregation Parameters 

Maximal Platelat Aggregation: 

D0-6: -3.6 (-9.3, 2.1); D0-12: -4.7 (-11.0, 1.5); 

D0-24: -2.6 (-7.9, 2.7); I24-48: -1.1 (-7.2, 4.9); 

I48-72: 8.4 (2.5, 14.3); I72-96: -0.1 (-5.1, 5.0); 

D+I0-96: 9.5 (1.6, 17.4) 

Late Aggregation: 

D0-6: 10.5 (0.8, 20.3); D0-12: 11.6 (1.2, 21.9); 

D0-24: 11.2 (1.4, 21.0); I24-48: 7.5 (-2.2, 17.1); 

I48-72: 18.1 (8.4, 27.8); I72-96: 4.2 (-5.5, 13.9); 

D+I0-96: 20.4 (8.4, 32.4) 

Thrombin Generation 

ETP 

D0-6: -1.51 (-3.7, 0.80); D0-12: -1.1 (-3.4, 1.1); 

D0-24: -1.5 (-3.9, 0.9); I24-48: -0.7 (-3.4, 2.0); 

I48-72: 0.8 (-1.9, 3.4); I72-96: 3.5 (0.8, 6.2); 

D+I0-96: 0.8 (-2.7, 4.3) 

Peak 

D0-6: -2.5 (-6.3, 1.3) D0-12: -1.9, (-5.7, 1.9); 

D0-24: -3.3 (-7.3, 0.7); I24-48; -1.3 (-6.1, 3.6); 

I48-72: -0.5 (-5.0, 4.0) I72-96: 3.8 (-0.8, 8.4) 

D+I0-96: -1.7 (-7.5, 4.2) 

Lag Time 

D0-6: 1.0 (-0.5, 2.5); D0-12: 1.0 (-0.5, 2.5); 

D0-24: 1.6 (0.1, 3.1); I24-48; 0.4 (-1.3, 2.2); 

I48-72: -1.0 (-2.7, 0.7); I72-96: -1.5 (-3.2, 0.2); 

D+I0-96: 0.1 (-2.1, 2.2) 

Inflammatory Markers 

Fibrinogen 

I24-48; 0.0 (-1.7, 1.8); I48-72: 0.0 (-1.8, 1.9) I72-96: 

-0.1 (-1.9, 1.7) 

CRP 

I24-48; 3.2 (-6.4, 12.8); I48-72: -1.9 (-12.5, 8.7); 

I72-96: -4.5 (-15.3, 6.3) 

Author: Steinvil et al. 

(2008, 188893) 

Period of Study: 

2003-2006 

Location: Tel Aviv, 

Israel 

Health Outcome: Various measures of 

inflammation sensitive biomarkers 

Study Design: Cohort 

Statistical Analyses: Linear regression 

Age Groups Analyzed: Mean = 46 yr 

Sample Description: 3,659 subjects living 

within 11 km of monitoring site 

Averaging Time: 24 h 

Mean (SD) unit: 0.8 ppm 

Range (percentiles):

25th = 0.7; 75th = 1.0 

Copollutant: correlation 

PM10: r = 0.75 

NO2: r = 0.857 

SO2: r = 0.671 

O3: r = -0.656 

 

Increment: 0.3 ppm 

Regression co-efficient [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3, 4, 5, 6, 7, last wk 

avg 

Fibrinogen: Men 

Lag 0: -3.3 (-6.1 to -0.6); Lag 1: -2.6 (-5.5 to 0.4); 

Lag 2: -3.4 (-6.6 to -0.3); Lag 3: -3.4 (-6.5 to -0.2); 

Lag 4: -5.9 (-8.9 to -2.9); Lag 5: -4.7 (-7.8 to -1.6); 

Lag 6: -2.0 (-5.1 to 1.0); Lag 7: -2.7 (-5.7 to 0.2); 

Last wk avg: -7.7 (-12.1 to -3.3) 

Notes: No effect on fibrinogen among women. CO 

had no effect on CRP among men and no effect on 

CRP and WBC among women for all Lag times 

examined. 

VARIOUS MEASURES OF CARDIOVASCULAR HEALTH 

Author: Briet et al. 

(2007, 093049) 

Period of Study: NR 

Location: Paris, France 

Health Outcome: Endothelial function, 

Reactive Hyperemia 

Study Design: Case-crossover 

Statistical Analyses: Multiple regression 

models 

Age Groups Analyzed: 18-35 yr 

Sample Description: 40 healthy white male 

nonsmokers 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

PM2.5, PM10, NO, NO2, SO2

Increment: NR 

β-Coefficient [Lower CI, Upper CI] 

Flow-mediated Brachial Artery Dilatation: 

-0.68 (-1.22, -0.15) 

Small Artery Reactive Hyperemia: 

10.46 (1.73, 19.31) 

January 2010 C-16 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Nautiyal et al. 

(2007, 190301) 

Period of Study:

August 1999-May 2000 

Location: 

Mandi Gobindgarh, India 

Morinda, India 

Health Outcome: Various measures of 

cardiovascular health via ECG (Minnesota 

Code) 

Study Design: Cross-sectional 

Statistical Analyses: NR 

Age Groups Analyzed: +15 yr 

Sample Description: 

 200 total survey participants (100/town) 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): 

Morinda 

Pure residential Site: 0-1 ppm 

GT Road Site: 2-3 ppm 

Mandi Gobindgarh 

Mixed Habitat Site: 0-3 ppm 

GT Road Site: 1-3 ppm 

Copollutant: 

 PM2.5, PM10, NOX, SOX

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined: NR 

No quantitative results presented 

Author: Wellenius et al. 

(2007, 092830) 

Period of Study:

February 2002-March 

2003 

Location: Boston, MA 

Health Outcome: Congestive heart failure 

Study Design: Cohort (retrospective) 

Statistical Analyses: Linear mixed models 

Age Groups Analyzed: 33-88 yr. 

Tai Chi Group mean age (n=14): 66 ± 13 yr. 

Control Group mean age (n=14): 63 ± 14 yr. 

Sample Description: 28 patients with CHF 

and impaired systolic function 

Averaging Time: 24 h 

Mean (SD) unit: 0.44 ppm 

Range (IQ): 0.20 ppm 

Copollutant: 

PM2.5: r = 0.35 

NO2, SO2, O3, BC 

 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined: 0, 1, 2, 3 

Results presented graphically 

Table C-2. Studies of CO exposure and cardiovascular hospital admissions and ED visits. 

Study Design Concentrations CO Effect Estimates (95% CI) 

STROKE 

Author: Chan et al. (2006, 

090193) 

Period of Study: 1997-2002 

Location:

Taipei, Taiwan 

ED Visits 

Health Outcome (ICD9): 

Cerebrovascular disease 

(430-437); Strokes (430-434); 

Hemorrhagic stroke (430-432); Ischemic 

stroke (433-434) 

Study Design: Time-series 

Statistical Analyses: GAM 

Age Groups Analyzed: All 

Sample Description: NR 

Averaging Time: 8 h 

Mean (SD) unit: 1.7 ppm 

Range (Min, Max): 0.6, 4.4 

Copollutant: correlation 

O3: r = 0.30 

SO2:r = 0.63 

NO2: r = 0.77 

PM2.5: r = 0.44 

PM10: r = 0.47 

Increment: 0.8 ppm 

OR Estimate [Lower CI, Upper CI] 

Lags (days) examined 0, 1, 2, 3 

Cerebrovascular disease: 

Lag 2, 1.03 (1.01, 1.06) 

Stroke: Lag 2, 1.03 (1.01, 1.05) 

Ischemic and Hemorrhagic stroke: not 

significant. 

Cerebrovascular 2 pollutant model: 

CO + O3: Lag 2, 1.03 (1.01-1.05) 

CO + PM2.5: Lag 2, 1.02 (1.00-1.04) 

CO + PM10: Lag 2, 1.03 (1.01-1.05) 

Author: Henrotin et al. (2007, 

093270) 

Period of Study: 1994-2004 

Location:

Dijon, France 

Health Outcome (ICD9 or ICD10): 

Stroke (Ischemic & Hemorrhagic) 

Study Design: Bidirectional case 

crossover 

Statistical Analyses: Conditional logistic regression 

Age Groups Analyzed: ≥ 40 yr 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 683 μg/m3 

Range (Min, Max): 0, 4014 

Copollutant: NR 

Increment: 10 μg/m3

OR Estimate [Lower CI, Upper CI] 

Lags (days) examined: 0, 1, 2, 3. 

Ischemic: 

Lag 0: 0.999 (0.997-1.001) 

Lag 1: 0.998 (0.997-1.001) 

Lag 2: 0.999 (0.998-1.001) 

Lag 3: 1.000 (0.998-1.001) 

Hemorrhagic: 

Lag 0: 1.000 (0.996-1.004) 

Lag 1: 1.001 (0.997-1.005) 

Lag 2: 0.999 (0.995-1.004) 

Lag 3: 0.998 (0.994-1.002) 

Also not significant when stratified by sex. 

January 2010 C-17 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Maheswaran et al. 

(2005, 090769) 

Period of Study: 1994-1998 

Location:

Sheffield, UK 

Health Outcome (ICD9 or ICD10): 

Stroke deaths (ICD9: 430-438); Stroke 

Hospital admissions (ICD10: I60-I69) 

Study Design: Ecological 

Statistical Analyses: 

Poisson regression 

Age Groups Analyzed: ≥ 45 yr 

Sample Description: 1,030 census 

districts 

Averaging Time: NR 

Mean (SD) unit: Quintiles 

Range (Min, Max): NR 

Copollutant: NR 

Increment:

NR – Quintiles of exposure 

RR Estimate [Lower CI, Upper CI] 

Adjusted for sex, age, deprevation, 

smoking. 

Quintiles: 

2nd: 1.04 (0.94-1.16) 

3rd: 1.01 (0.91-1.13) 

4th: 1.10 (0.99-1.23) 

5th: 1.11 (0.99-1.25) 

Adjusted for sex, age: 

2nd: 1.11 (1.01-1.22) 

3rd: 1.15 (1.04-1.27) 

4th: 1.29 (1.17-1.42) 

5th: 1.37 (1.24-1.52) 

Author: Tsai et al. (2003, 

080133) 

Period of Study: 

1997-2000 

Location:

Kaohsiung, Taiwan 

Study Design: Case-crossover 

Health Outcome (ICD9 or ICD10): 

Cerebrovascular diseases: ICD9: 430 to 

438 (Subarachnoid hemorrhagic stroke 

430, Primary intracerebral hemorrhage 

(PIH): 431-432, Ischemic stroke (IS): 

433-435). 

Statistical Analyses: NR 

Age Groups Analyzed: All 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 0.79 ppm 

Range (Min, Max): 0.24, 1.72 

Copollutant: NR 

Increment: 0.8 ppm (IQR) 

RR Estimate [Lower CI, Upper CI] 

Lag (days): 0-2 

>20oC 

PIH: OR 1.21 (1.09-1.34) 

IS: OR 1.21 (1.14-1.28) 

<20oC 

PIH: OR 1.18 (0.80-0.72) 

IS: OR 1.77 (1.31-2.39) 

Notes: 

2-pollutant models: 

PIH results persisted when adjusting for 

SO2 and O3

IS results persisted when controlling for 

PM10, SO2 and O3

Author: Villeneuve et al. (2006, 

090191) 

Period of Study: 1992-2002 

Location:

Edmonton, Canada 

ED Visits (within 5 hospitals) 

Health Outcome (ICD9): Stroke (430-

438); Ischemic (434-436) Hemorrhagic 

(430-432); Transient Ischemic Attack 

(435) 

Study Design: Case-crossover 

Statistical Analyses: Conditional 

logistic regression 

Age Groups Analyzed: 65+ yr 

Sample Description: 

12,422 visits 

Averaging Time: 24 h 

Mean (SD) unit: 0.8 ppm 

Range (percentiles):

25th = 0.5; 75th = 1.0 

Copollutant correlation:

O3: r = -0.54 

PM2.5: r = 0.43 

PM10: r = 0.30 

Increment: 0.5 ppm 

OR Estimate [Lower CI, Upper CI] 

Lags (days) examined: 0, 1 & 0-2 

Ischemic (April-Sept) 

Lag 0: 1.16 (1.00, 1.33) 

Lag 1: 1.17 (1.01, 1.36) 

Lag 0-2: 1.32 (1.09, 1.60) 

Notes: 

- Not significant for all seasons or Oct-Mar.

- Hemorrhagic: Not significant for all 

seasons or Oct-Mar, Apr-Sept. 

- Transient Ischemic Attack: Not significant 

for all seasons or Oct-Mar, Apr-Sept. 

Author: Wellenius et al. (2005, 

088685) 

Period of Study: NR 

Location:

9 U.S. cities: Chicago, Detroit, 

Pittsburgh, Cleveland, 

Birmingham, New Haven, 

Seattle, Minneapolis, Salt Lake 

City 

ED Visits 

Health Outcome: 

Stroke among Medicare beneficiaries: 

(Ischemic, hemorrhagic) 

Study Design: Time-series 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: ≥ 65 yr 

Sample Description: 155,503 visits 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (percentiles):

25th = 0.73; 50th = 1.02; 

75th = 1.44 (ppm) 

Copollutant: correlation 

PM10: r = 0.43 

Increment: 0.71 ppm 

% Change [Lower CI, Upper CI] 

Lag: 0 

Ischemic: 2.83 (1.23-4.46) 

Hemorrhagic: -1.61 (-4.79 to 1.68) 

January 2010 C-18 
Study Design Concentrations CO Effect Estimates (95% CI) 

ISCHEMIC HEART DISEASE 

Author: D’Ippoliti et al. (2003, 

074311) 

Period of Study: 1995-1997 

Location:

Rome, Italy 

Hospital Admissions 

Health Outcome (ICD9): MI (410) 

Study Design: Case-crossover 

Statistical Analyses: Conditional 

logistic regression 

Age Groups Analyzed: 18+ yr 

Sample Description: 

6,531 patients. 

Averaging Time: 24 h 

Mean (SD) unit: 4.4 mg/m3

Range (percentiles):

25th = 2.8; 75th = 4.3 

Copollutant: correlation 

TSP: r = 0.35 

SO2: r = 0.56 

NO2: r = 0.31 

Increment: 1 mg/m3

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined (days): 0, 1, 2, 3, 4, 0-2 

Acute MI 

Lag 0: 1.021 (0.988-1.054) 

Lag 1: 1.020 (0.988-1.054) 

Lag 2: 1.033 (1.001-1.066) 

Lag 3: 1.010 (0.982-1.040) 

Lag 4: 1.025 (0.996-1.055) 

Lag 0-2: 1.044 (1.000- .089 

Author: Hosseinpoor et al. 

(2005, 087413) 

Period of Study:

1996-2001 

Location: 

Tehran, Iran 

Health Outcome: Angina Pectoris 

(ICD9: 413; ICD10: I20) 

Study Design: Time series 

Statistical Analyses: 

Poisson regression 

Age Groups Analyzed: All 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 10.8 mg/m3

Range (Min, Max): 1.6, 57.8 

Copollutant: NR 

Increment: 1 mg/m3

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3 

Lag 1: 1.00957 (1.00600-1.01315) 

Author: Lanki et al. (2006, 

089788) 

Period of Study: 1994-2000 

Location:

5 European cities: 

Augsburg, Germany 

Barcelona, Spain 

Helsinki, Finland 

Rome, Italy 

Stockholm, Sweden 

Health Outcome: First AMI (ICD9: 410; 

ICD10: I21, I22) 

Study Design: Time series 

Statistical Analyses: 

Poisson regression (GAM) 

Age Groups Analyzed: 

35+ yr 

Sample Description:

26,854 Hospital Admissions 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Unit: mg/m3

Range (percentiles):

Augsburg, Germany 

25th = 0.7; 75th = 1.1 

Barcelona, Spain 

25th = 0.6; 75th = 1.4 

Helsinki, Finland 

25th = 0.3; 75th = 0.5 

Rome, Italy 

25th = 1.7; 75th = 2.9 

Stockholm, Sweden 

25th = 0.3; 75th = 0.5 

Copollutant: correlation 

PM10: r = 0.21 – 0.56 

NO2: r = 0.43 – 0.75 

O3: r = -.023 – 020 

Increment: 0.2 mg/m3

RR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: 0, 1, 2, 3 

All 5 cities: 

Lag 0: 1.005 (1.000-1.010) 

Lag 1: 1.002 (0.996-1.007) 

Lag 2: 1.002 (0.997-1.007) 

Lag 3: 0.998 (0.992-1.003) 

3 cities with Hospital Discharge 

Register(HDR): 

Lag 0: 1.007 (1.001-1.012) 

Lag 1: 1.002 (0.996-1.008) 

Lag 2: 1.003 (0.998-1.009) 

Lag 3: 1.004 (0.988-1.020) 

3 cities with HDR – ≤ 75years 

Fatal: 

Lag 0: 1.027 (1.006-1.048) 

Lag 1: 1.021 (1.000-1.042) 

Lag 2: 1.018 (0.997-1.039) 

Lag 3: 1.015 (0.994-1.037) 

Non-Fatal: 

Lag 0: 1.001 (0.995-1.008) 

Lag 1: 1.000 (0.994-1.007) 

Lag 2: 1.004 (0.998-1.011) 

Lag 3: 0.999 (0.992-1.006) 

3 cities with HDR – ≥ 75years 

Fatal: 

Lag 0: 1.009 (0.992-1.006) 

Lag 1: 1.001 (0.985-1.018) 

Lag 2: 1.006 (0.990-1.023) 

Lag 3: 1.000 (0.983-1.017) 

Non-Fatal: 

Lag 0: 1.015 (1.004-1.086) 

Lag 1: 1.006 (0.995-1.017) 

Lag 2: 0.995 (0.983-1.006) 

Lag 3: 0.998 (0.987-1.009) 

January 2010 C-19 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Lee et al. (2003, 

095552) 

Period of Study: 1997-1999 

Location:

Seoul, Korea 

Study Design: Time-series 

Health Outcome (ICD9 or ICD10): 

Angina: ICD10: 120 

AMI: ICD10: I21-I23 

Other Acute IHDs: ICD10: I24 

Statistical Analyses: Poisson 

regression, GAM 

Age Groups Analyzed: 64+ yr 

Sample Description: 822 days 

Averaging Time: Daily max 

Mean (SD) unit: 1.8 ppm 

Range (percentiles): 

25th = 1.2 

75th = 2.2 

Copollutant: correlation 

PM20: 0.60 

SO2: 0.81 

NO2: 0.79 

O3: -0.39 

Increment: 1 ppm (IQR) 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3, 4, 5, 6 

All yr: 

Lag 5: All ages: 0.94 (0.91 0.98) 

Lag 5: 64+ age: 1.07 (1.01-1.13) 

Summer: 

Lag 5: All ages: 1.19 (1.02-1.38) 

Lag 5: 64+ age: 1.60 (1.27-2.03) 

2-pollutant model: 

Lag 5: 64+ age: 

CO + PM10: 1.04 (0.98-1.11) 

Author: Maheswaran et al. 

(2005, 090769) 

Period of Study:

1994-1998 

Location: 

Sheffield, UK 

Emergency Hospital Admission 

Health Outcome (ICD9): CHD (410-414) 

Study Design: Ecological 

Statistical Analyses: Poisson 

regression 

Age Groups Analyzed: 45+ yr 

Sample Description:

11,407 Emergency Hospital Admissions 

for CHD in patients 45+ yr (within 1,030 

census districts) 

Averaging Time: NR 

Mean (SD) unit: Quintiles 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NA 

RR Estimate [Lower CI, Upper CI] 

Lowest quintile reference category 

Adjusted for sex, age, deprivation, smoking:

2nd: 0.97 (0.89-1.07) 

3rd: 0.94 (0.86-1.04) 

4th: 0.96 (0.97-1.06) 

5th: 0.88 (0.79- 0.98) 

Adjusted for sex, age: 

2nd: 1.09 (1.00-1.19) 

3rd: 1.15 (1.05-1.26) 

4th: 1.19 (1.09-1.30) 

5th: 1.20 (1.09-1.32) 

Author: Mann et al. (2002, 

036723) 

Period of Study: 1988-1995 

Location:

Southern California 

Health Outcome (ICD9): IHD (IHD) 

(410-414); MI (410) 

Study Design: Time series 

Statistical Analyses: 

Poisson regression, GAM 

Age Groups Analyzed: All 

Sample Description: 54,863 IHD 

admissions among Southern California 

Kaiser- Permanente members (within 

20km of monitor) 

Averaging Time: 8 h 

Mean (SD) unit: 2.07 ppm 

Range (Min, Max): 0.30, 11.8 

Copollutant: correlation 

Ranging across 7 regions: 

NO2: r = 0.64, 0.86 

O3: r = -0.37, 0.28 

PM10: r = 0.15, 0.40 

 

Increment: 1 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 2 ma, 

3 ma, 4 ma 

With arrythmia: 

Lag 0: 2.99 (1.80-4.99) 

Lag 1: 1.51 (0.37-2.66) 

Lag 2: 1.26 (0.15-2.38) 

2 ma: 2.66 (1.40-3.94) 

3 ma: 2.59 (1.27-3.92) 

4ma: 2.25 (0.90-3.63) 

With CHF: 

Lag 0: 3.60 (1.620-5.63) 

Lag 1: 3.34 (1.48-5.22) 

Lag 2: 1.90 (0.11-3.72) 

2 ma: 4.23 (2.13-6.37) 

3 ma: 4.14 (1.96-6.37) 

4 ma: 4.07 (1.81-6.38) 

Without secondary diagnosis: 

Lag 0: 1.62 (0.65-2.59) 

Lag 1: 1.45 (0.54-2.37) 

Lag 2: 0.92 (0.04-1.82) 

2 ma: 1.83 (0.80-2.86) 

3 ma: 1.79 (0.72-2.87) 

4 ma: 1.82 (0.71-2.94) 

Author: Szyszkowicz (2007, 

193793) 

Period of Study: 1997-2003 

Location: Montreal, Canada 

Study Design: Time-series 

Health Outcome (ICD9 or ICD10): 

ED Visits. 

IHD: ICD9: 410-414 

Statistical Analyses: Poisson 

regression (GLMM) 

Age Groups Analyzed: All 

Sample Description: 4,979 ED Visits 

Averaging Time: 24 h 

Mean (SD) unit: 0.5 ppm 

Range (Min, Max): 0.1, 3.1 

Copollutant: NR 

 

Increment: 0.2 ppm 

% Change [Lower CI, Upper CI] ; lag: 

Lags examined (days): 0, 1 

All Patients: Lag 0: 5.4 (2.3-8.5) 

Males: Lag 0: 7.5 (3.6-11.6) 

Females: Lag 0: 2.7 (-2.0 to 7.6) 

Ages ≥ 64 

All Patients: Lag 0: 4.9 (1.3-8.7) 

Males: Lag 0: 7.5 (2.6-12.6) 

Females: Lag 0: 2.4 (-3.0 to.0) 

Lag 1 not significant for all results 

January 2010 C-20 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: von Klot et al. (2005, 

088070) 

Period of Study: 1992-2001 

Location:

5 European cities: 

Augsburg, Germany 

Barcelona, Spain 

Helsinki, Finland 

Rome, Italy 

Stockholm, Sweden 

Health Outcome: Hospital cardiac (mi), 

angina, dysrythmia, heart failure) readmissions 

Study Design: 

Prospective Cohort 

Statistical Analyses: Poisson 

regression 

Age Groups Analyzed: All 

Sample Description: 22,006 survivors 

of first MI 

Averaging Time: 24 h 

Unit: mg/m3

Mean (SD) unit:

Augsburg, Germany: 0.93 

Barcelona, Spain: 1.00 

Helsinki, Finland: 0.42 

Rome, Italy: 2.21 

Stockholm, Sweden: 0.43 

Range (Min, Max): NR 

Copollutant: correlation 

PM10: r = 0.21 – 0.57 

NO2: r = 0.44 – 0.75 

O3: r = -.027 – 0.47 

Increment: 0.2 mg/m3 (0.172 ppm) 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3 

Lag 0: 

MI:1.022 (0.998-.047) 

Angina: 1.009 (0.992-.02) 

Cardiac: 1.014 (1.001-.026) 

HEART FAILURE 

Author: Lee et al. (2007, 

090707) 

Period of Study: 1996-2004 

Location:

Kaohsiung City, Taiwan 

Hospital Admissions 

Health Outcome (ICD9): CHF (428) 

Study Design: Case-crossover 

Statistical Analyses: Conditional 

logistic regression 

Age Groups Analyzed: All 

Sample Description:

13,475 Hospital Admissions 

(63 Hospitals) 

Averaging Time: 24 h 

Mean (SD) unit: 0.76 ppm 

Range (Min, Max): 0.14, 1.72 

Copollutant: NR 

 

Increment: 0.31 ppm 

OR Estimate [Lower CI, Upper CI] 

Lag examined (days): 0-2 

≥ 25°C: 1.19 (1.09-1.31) 

<25°C: 1.39 (1.24-1.54) 

Adjusted for PM10: 

≥ 25°C; 1.15 (1.04-1.27) 

<25°C; 1.21 (1.206-1.38) 

Adjusted for SO2: 

≥ 25°C: 1.23 (1.11-1.36) 

<25°C: 1.39 (1.24-1.55) 

Adjusted for NO2: 

≥ 25°C: 1.22 (1.08-1.39) 

<25°C: 0.94 (0.81-1.10) 

Adjusted for O3: 

≥ 25°C: 1.17 (1.07-1.28) 

<25°C: 1.36 (1.22-1.51) 

Author: Symons et al. (2006, 

091258) 

Period of Study: 2002 

(April-November) 

Location:

Johns Hopkins Bayview 

Medical Center, Baltimore, MD 

Hospital Admissions 

Health Outcome: NR 

Study Design: Case-crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

398 Hospital Admissions for CHF 

Averaging Time: 24 h 

Mean (SD) unit: 0.4 ppm 

Range (Min, Max): 0.1, 1.0 

Copollutant: NR 

Increment: 0.2 ppm 

OR Estimate [Lower CI, Upper CI] 

Lags examined (days): 

0, 1, 2, 3, cum 1, cum 2, cum 3 

Lag 0: 0.86 (0.67-1.11) 

Lag 1: 0.90 (0.70-1.17) 

Lag 2: 0.96 (0.73-1.26) 

Lag 3: 0.88 (0.67-1.16) 

Cum. Lag1: 0.82 (0.60-1.13) 

Cum. Lag2: 0.80 (0.54-1.17) 

Cum. Lag3: 0.27 (0.46-1.14) 

Author: Wellenius et al. (2005, 

087483) 

Period of Study: 1987-1999 

Location:

Pittsburgh, PA 

Hospital Admissions 

Health Outcome (ICD9): CHF 

(428, 428.1) 

Study Design: Case-crossover 

Statistical Analyses: Conditional 

logistic regression 

Age Groups Analyzed: 65+ yr 

Sample Description:

54,019 Hospital Admissions among 

Medicare beneficiaries 

Averaging Time: 24 h 

Mean (SD) unit: 1.03 ppm 

Range (percentiles): 

25th = 0.68; 75th = 1.23 

Copollutant: correlation 

PM10: r = 0.57 

NO2: r = 0.70 

O3: r = -0.25 

SO2: r = 0.54 

Increment: 0.55 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3 

Lag 0: 

Single pollutant model: 4.55 (3.33-5.79) 

Adjusted for PM10: 5.18 (3.49-6.89) 

Adjusted for NO2: 4.84 (3.06-6.66) 

Adjusted for O3: 4.35 (3.08-5.64) 

Adjusted for SO2: 4.51 (3.15-5.90) 

January 2010 C-21 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Yang (2008, 157160) 

Period of Study: 1996-2004 

Location: Taipei, Taiwan 

Hospital Admissions 

Health Outcome: CHF 

Study Design: Case-crossover 

Statistical Analyses: NR 

Age Groups Analyzed: NR 

Sample Description: 24,240 CHF HA 

from 47 hospitals 

Averaging Time: 24 h 

Mean (SD) unit: 1.26 ppm 

Range (Min, Max): 0.12, 3.66 

Copollutant: PM10, NO2, O3, SO2

 

Increment: NR 

OR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2 

Single Pollutant Model 

Warm days (>20o C): 1.24 (1.16, 1.33) 

Cool days (<20o C): 1.05 (0.96, 1.15) 

Two Pollutant Models 

Warm days (≥20°C) 

Adjusted for PM10: 1.16 (1.08, 1.26) 

Adjusted for NO2: 1.02 (0.92, 1.13) 

Adjusted for O3: 1.25 (1.17, 1.34) 

Adjusted for SO2: 1.32 (1.22, 1.42) 

Cool days (<20°C) 

Adjusted for PM10: 1.09 (0.97, 1.21) 

Adjusted for NO2: 1.07 (0.92, 1.25) 

Adjusted for O3: 0.89 (0.80, 0.99) 

Adjusted for SO2: 1.03 (0.92, 1.16) 

CARDIOVASCULAR DISEASES – NON-SPECIFIC 

Author: Ballester et al. (2001, 

013257) 

Period of Study: 1994-1996 

Location: Valencia, Spain 

ED Visits 

Health Outcome (ICD9: CVD (390-

459); Heart diseases (410-414, 427, 

428); cerebrovascular disease (430-438)

Study Design: Time series 

Statistical Analyses: Poisson 

regression 

Age Groups Analyzed: All 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 6.2 mg/m3

Range (Min, Max): 0.6, 17.8 

Copollutant: correlation 

BS: r = 0.64 

NO2: r = 0.03 

SO2: r = 0.74 

O3: r = -0.26 

Increment: 1 mg/m3

RR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined (days): 0, 1, 2, 3, 4, 5 

All cardiovascular: 

Lag 2: 1.0077 (0.9912-1.0138) 

Heart Disease: 

Lag 1: 1.0092 (0.9945-1.0242) 

Cerebrovascular Disease: 

Lag 1: 0.9874 (0.9646-1.0107) 

Author: Ballester et al. (2006, 

088746) 

Period of Study: 1995-1999 

Location: 14 Cities in Spain 

Health Outcome 

(ICD9: All CVD (390-459);Heart 

diseases (410-414, 427, 428) 

Study Design: Time series 

Statistical Analyses: GAM 

Age Groups Analyzed: All 

Sample Description: NR 

Averaging Time: 8 h 

Mean (SD) unit: 

Range across 14 cities, 

1.4-2.8 mg/m3

Range (percentiles):

10th = 0.4-1.7; 90th = 2.0-3.9 

Copollutant: NR 

Increment: 1 mg/m3

% Change [Lower CI, Upper CI] 

Lags examined (days): 0-1 

All CVD: Lag 0-1: 2.06 (0.65-3.48) 

Heart Disease: Lag 0-1: 4.15 (1.31-7.08) 

Author: Barnett et al. (2006, 

089770) 

Period of Study: 1998-2001 

Location:

Brisbane, Canberra, 

Melbourne, Perth, Sydney 

Australia 

Auckland & Christchurch, New 

Zealand 

Hospital Admissions with 

CVDs 

Health Outcome (ICD9: Arrythmia 

(247); Cardiac Disease (390-429); 

Cardiac Failure (428); IHD (410-413); MI 

(410); Total CVD (390-459) 

Study Design: Case-crossover 

Statistical Analyses: Conditional logistic regression

Age Groups Analyzed: 

15-64 yr & ≥ 65 yr 

Sample Description: NR 

Averaging Time: 8 h 

Mean (SD) unit: ppm 

Brisbane: 1.7 

Canberra: 0.9 

Melbourne: 1.0 

Perth: 1.0 

Sydney: 0.8 

Auckland: 2.1 

Christchurch: 0.5 

Range (Min, Max): ppm 

Brisbane: 0.0, 7.0 

Canberra: 0.0, 5.8 

Melbourne: 0.1, 8.0 

Perth: 0.1, 4.0 

Sydney: 0.0, 4.5 

Auckland: 0.2, 7.9 

Christchurch: 0.0, 5.4 

Copollutant NR 

Increment: 0.9 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 0-1 

15-64 yr 

Arrythmia: 2.5 (0.1-4.9) 

Cardiac: 1.7 (0.5-2.9) 

Cardiac Failure: 4.2 (0.6-7.8) 

IHD: 1.6 (-0.6 to 3.9) 

MI: 1.8 (-0.7 to 4.3) 

Total CVD: 1.2 (0.3-2.1) 

≥ 65 yr 

Arrythmia: 0.1 (-1.8 to 2.1) 

Cardiac: 2.8 (1.3-4.4) 

Cardiac Failure: 6.0 (3.5-8.5) 

IHD: 2.3 (0.9-3.8) 

MI: 2.9 (0.8-4.9) 

Total CVD: 2.2 (0.9-3.4) 

January 2010 C-22 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Bell et al. (2009, 

193780) 

Period of Study: 1999-2005 

Location:

126 U.S. urban counties 

Hospital Admissions with 

CVDs 

Health Outcome (ICD9): Cardiac failure 

(428); cerebrovascular events (430-

438); heart rhythm disturbances (426-

427); ihd (410-414,429); peripheral 

vascular disease (440-448) 

Study Design: Time series 

Statistical Analyses: Log-linear overdispersed Poisson regression 

Age Groups Analyzed: ≥ 65 yr 

Sample Description: 

 >9.3 million Medicare subjects 

Averaging Time: 1 h 

Mean (SD) unit: 1.6 ppm 

Median (SD) unit: 1.3 ppm 

Median Range (Min, Max): 

 0.2, 9.7 

Copollutant: 

PM2.5: r = 0.26 

NO2: r = 0.56 

EC: r = 0.48 

Increment: 1 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 0-2 

Lag 0: 

Single pollutant model: 0.96 (0.79-1.12) 

Adjusted for PM2.5: 0.76 (0.57-0.96) 

Adjusted for NO2: 0.55 (0.36-0.74) 

Adjusted for EC: 0.97 (0.38-1.57) 

Author: Chang et al. (2005, 

080086) 

Period of Study: 1997-2001 

Location:

Taipei, Taiwan 

Health Outcome (ICD9): CVD Hospital 

Admissions (410-429) 

Study Design: Case-crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: All 

Sample Description:

74,509 CVD hospital admissions 

(47 Hospitals) 

Averaging Time: 24 h 

Mean (SD) unit: 1.37 ppm 

Range (Min, Max): 0.37, 3.66 

Copollutant: NR 

Increment: 0.49 ppm 

OR Estimate [Lower CI, Upper CI] 

Lag examined (days): 0-2 

≥ 20°C: 1.090 (1.064-1.118) 

<20°C: 0.984 (0.927-1.044) 

Adjusted for PM10: 

≥ 20°C: 1.171 (1.132-1.211) 

<20°C: 0.946 (0.892-1.003) 

Adjusted for SO2: 

≥ 20°C: 1.232 (1.194-1.272) 

<20°C: 1.098 (1.034-1.165) 

Adjusted for NO2: 

≥ 20°C: 1.048 (1.003-1.095 

<20°C: 0.983 (0.914-1.058) 

Adjusted for O3: 

≥ 20°C: 1.196 (1.161-1.232) 

<20°C: 1.092 (1.031-1.157) 

Author: Filhol. (2008, 190260) 

Period of Study:

January 2001-July 2003 

Location:

Sao Paulo, Brazil 

ED Visits 

Health Outcome (ICD10): Hypertension 

and Cardiac Ischemic Disease (I10-I25) 

Study Design: Time series 

Statistical Analyses: Linear Poisson 

regression models 

Age Groups Analyzed: >18 yr 

Sample Description: 45,000 

Cardiovascular emergency room visits 

from diabetic and non-diabetic patients 

(tertiary referral teaching hospital) 

Averaging Time: 8 h 

Mean (SD) unit: 2.7 ppm 

Range (Min, Max): 0.7, 12.1 

Copollutant: correlation 

PM10: r = 0.69 

NO2: r = 0.58 

SO2: r = 0.52 

O3: r = 0.07 

Increment: 1.2 ppm 

Regression Coefficients [SEM] 

Lags examined (days): 0, 1, 2 

CVD Visits/Diabetes: 

Lag 0: 0.0575 (0.0410) 

Lag 1: - 0.0056 (0.0418) 

Lag 2: -0.0324 (0.0426) 

2-day moving avg: 0.0324 (0.0470) 

3-day moving avg: 0.0074 (0.0528) 

4-day moving avg: -0.0025 (0.0582) 

CVD Visits/Non-Diabetes: 

Lag 0: 0.0286 (0.0095) 

Lag 1: 0.0098 (0.0091) 

Lag 2: 0.0102 (0.0089) 

2-day moving avg: 0.0271 (0.0108) 

3-day moving avg: 0.0281 (0.0120) 

4-day moving avg: 0.0306 (0.0131) 

Author: Fung et al. (2005, 

074322) 

Period of Study: 1995-2000 

Location:

Windsor, Ontario, 

Canada 

Hospital Admissions of 

CVDs 

Health Outcome (ICD9): CHF (428); 

IHD (410-414); dysrythmias (427) 

Study Design: Time series 

Statistical Analyses: GLM 

Age Groups Analyzed: All 

Sample Description:

11,632 Cardiac hospital admissions 

Averaging Time: 24 h 

Mean (SD) unit: 1.3 ppm 

Range (Min, Max): 0.0, 11.8 

Copollutant: correlation 

PM10: r = 0.21 

NO2: r = 0.38 

SO2: r = 0.16 

O3: r = 0.10 

Increment: 1.2 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 0, 0-1, 0-2 

<65 yr 

Lag 0: -3.1 (-7.4 to 1.4) 

Lag 0-1: -2.7 (-8.1 to 3.0) 

Lag 0-2: -0.5 (-6.7 to 6.0) 

≥ 65 yr 

Lag 0: 0.5 (-2.2 to 3.3) 

Lag 0-1: 2.3 (-1.1 to 5.9) 

Lag 0-2: 2.8 (-1.1 to 7.0) 

January 2010 C-23 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Jalaludin et al. (2006, 

189416) 

Period of Study: 

1997-2001 

Location:

Sydney, Australia 

ED Visits 

Health Outcome (ICD9): 

All cardiovascular (390-459); cardiac 

disease (390-429); IHD (410-413); 

cerebrovascular or stroke (430-438) 

Study Design: Time series 

Statistical Analyses: GLM & GAM 

Age Groups Analyzed: 65+ yr 

Sample Description: NR 

Averaging Time: 8 h 

Mean (SD) unit: 0.82 ppm 

Range (Min, Max): 0.02, 4.63 

Copollutant: correlation 

PM10: r = 0.31 

NO2: r = 0.71 

SO2: r = 0.51 

O3: r = 0.19 

Increment: 0.69 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2, 3, 0-1 

All Cardiovascular: 

Lag 0: 2.32 (1.45-3.19) 

Lag 1: 1.33 (0.47-2.20) 

Lag 0-1: 2.35 (1.39-3.32) 

Cardiac Disease: 

Lag 0: 2.52 (1.50-3.54) 

Lag 1: 1.85 (0.83-2.88) 

Lag 2: 1.11 (0.0-2.15) 

Lag 0-1: 2.85 (1.71-4.01) 

IHD: 

Lag 0: 2.83 (1.22-4.48) 

Lag 1: 1.58 (0.01-3.19) 

Lag 0-1: 2.86 (1.07-4.68) 

Stroke: No results were significant for 

Stroke. 

All CVD: 

Cool period: Lag 0: 3.26 (2.00-4.53) 

Cardiac Disease: 

Cool period: Lag 0: 3.43 (1.95-4.93) 

IHD: 

Cool period: Lag 0: 3.64 (1.28-6.06) 

Warm period: Lag 0: 2.29 (0.01-4.62) 

Stroke: 

Cool period: Lag 0: 3.54 (0.78-6.37) 

Notes: 

Cool: May to October 

Warm: November to April 

Author: Koken et al. (2003, 

049466) 

Period of Study: 1993-1997 

Location:

Denver, CO 

Hospital Admissions for CVD 

Health Outcome (ICD9: MI (410-

410.92); coronary atherosclerosis 

(414-414.05); pulmonary heart disease 

(416-416.9); cardiac dysrythmia 

(427-427.9); CHF (428) 

Study Design: Time series 

Statistical Analyses: GLM 

Age Groups Analyzed: >65 yr 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 0.9 ppm 

Range (Min, Max): 0.3, 1.6 

Copollutant: correlation 

PM10: r = 0.25 

NO2: r = 0.73 

SO2: r = 0.21 

O3: r = -0.40 

Increment: 0.3 ppm 

% Change [Lower CI, Upper CI] 

Lags examined (days): 1, 2, 3, 4 

CHF: Lag 3: 10.5 (0.1-22.0) 

CO not significantly associated with other 

Lag periods. 

Author: Linn et al. (2000, 

002839) 

Period of Study: 1992-1995 

Location:

Los Angeles, CA 

Health Outcome: 

Hospital Admissions for Cardiovascular, 

Cerebrovascular, Pulmonary. 

Study Design: Time series 

Statistical Analyses: 

Ordinary least squares regression; 

Poisson regression 

Age Groups Analyzed: >30 yr 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 

Winter: 1.7; Spring: 1.0; 

Summer: 1.2; Fall: 2.1 

Range (Min, Max):

Winter: 0.5, 5.3; Spring: 0.4, 2.2; 

Summer: 0.3, 2.7; Fall: 0.2, 4.3 

Copollutant: correlation

Winter: 

PM10: r = 0.78; NO2: r = 0.89; 

O3: r = -0.43; 

Spring: 

PM10: r = 0.54; NO2: r = 0.92; 

O3: 0.29 

Summer: 

PM10: r = 0.72; NO2: r = 0.94; 

O3: 0.03 

Fall: 

PM10: r = 0.58; NO2: r = 0.84; 

O3: r = -0.36 

Increment: 1 ppm 

Co-efficient [SE] 

Lags examined (lags): 0, 1 

Lag 0: 

Cardiovascular 

All: 0.032 (0.003)* (e.g. 3.2% increase) 

Winter: 0.038 (0.006)* 

Spring: 0.010 (0.015) 

Summer: 0.035 (0.014)* 

Fall: 0.027 (0.006)* 

Cerebrovascular 

All: 0.009 (0.007) 

Winter: -0.008 (0.014) 

Spring: 0.107 (0.033)* 

Summer: 0.030 (0.033) 

Fall: 0.008 (0.012) 

MI 

All: 0.040 (0.009) * 

CHF 

All: 0.025 (0.009)* 

Cardiac Arrythmia 

All: 0.023 (0.009)* 

Stroke 

All: 0.044 (0.009)* 

Notes:* p < 0.05 

January 2010 C-24 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Metzger et al. (2004, 

044222) 

Period of Study: 1993-2000 

Location:

Atlanta, GA 

ED Visits (from 31 hospitals) 

Health Outcome (ICD9:

Cardiovascular: 

IHD (410-414); Acute MI (410); 

Dysrythmia (427); Cardiac Arrest 

(427.5); CHF (428); Peripheral Vascular 

& Cereberovascular Disease (PVCD) 

(433-437, 440, 443, 444, 451-453); 

Atherosclerosis (440); Stroke (436) 

Study Design: Case-crossover 

Statistical Analyses: Poisson regression (GLM) 

Age Groups Analyzed: All 

Sample Description: 4,407,535 visits 

Averaging Time: 1 h 

Median (SD) unit: 1.5 ppm 

Range (percentiles):

10th = 0.5; 90th = 3.4 

Copollutant: correlation 

PM10: r = 0.47 

NO2: r =0.68 

SO2: r =0.26 

O3: r =0.20 

 

Increment: 1 ppm 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0-2ma 

All CVD: 1.017 (1.008-1.027) 

Dysrythmia: 1.012 (0.993-1.031) 

CHF: 1.010 (0.988-1.032) 

IHD: 1.016 (0.999-1.034) 

PVCD: 1.031 (1.010-1.052) 

Author: Peel et al. (2007, 

090442) 

Period of Study: 1993-2000 

Location:

Atlanta, GA 

ED Visits (from 31 hospitals) 

Health Outcome (ICD9:

Cardiovascular: 

IHD (410-414); Dysrythmia (427); CHF 

(428); PVCD (433-437, 440, 443, 444, 

451-453) 

Study Design: Case-crossover 

Statistical Analyses: Conditional 

logistic regression 

Age Groups Analyzed: All 

Sample Description: 4,407,535 visits 

Averaging Time: 1-h 

Mean (SD) unit: 1.8 ppm 

Range (SD): SD: 1.2 

Copollutant: NR 

Increment: 1.2 ppm 

OR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0-2ma 

IHD: 

Without Diabetes: 1.023 (1.004-1.420) 

Without CHF: 1.024 (1.006-1.042) 

Dysrythmias: 

With Hypertension: 1.065 (1.015-1.118) 

PVCD: 

With Hypertension: 1.038 (1.004-1.074) 

Without Hypertension: 1.027 (1.002-1.054)

With Diabetes: 1.065 (1.012-1.121) 

Without Diabetes: 1.025 (1.003-1.048) 

With COPD: 1.113 (1.027-1.205) 

Without COPD: 1.026 (1.004-1.047) 

Without CHF: 1.029 (1.008-1.051) 

With Dysrythmias: 1.072 (1.011-1.138) 

Without Dysrythmias: 1.026 (1.004-1.048) 

CHF: With COPD: 1.058 (1.003-1.115) 

Author: Slaughter et al. (2005, 

073854) 

Period of Study: 1995-2001 

Location:

Spokane, WA 

Health Outcome (ICD9: Cardiac Hospital 

Admissions: (390-459) 

Study Design: Time series 

Statistical Analyses: 

Poisson regression (GLM & GAM) 

Age Groups Analyzed: All 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 0.42-1.82 

Range (Min, Max): NR 

Copollutant correlation:

PM10: r = 0.32 

PM2.5: r = 0.62 

Increment: NR 

RR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined (days): 1, 2, 3 

No significant association. Results not 

reported. 

Author: Tolbert et al. (2007, 

090316) 

Period of Study: 1993-2004 

Location:

Atlanta, GA 

ED Visits (from 41 hospitals) 

Health Outcome (ICD9): IHD (410-

414), cardiac dysrhythmias (427), CHF 

(428), peripheral vascular and 

cerebrovascular diseases (433-437, 

440, 443-445 and 451-453) 

Study Design: Time series 

Statistical Analyses: Poisson 

generalized linear model 

Age Groups Analyzed: NR 

Sample Description: 10,234,490 ED 

Visits (238,360 CVD group) 

Averaging Time: 1 h 

Mean (SD) unit: 1.6 ppm 

Range (Min, Max): 0.1, 7.7 

Copollutant: 

PM10: r = 0.51 

NO2: r =0.70 

SO2: r =0.28 

O3: r =0.27 

PM2.5: r = 0.47 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 1, 2, 3 

Single-Pollutant Model 

3-day ma: 1.020 (1.010, 1.030) 

Results for multi-pollutant models presented 

graphically 

January 2010 C-25 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Yang et al. (2004, 

094376) 

Period of Study: 1997-2000 

Location:

Kaohsiung City, Taiwan 

Health Outcome (ICD9: 

CVDs (410-429) 

Study Design: Case-crossover 

Statistical Analyses: Conditional 

logistic regression 

Age Groups Analyzed: All 

Sample Description: 

29,661 Cardiovascular hospital 

admissions (63 hospitals) 

Averaging Time: 24 h 

Mean (SD) unit: 0.79 ppm 

Range (Min, Max): 0.24, 1.72 

Copollutant: NR 

Increment: 0.28 ppm 

OR Estimate [Lower CI, Upper CI] 

Lag examined (days): 0-2 

≥ 25°C: 1.264 (1.205-1.326) 

<25°C: 1.448 (1.357-1.545) 

Adjusted for PM10: 

≥ 25°C: 1.206 (1.146-1.270) 

<25°C: 1.314 (1.213-1.423) 

Adjusted for SO2: 

≥ 25°C: 1.406 (1.327-1.489) 

<25°C: 1.3450 (1.352-1.555) 

Adjusted for NO2: 

≥ 25°C: 1.246 (1.166-1.332) 

<25°C: 0.905 (0.819-0.999) 

Adjusted for O3: 

≥ 25°C: 1.250 (1.191-1.311) 

<25°C: 1.447 (1.356-1.545) 

Table C-3. Studies of CO exposure and neonatal and postneonatal outcomes. 

Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Bell et al. (2007, 

091059) 

Period of Study: 1999-2002 

Location:

Connecticut and 

Massachusetts 

Health Outcome: 

Birth weight and LBW 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

358,504 full-term live 

singleton births (32-44 wk) 

Averaging Time: 24 h 

Mean (SD) unit: 

0.65 ppm (0.18) 

Range (Min, Max): NR 

Copollutant: NR 

Increment: Interquartile range – 0.30 ppm 

Regression co-efficient for birth weight (g) [Lower 

CI, Upper CI] 

Entire pregnancy: -16.2 (-19.7 to -12.6) 

Stratified by race. 

Black mother: -10.9 (-20.2 to -1.6) 

White mother: -17.5 (-21.3 to -13.7) 

OR for LBW [Lower CI, Upper CI] 

Entire pregnancy: 1.028 (0.983-1.074) 

Author: Brauer et al. (2008, 

156292) 

Period of Study: 1999-2004 

Location:

Vancouver, Canada 

Health Outcome: LBW, 

PTB and SGA 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

70,249 live singleton births 

Averaging Time: LUR model 

Mean (SD) unit: 633 μg/m3

Range (Min, Max): 

124, 1409 

Copollutant: correlation: 

PM10: r = 0.73 

NO2: r = 0.75 

SO2: r = 0.82 

O3: r = -0.39 

Increment: 100 μg/m3

OR for SGA [Lower CI, Upper CI] ; 

Entire pregnancy: 1.06 (1.03-1.08) 

OR for term LBW [Lower CI, Upper CI] ; 

Entire pregnancy: 1.02 (0.96-1.09) 

OR PTB [Lower CI, Upper CI] ; 

Entire pregnancy: 1.16 (1.01-1.33) 

Author: Chen et al. (2002, 

024945) 

Period of Study: 1991-1999 

Location:

Northern Nevada 

Health Outcome:

Birth weight & LBW 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

39,338 full term live 

singleton births (37-44 wk) 

Averaging Time: 8 h 

Mean (SD) unit: 0.98 ppm 

Range (Min, Max): 0.25, 4.87 

Copollutant: NR 

Increment: NR 

Regression co-efficient for birth weight (g) [SE] 

Trimesters: 

First: -1.02 (6.68) 

Second: -0.07 (6.58) 

Third: -3.95 (6.76) 

Entire pregnancy: -8.28 (14.9) 

Notes: CO not associated with LBW 

January 2010 C-26 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Conceicao et al. 

(2001, 016628) 

Period of Study: 1994-1997 

Location:

Sao Paulo, Brazil 

Health Outcome: Child 

mortality, under 5 yr of age 

Study Design: Time series 

Statistical Analyses: 

Poisson regression (GAM) 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 

4.4 ppm (2.2) 

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: NR 

Regression co-efficient for Child mortality – 

under 5 yr of age [SE] ; 

Lags examined: 0, 1, 2, 3 

Lag 2: 0.0306 (0.0076) (p < 0.01) 

Lag chosen for best fitting model 

Author: Gilboa et al. (2005, 

087892) 

Period of Study: 1997-2000 

Location:

Texas 

Health Outcome: 

Birth defects (heart defects 

and orofacial clefts) 

Study Design: Case control

Statistical Analyses: 

Conditional Logistic 

regression 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: Exposure categories (ppm):<0.4; 0.4 – 

0.5; 0.5 – 0.7; >0.7 

OR for Birth Defects [Lower CI, Upper CI] ; 

Exposure period: wk 3 to 8 of pregnancy 

Conotruncal defects: 

1.00; 1.38 (0.97-1.97); 1.17 (0.81-1.70); 1.46 

(1.03-2.08) 

Tetralogy of Fallot: 

1.00; 0.92 (0.52-1.62); 1.27 (0.75-2.14); 2.04 

(1.26-3.29) 

Notes: CO was not associated with the following 

defects: Aortic artery and valve, atrial septal, 

pulmonary artery and valve, ventricular septal, 

endocardial cushion and mitral valve , cleft lip, cleft 

palate, aortic valve stenosis, coarctation of the 

aorta, ostium secundum. 

Author: Gouveia et al. (2004, 

055613) 

Period of Study: 1997 

Location:

Sao Paulo, Brazil 

Health Outcome:

Birth weight & LBW 

Study Design:

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

179,460 live singleton term 

births (>37 wk) 

Averaging Time: 8 h 

Mean (SD) unit: 3.7 ppm 

Range (Min, Max): 

1.1, 11.4 

Copollutant: NR 

 

Increment: 1 ppm 

Regression co-efficient for birth weight (g) [Lower 

CI, Upper CI] 

Trimesters: 

First: -23.1 (-41.3 to -4.9) 

Second: 3.2 (-18.2 to 24.5) 

Third: 1.9 (-18.2 to 22.0) 

OR for LBW ) [Lower CI, Upper CI] 

4th quartile exposure (compared to lowest quartile): 

First: 1.02 (0.82-1.27); Second: 1.07 (0.88-1.30); 

Third: 0.93 (0.76-1.12) 

Author: Ha et al. (2001, 

019390) 

Period of Study: 1996-1997 

Location:

Seoul, South Korea 

Health Outcome: 

LBW 

Study Design:

Retrospective cohort 

Statistical Analyses: 

Logistic regression (GAM) 

Age Groups Analyzed: NA 

Sample Description:

276 763 full-term live 

singleton births (>37 wk) 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max):

Percentiles: 

25th: 0.99 ppm 

75th: 1.41 ppm 

Copollutant correlation: 

TSP: r = 0.73 

NO2: r = 0.75 

SO2: r = 0.82 

O3: r = -0.39 

Increment: 0.42 ppm 

RR for LBW [Lower CI, Upper CI] 

Trimesters: 

First: 1.08 (1.04, 1.12) 

Third: 0.91 (0.87, 0.96) 

Author: Ha et al. (2003, 

042552) 

Period of Study: 1995-1999 

Location:

Seoul, South Korea 

Health Outcome:

 Post-neonatal mortality 

(1 mo-1 yr) (also looked at 

older age groups) 

Study Design: Time series 

Statistical Analyses: 

Poisson regression (GAM) 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 1.2 ppm 

Range (Min, Max): 0.39, 3.38 

Copollutant correlation: 

PM10: r = 0.63 

NO2: r = 0.72 

SO2: r = 0.75 

O3: r = -0.46 

Increment: 0.57 ppm 

RR for Post–neonatal mortality (1 mo-1 yr) 

[Lower CI, Upper CI] 

Lags examined: 0 

Total mortality: 

Lag 0: 1.020 (0.976-1.067) 

Respiratory mortality: 

Lag 0: 1.388 (1.009-1.911) 

January 2010 C-27 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Hajat et al. (2007, 

093276) 

Period of Study: NR 

Location: 

Birmingham, Bristol, Leeds, 

Liverpool, London, 

Manchester, Middlesbrough, 

Newcastle, Nottingham, 

Sheffield 

England 

Health Outcome: Neonatal 

and postneonatal mortality 

Study Design: Time series 

Statistical Analyses:

Poisson regression (GLM) 

Age Groups Analyzed: NA 

Sample Description:

22,288 total infant deaths 

between 1990 and 2000 

Averaging Time: 3 days 

Mean (SD) unit: (mg/m3) 

Birmingham: 0.64; Bristol: 1.01; Leeds: 

0.73; Liverpool: 0.51; London: 0.77; 

Manchester: 0.63; Middlesbrough: 0.37; 

Newcastle: 0.67; Nottingham: 0.62; 

Sheffield: 0.60 

Range (Min, Max):

Birmingham: 0.4, 0.8; Bristol: 0.6, 1.2; 

Leeds: 0.5, 0.9; Liverpool: 0.3, 0.6; 

London: 0.5, 0.9; Manchester: 0.4, 0.7; 

Middlesbrough: 0.2, 0.4; Newcastle: 0.5, 

0.8; Nottingham: 0.4, 0.7; Sheffield: 0.3, 

0.7 

Copollutant: SO2, NO2, NO, O3, PM10 

Increment: 1 mg/m3

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0, 1, 2 

All infant deaths: 1.02 (0.96, 1.09) 

Neonatal deaths: 0.99 (0.92, 1.07) 

Post-neonatal deaths: 1.09 (0.94, 1.25) 

City-specific results of all infant mortality displayed 

graphically 

Author: Huynh et al. (2006, 

091240) 

Period of Study: 1999-2000 

Location:

California 

Health Outcome:

PTB (24-36 wk gestation) 

Study Design: Case-control

Statistical Analyses:

Conditional Logistic 

regression 

Age Groups Analyzed: 

Cases = 24- to 36-wk 

gestation; Controls = 39- to 

44-wk 

Sample Description:

10,673 PTBs (cases); 

32,119 term births (controls) 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: 1 ppm 

Exposure level – Quartiles of exposure for first mo 

and last two wk of gestation (mg/m3

) 

First: <0.61; Second: 0.61 – 0.82; Third: 0.82 – 

1.07; 

Fourth: >1.07 

Quartiles for entire pregnancy and last two wk of 

pregnancy were similar. 

OR for PTB [Lower CI, Upper CI] 

First mo of gestation: 

Per 1 ppm increase: 1.10 (0.99-1.20) 

Second quartile: 0.94 (0.88-1.01) 

Third quartile: 1.04 (0.97-1.11) 

Fourth quartile: 1.05 (0.96-1.14) 

Last two wk of gestation: 

Per 1 ppm increase: 1.00 (0.93-1.09) 

Second quartile: 1.03 (0.97-1.10) 

Third quartile: 1.04 (0.97-1.12) 

Fourth quartile: 0.99 (0.91-1.08) 

Entire pregnancy: 

Per 1 ppm increase: 1.06 (0.95-1.18) 

Second quartile: 0.97 (0.91-1.04) 

Third quartile: 0.99 (0.92-1.05) 

Fourth quartile: 1.02 (0.94-1.09) 

Lowest quartile used as reference group 

Author: Hwang and Jaakkola 

(2008, 193794) 

Period of Study: 2001-2003 

Location: Taiwan 

Health Outcome: Oral clefts 

(with or without palate) 

Study Design: Case control

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description: 

6,530 cases from 721,289 

newborns 

Averaging Time: 8 h 

Mean (SD) unit: 0.69 (0.4) 

Range (Min, Max): 0.25, 2.7 

Copollutant correlation: PM10: r = -

0.19 

NOX: r = 0.82 

SO2: r = 0.24 

O3: r = -0.19 

Increment: 100 ppb 

RR for oral cleft [Lower CI, Upper CI] 

Month 1: 1.00 (0.96-1.04) 

Month 2: 1.00 (0.96-1.03) 

Month 3: 1.00 (0.96-1.03) 

Author: Jalaludin et al. 

(2007, 156601) 

Period of Study: 1998-2000 

Location:

Sydney, Australia 

Health Outcome: PTB 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

123,840 full term live 

singleton births (<42 wk) 

Averaging Time: 8 h 

Mean (SD) unit: 0.9 ppm (0.68) 

Range (Min, Max): NR 

Copollutant correlation: PM10: r = 0.28

NO2: r = 0.60 

SO2: r = 0.24 

O3: r = -0.21 

Increment: 1 ppm 

RR for PTB [Lower CI, Upper CI] 

First mo: 

All of Sydney: 0.89 (0.84-0.95) 

Within 5km of site: 1.03 (0.68-1.54) 

First trimester: 

All of Sydney: 0.77 (0.71-0.83) 

Within 5km of site: 1.24 (0.81-1.91) 

1 mo prior to birth: 

All of Sydney: 0.96 (0.88-1.04) 

Within 5km of site: 1.00 (0.86-1.15) 

3 mo prior to birth: 

All of Sydney: 0.99 (0.90-1.09) 

Within 5km of site: 1.11 (0.94-1.31) 

January 2010 C-28 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Lee et al. (2003, 

043202) 

Period of Study: 

1996-1998 

Location:

Seoul, South Korea 

Health Outcome:

LBW 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description: 

388,105 full-term live 

singleton births (37-44 wk) 

Averaging Time: 24 h 

Mean (SD) unit: 1.2 ppm 

Range (Min, Max): 0.4, 3.4 

Copollutant correlation: 

PM10: r = 0.47 

NO2: r = 0.77 

SO2: r = 0.79 

Increment: 0.5 ppm 

OR for LBW [Lower CI, Upper CI] 

First: 1.04 (1.01-1.07) 

Second: 1.03 (1.00-1.06) 

Third: 0.96 (0.93-0.99) 

Entire pregnancy: 1.05 (1.01-1.09) 

Author: Leem et al. (2006, 

089828) 

Period of Study: 2001-2002 

Location:

Incheon, Korea 

Health Outcome: 

PTB 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

52,113 live singleton births 

Averaging Time: 

Kriging was used to estimate exposure 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant correlation: 

PM10: r = 0.27 

NO2: r = 0.63 

SO2: r = 0.31 

 

Increment:

Exposure level – Quartiles of exposure for first 

trimester (mg/m3) 

First: 0.47-0.63; Second: 0.6 -0.77; 

Third: 0.78-0.90; Fourth: 0.91-1.27 

- exposure groups for third trimester was similar 

OR for PTB [Lower CI, Upper CI] 

First Trimester: 

Second quartile: 0.92 (0.81-1.05) 

Third quartile: 1.14 (1.01-1.29) 

Fourth quartile: 1.26 (1.11-1.44) 

Third Trimester: 

Second quartile: 1.07 (0.95-1.21) 

Third quartile: 1.07 (0.94-1.22) 

Fourth quartile: 1.16 (1.01-1.34) 

Lowest quartile used as reference group. 

Author: Lin et al. (2004, 

095787) 

Period of Study: 1998-2000 

Location:

Sao Paulo, Brazil 

Health Outcome: 

Neonatal death (within first 

28 days of life) 

Study Design: Time series 

Statistical Analyses: 

Poisson regression (GAM) 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 2.83 ppm 

Range (Min, Max): 0.54, 10.25 

Copollutant correlation:

PM10: r = 0.71 

NO2: r = 0.67 

SO2: r = 0.55 

O3: r = 0.03 

Increment: NR 

Regression coefficent for neonatal death [SE] 

Lags examined: 0 

Lag 0: 0.0061 (0.0110) 

Author: Lin et al. (2004, 

089503) 

Period of Study: 1995-1997 

Location:

Taipei & Kaoshiung, Taiwan 

Health Outcome:

LBW 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description: 

92,288 full-term live 

singleton births (>37 wk) 

within 3 km of monitoring 

site. 

Averaging Time: 24 h 

Mean (SD) unit:

Taipei (avg over 5 sites) 

0.84-1.31 

Kaohsiung (avg over 5 sites) 

5.56-10.05 

Range (Min, Max): NR 

Copollutant: NR 

Increment: Exposure groups 

M = Median exposure 1.1-14.2 ppm 

H = High exposure >14.2 ppm 

OR for LBW [Lower CI, Upper CI] 

Trimesters: 

First: M 1.01 (0.89, 1.16), H 0.90 (0.75, 1.09) 

Second: M 1.02 (0.90, 1.16), H 1.00 (0.82, 1.22) 

Third: M 0.88 (0.77, 1.00), H 0.86 (0.71, 1.03) 

Entire pregnancy: 

M 0.89 (0.77, 1.01), H 0.77 (0.63, 0.94) 

Notes: Cut off for exposures groups for second and 

third trimester were similar to those presented 

above. 

January 2010 C-29 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Liu et al. (2003, 

089548) 

Period of Study: 1985-1998 

Location:

Vancouver, BC, Canada 

Health Outcome:

PTB, IUGR, LBW 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

229,085 live singleton births 

Averaging Time: 24 h 

Mean (SD) unit: 1.0 ppm 

Range (Min, Max): 25th: 0.7; 75th: 1.2 

Copollutant: NR 

 

Increment: 1.0 ppm 

OR for LBW [Lower CI, Upper CI] 

Month of pregnancy: 

First mo: 1.01 (0.93-1.09) 

Last mo: 0.96 (0.88-1.04) 

OR for PTB [Lower CI, Upper CI] 

First mo: 0.95 (0.89-1.01) 

Last mo: 1.08 (1.01-1.15) 

OR for IUGR [Lower CI- Upper CI] 

First mo: 1.06 (1.01-1.10) 

Last mo: 0.98 (0.94-1.03) 

Trimester 1: 1.05 (1.00-1.10) 

Trimester 2: 0.97 (0.92-1.01) 

Trimester 3: 0.97 (0.93-1.02) 

Author: Liu et al. (2007, 

090429) 

Period of Study: 1995-2000 

Location:

Calgary, Edmonton, 

and Montreal, Canada 

Health Outcome: IUGR 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

386,202 live singleton births 

Averaging Time: 24 h 

Mean (SD) unit: 1.1 ppm 

Range (Min, Max): 25th: 0.6; 75th: 1.3 

Copollutant correlation: 

PM2.5: r = 0.31 

NO2: r = 0.71 

SO2: r = 0.21 

O3: r = -0.42 

Increment: 1 ppm 

RR for LBW [Lower CI, Upper CI] 

Notes: CO was associated with an increased risk 

of IUGR of approximately 16% and 23% in the first 

and nine mo of pregnancy. 

(All results presented in Figures) 

Author: Maisonet et al. 

(2001, 016624) 

Period of Study: 1994-1996 

Location:

Northeastern USA 

Health Outcome: 

Live birth weight 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

89,557 live singleton term 

births (37-44 wk) 

Averaging Time: 24 h 

Mean (SD) unit: NR 

Range (Min, Max):

Percentiles: 

25th: 0.93 ppm; 75th: 1.23 ppm 

Copollutant: NR 

Increment: 1 ppm 

OR for LBW [Lower CI, Upper CI] 

Trimester: 

First: 1.08 (0.91-1.28); Second: 1.14 (0.83-1.58); 

Third: 1.31 (1.06-1.62) 

Stratified results among African-Americans: 

First: 1.43 (1.18-1.74); Second: 1.27 (0.87-1.86); 

Third: 1.75 (1.50-2.04) 

Notes: CO had no effect on whites or Hispanics 

Author: Mannes 

et al. (2005, 087895) 

Period of Study: 1998-2000 

Location:

Sydney, Australia 

Health Outcome:

Birth weight and SGA 

Study Design:

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

138,056 full-term all 

singleton births (including 

stillbirths) (at least 20-wk 

gestation) 

Averaging Time: 8 h 

Mean (SD) unit: 0.8 ppm 

Range (Min, Max): 0.0, 4.6 

Copollutant: correlation

PM10: r = 0.26 

NO2: r = 0.57 

O3: r = -0.20 

 

Increment: 1 ppm 

Regression coefficients for birth weight (g) [Lower 

CI, Upper CI] 

All births: 

First trimester: 1.86 (-8.31 to 12.03) 

Second trimester: -10.72 (-23.09 to 1.65) 

Third trimester: -6.63 (-18.57 to 5.31) 

One mo prior to birth: -15.28 (-25.59 to -4.97) 

Births within 5 km of monitor: 

First trimester: -8.56 (-28.60 to 10.68) 

Second trimester: -28.87 (-50.98 to -6.76) 

Third trimeste: -22.88 (-44.58 to -1.18) 

One mo prior to birth: -10.41 (-30.03 to 9.21) 

OR for SGA [Lower CI, Upper CI] 

All births: 

First trimester: 0.95 (0.88-1.04) 

Second trimester: 0.99 (0.90-1.10) 

Third trimester: 1.01 (0.91-1.11) 

One mo prior to birth: 1.06 (0.98-1.16) 

Births within 5km of monitor: 

First trimester 0.99 (0.86-1.14) 

Second trimester: 1.06 (0.90-1.25) 

Third trimester: 1.05 (0.90-1.23) 

One mo prior to birth: 1.10 (0.96-1.27) 

January 2010 C-30 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Medeiros et al. 

(2005, 089824) 

Period of Study: 1998-2000 

Location:

Sao Paulo, Brazil 

Health Outcome: Birth 

weight and LBW 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

311,735 full-term live 

singleton births (37-41 wk) 

Averaging Time: 24 h 

Mean (SD) unit:

Daily mean shown in Figure (see paper)

Range (Min, Max): NR 

Copollutant: NR 

Increment: 1 ppm 

Regression coefficient for birth weight (g) 

[Lower CI, Upper CI] 

Trimesters: 

First: -11.9 (-15.5 to -8.2); Second: 4.9 (0.5-9.3); 

Third: 12.1 (7.6-16.6) 

OR for LBW [Lower CI, Upper CI] 

4th quartile exposure (compared to lowest quartile)

First: 0.98 (0.91-1.06); Second: 0.97 (0.90-1.05); 

Third: 1.03 (0.96-1.11) 

Author: Mortimer et al. 

(2008, 187280) 

Period of Study: 

November 2000-April 2005 

Location: Central Valley of 

Californinia 

Health Outcome: Allergic 

sensitization 

Study Design: Cohort 

Statistical Analyses: Chisquare tests 

Age Groups Analyzed: 

6-11 yrs. 

Sample Description: 170 

children with asthma from 

the FACES-LiTE study 

Averaging Time: 8 h 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

Entire Prenatal: 

PM10: r = 0.32 

NO2: r = 0.74 

O3: r = -0.40 

Trimester 2: 

PM10: r = 0.32 

NO2: r = 0.68 

O3: r = -0.26 

 

Increment: NR 

Trimester specific results presented graphically 

Single-pollutant Model for “sensitized to at least 

one outdoor allergen” 

OR adjusted for yr of birth and sex [Lower CI, 

Upper CI] 

Entire Pregnancy 

24-h avg: 1.45 (1.02, 2.07) 

Daily max: 1.53 (1.01, 2.33) 

8-h max: 1.55 (1.01, 2.37) 

2nd Trimester 

24-h avg: 1.52 (0.93, 2.47) 

Daily max: 1.50 (0.92, 2.45) 

8-h max: 1.45 (0.90, 2.35) 

Coefficient adjusted for yr of birth and sex [SE] 

Entire Pregnancy 

24-h avg: 1.33 (0.68) 

Daily max:0.54 (0.27) 

8-h max: 0.84 (0.42) 

2nd Trimester 

24-h avg: 0.57 (0.34) 

Daily max: 0.21 (0.13) 

8-h max: 0.32 (0.21) 

Author: Parker et al. (2005, 

087462) 

Period of Study: 2000 

Location:

California 

Health Outcome:

Birth weight & SGA 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

18,247 full-term live 

singleton births (40 wk) 

within 5 mi of a monitor 

Averaging Time: 24 h 

Mean (SD) unit: 0.78 ppm 

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: Quartiles of exposure for first trimester 

First: <0.57; Second: 0.57-0.76 ; 

Third: 0.76- 0.93; Fourth: >0.93 

- exposure groups for other trimesters were similar 

Regression co-efficient for birth weight (g) [Lower 

CI, Upper CI] 

Trimesters: 

4th quartile exposure (compared to lowest quartile)

First: -7.3 (-29.7 to 15.0); Second: 14.2 (-8.9 to 

37.3); 

Third: -8.4 (-32.2 to 15.3); 

Entire pregnancy: -20.5 (-40.1 to -0.8) 

OR for SGA [Lower CI, Upper CI] 

4th quartile exposure (compared to lowest quartile)

First: 0.91 (0.76-1.09); Second: 0.80 (0.66-0.97); 

Third: 0.90 (0.75-1.10); 

Entire pregnancy: 0.95 (0.81-1.12) 

January 2010 C-31 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Ritz et al. (2000, 

012068) 

Period of Study: 1989-1993 

Location:

Southern California 

Health Outcome: PTB 

Study Design: 

Retrospective Cohort 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: 

Eligible study subjects were 

singletons born at 26- to 

44-wk gestation 

Sample Description:

97,518 neonates born in 

Southern California 

Averaging Time: 6-9 a.m. 

Mean (SD) unit: 2.70 ppm 

Range (Min, Max): 

0.36, 9.12 

Copollutant correlation: 

PM10: r = 0.37 

NO2: r = 0.60 

O3: r = -0.44 

Increment: 3 ppm 

RR for PTB [Lower CI, Upper CI] 

Adjusted for various risk factors and season of birth 

and conception 

6 wk prior to birth: 1.04 (0.99-1.10) 

1st mo of pregnancy: 1.04 (0.99-1.09) 

Adjusted for various risk factors 

6 wk prior to birth: 1.06 (1.02-1.10) 

1st mo of pregnancy: 1.01 (0.97-1.04) 

Author: Ritz et al. (2002, 

023227) 

Period of Study: 1987-1993 

Location:

Southern California 

Health Outcome:

Birth defects (heart defects 

and orofacial clefts) 

Study Design: Case control

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: Exposure categories: ppm 

<1.14; 1.14-1.57; 1.57- 2.39; >2.39 

OR for Birth defects [Lower CI, Upper CI]:

Period of exposure: Second mo of pregnancy. 

Aortic artery and valve defects: 

1.00 (ref group); 1.10 (0.73-1.66); 1.25 (0.74-2.13); 

0.93 (0.47-1.85) 

Pulmonary artery and valve anomalies: 

1.00 (ref group); 1.09 (0.69-1.73); 0.92 (0.50-1.70); 

1.00 (0.46-2.17) 

Ventricular septal defects: 

1.00 (ref group); 1.62 (1.05-2.48); 2.09 (1.19-3.67); 

2.95 (1.44-6.05) 

Conotruncal defects: 

1.00 (ref group); 0.79 (0.47-1.32); 0.73 (0.36-1.47); 

0.95 (0.38-2.38) 

Notes: Results also presented for more specific 

defects, however CO showed no association (see 

paper Table 3.). CO not associated with orofacial 

clefts) 

Author: Ritz et al. (2006, 

089819) 

Period of Study: 1989-2000 

Location:

Southern California 

Health Outcome:

Postneonatal mortality 

(28 days to 1 yr); all causes; 

SIDS 

Study Design: Case control

Statistical Analyses: 

Conditional Logistic 

regression 

Sample Description:

Mothers residing within 

16 km of monitoring site 

Averaging Time: 24 h 

Mean (SD) unit: 1.63 ppm 

Range (Min, Max): 

0.38, 3.44 

Copollutant: correlation 

PM10: r = 0.33 

NO2: r = 0.72 

O3: r = -0.57 

Increment: 1 ppm 

OR for Post-neonatal death [Lower CI, Upper CI] 

Exposure period: 2 wk prior to death, 1 mo prior to 

death, 2 mo prior to death, 6 mo prior to death 

All causes: 

2 wk prior to death: 1.14 (1.03-1.25) 

2 mo prior to death: 1.11 (1.06-1.16) 

SIDS: 

2 mo prior to death: 1.19 (1.10-1.28) 

Term/normal weight births 

2 mo prior to death: 

All causes: 1.12 (1.05-1.19) 

SIDS: 1.17 (1.07-1.29) 

Respiratory: 1.14 (0.95-1.36) 

Preterm &/or LBW births 

2 mo prior to death: 

All causes: 1.12 (1.01-1.25) 

SIDS: 1.46 (1.09-1.94) 

Respiratory: 1.03 (0.83-1.27) 

Notes: These results did not persist in multipollutant 

models (CO, NO2, PM10, O3) 

January 2010 C-32 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Ritz et al. (2007, 

096146) 

Period of Study: 

January-December 2003 

Location:

Los Angeles, CA 

Health Outcome: PTB 

Study Design: 

Nested case-control 

Statistical Analyses: 

Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

A survey of 2,543 of 6,374 

women sampled from a 

cohort of 58,316 eligible 

births in Los Angeles county.

Averaging Time: 24 h 

Mean (SD) unit: NR 

Copollutant correlation: 

TSP: r = 0.73 

NO2: r = 0.75 

SO2: r = 0.82 

O3: r = -0.39 

Increment: Exposure categories (ppm):

Less than 0.58: 0.59-0.91; 0.92-1.25; >1.25 

RR for LBW [Lower CI, Upper CI] 

First trimester: 

1.00 (Ref group); 1.17 (1.08-1.26); 1.15 (1.05-1.26); 

1.25 (1.12-1.38) 

6 wk prior to birth 

1.00 (Ref group); 1.00 (0.93-1.08); 1.08 (0.98-1.20); 

1.03 (0.93-1.14) 

Entire pregnancy: 

1.00 (Ref group); 0.76 (0.70-0.82); 0.84 (0.77-0.91); 

1.03 (0.91-1.17) 

Author: Salam et al. (2005, 

087885) 

Period of Study: 1975-1987 

Location:

California 

Health Outcome: Birth 

weight, LBW , IUGR 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Linear and logistic 

regression 

Age Groups Analyzed: NA 

Sample Description:

3,901 infants from the 

California Children’s Health 

Study 

Averaging Time: 24-h 

Mean (SD) unit:

1.8 ppm (0.9) 

(Entire pregnancy) 

Range: NR 

Copollutant: correlation

PM10: r = 0.41 

NO2: r = 0.69 

O3: r = -0.27 

 

Increment: Entire pregnancy 1.2 ppm 

Trimesters: First: 1.4 ppm; Second: 1.4 ppm; 

Third: 1.3 ppm 

Regression co-efficient for birth weight (g) 

[Lower CI, Upper CI] 

Trimesters: 

First: -21.7 (-42.3 to -1.1); 

Second: 11.3 (-9.7 to 32.3); 

Third: 11.8 (-8.4 to 32.1); 

Entire pregnancy: 2.2 (-20.1 to 24.4) 

OR for LBW [Lower CI, Upper CI] 

Trimesters: 

First: 1.0 (0.7-1.5); Second: 0.9 (0.6-1.3); 

Third: 0.7 (0.5-1.1); Entire pregnancy: 0.8 (0.6-1.3) 

OR for IUGR [Lower CI, Upper CI] 

Trimesters: 

First: 1.2 (1.0-1.4); Second: 1.0 (0.9-1.1); 

Third: 1.0 (0.8-1.1); Entire pregnancy: 1.0 (0.9-1.2) 

Author: Son et al. (2008, 

190323) 

Period of Study: NR 

Location: Seoul, Korea 

Health Outcome:

Postneonatal mortality from 

all causes 

Study Design: Case 

crossover and time series 

Statistical Analyses:

Conditional logistic 

regression 

Age Groups Analyzed: NA 

Sample Description: 1,286 

first-born birth and infant 

death records from 

1999-2003 (only 

postneonatal deaths) 

Averaging Time: 8 h 

Mean (SD) unit: 1.01 ppm 

Range (Min, Max): 0.29, 3.54 

Copollutant: 

PM10, NO2, O3, SO2 

 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Lags examined (days): 0-7 

Time Series: 1.323 (1.077, 1.625) 

Case-crossover(1:6): 1.029 (0.833, 1.271) 

CLR Analyses using different control selection 

schemes 

1:2: 1.076 (0.839, 1.379) 

1:4: 0.981 (0.784, 1.228) 

1:6: 1.029 (0.833, 1.271) 

Author: Strickland et al. 

(2009, 190324) 

Period of Study: NR 

Location: Atlanta, GA 

Health Outcome:

Cardiovascular 

malformations 

Study Design:

Retrospective cohort 

Statistical Analyses:

Poisson GLM 

Age Groups Analyzed: NA 

Sample Description:

Pregnancies reaching at 

least 20-wk gestation that 

were conceived during 

January 1, 1986-March 12, 

2003 

Averaging Time: 24-h 

Mean (SD) unit: 

By season of conception: 

March-May: 0.9 ppm 

June-August: 0.8 ppm 

Sept.-Nov.: 0.9 ppm 

Dec.-Feb.: 0.7ppm 

By yr of conception: 

1986-1991: 0.7 ppm 

1992-1997: 0.8 ppm 

1998-2003: 0.7 ppm 

Range (IQR): 0.3 

Copollutant: 

PM10 (24 h): r = 0.32 

NO2 (24 h): r = 0.41 

O3 (8 h): r = 0.07 

SO2 (24 h): r = 0.23 

Increment: NR 

RR Estimate [Lower CI, Upper CI] 

Atrial septal defect, secundum: 1.16 (0.67, 2.00) 

Coarctation of the aorta: 1.15 (0.65, 2.06) 

Hypoplastic left heart syndrome: 0.82 (0.37, 1.84) 

Patent ductus arteriosus: 1.39 (0.72, 2.68) 

Pulmonary stenosis, valvar: 0.97 (0.53, 1.75) 

Tetralogy of Fallot: 1.09 (0.59, 2.00) 

Transposition of the great arteries: 1.29 (0.58, 2.85)

Ventricular septal defect, muscular: 

1.08 (0.77, 1.50) 

Ventricular septal defect, perimembranous: 

1.06 (0.67, 1.68) 

 Conotruncal defect: 1.22 (0.81, 1.85) 

Left ventricular outflow tract defect: 

1.09 (0.70, 1.68) 

Right ventricular outflow tract defects: 

0.73 (0.44, 1.22) 

January 2010 C-33 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Tsai et al. (2006, 

090709) 

Period of Study: 1994-2000 

Location:

Kaoshiung, Taiwan 

Health Outcome: 

Postneonatal death 

(27 days-1 yr old) 

Study Design: Case 

crossover 

Statistical Analyses: 

Poisson regression 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: 8.27 ppm x10 

Range (Min, Max): 2.26, 17.7 

Copollutant: NR 

Increment: Interquartile range: 0.31 ppm 

OR for Post-neonatal mortality [Lower CI, Upper CI] 

Lag examined: 0-2 

Lag 0-2: 1.051 (0.304-3.630) 

Author: Wilhelm et al. (2005, 

088668) 

Period of Study: 1994-2000 

Location:

Los Angeles, CA 

Health Outcome: 

Term LBW and PTB 

Study Design: 

Retrospective cohort 

Statistical Analyses: Logistic regression 

Age Groups Analyzed: NA 

Sample Description:

518,254 births within 4 mi of 

a monitoring station. Varied 

according to analyses. 

Averaging Time: 24 h 

Mean (SD) unit: 

Trimester 1: 1.42 ppm 

Results for third trimester and 6 wk prior 

to birth were similar to first trimester 

Range (Min, Max): 

0.26, 2.82 

Copollutant correlation: 

First Trimester: 

PM10: r = 0.12 

PM2.5: r = 0.57 

NO2: r = 0.81 

SO2: r = -0.31 

 

Increment: 1 ppm 

RR for PTB [Lower CI, Upper CI] 

First trimester: 

<1 mile: 1.06 (1.00-1.12) 

1-2 miles: 1.06 (1.03-1.10) 

2-4 miles: 1.08 (1.06-1.09) 

ZIP code level: 1.04 (1.01-1.07) 

6 wk prior to birth: 

<: 1.04 (0.98-1.09) 

1-2 miles: .04 (1.01-1.08) 

2-4 miles: 1.01 (0.99-1.02) 

ZIP code level: 1.03 (1.00-1.06) 

Notes: All results above did not persist in 

multipollutant model (CO, NO2, O3, PM10) 

OR for term LBW [Lower CI, Upper CI] 

Third trimester: 

<1 mile: 1.10 (0.98-1.23) 

1-2 miles: 1.05 (0.99-1.13) 

2-4 miles: 1.06 (1.02-1.10) 

ZIP code level: 1.12 (1.05-1.19) 

Notes: All results above did not persist in 

multipollutant model (CO, NO2, O3, PM10) 

See paper for results based on exposure category 

groupings. 

Author: Woodruff et al. 

(2008, 098386) 

Period of Study: 1999-2002 

Location:

U.S. counties with >250,000 

residents 

Health Outcome:

Postneonatal deaths 

all causes; respiratory; 

SIDS; ill-defined + SIDS; 

other causes. 

Study Design: 

Retrospective cohort 

Statistical Analyses: 

Logistic regression (GEE) 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: 24 h 

Mean (SD) unit: All causes: 0.70 ppm 

Range (Min, Max):

Percentiles: 25th: 0.48; 75th: 0.87 

Copollutant correlation: 

PM10: r = 0.18 

SO2: r = 0.27 

O3: r = -0.46 

Increment: 0.39 ppm 

OR for Post-neonatal mortality [Lower CI, Upper 

CI] 

Avg exposure over the first 2 mo of life: 

All causes: 1.01 (0.95-1.07) 

Respiratory: 1.14 (0.93-1.40) 

SIDS: 0.88 (0.76-1.03) 

Ill-defined + SIDS: 0.93 (0.84-1.02) 

Other causes: 1.02 (0.97-1.07) 

Author: Yang et al. (2004, 

094376) 

Period of Study: 1994-2000 

Location:

Taipei, Taiwan 

Health Outcome: 

Postneonatal mortality 

(27 days-1 yr old) 

Study Design: Case 

crossover 

Statistical Analyses: 

Poisson regression 

Age Groups Analyzed: NA 

Sample Description: NR 

Averaging Time: 24-h 

Mean (SD) unit: 15.8 ppm x10 

Range (Min, Max): 3.20, 48.4 

Copollutant: NR 

 

Increment: Interquartile range: 0.56 ppm 

OR for Post-neonatal mortality [Lower CI, Upper CI] 

Lag examined: 0-2 

Lag 0-2: 1.038 (0.663-1.624) 

January 2010 C-34 
Table C-4. Studies of short-term CO exposure and respiratory morbidity 

Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Andersen et al. 

(2008, 096150) 

Period of Study: 

Dec 1998-Dec 2004 

Location:

Copenhagen, Denmark 

Health Outcome: Wheezing 

symptoms 

Study Design: Panel 

Statistical Analyses: Logistic 

regression (GEE) 

Age Groups Analyzed: 0-3 yrs 

Sample Description:

205 children of mothers with asthma 

Averaging Time: 24h 

Mean (SD) unit: 0.29 (0.10) ppm 

Range (percentiles):

25th = 0.22; 75th = 0.34 

Copollutant: correlation 

PM10: r = 0.45 

PM2.5: r = 0.45 

UFPNC: r = 0.52 

NO2: r = 0.75 

NOX: r = 0.74 

O3: r = -0.63 

Increment: NR 

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: 0, 1, 2, 3, 4, 2-4 

Lag 0: 0.96 (0.80, 1.15) 

Lag 1: 0.92 (0.77, 1.10) 

Lag 2: 1.08 (0.92, 1.28) 

Lag 3: 1.07 (0.90, 1.26) 

Lag 4: 1.02 (0.84, 1.23) 

3d mean: 1.07 (0.87, 1.32) 

Author: Bhattacharyya et 

al. (2009, 180154) 

Period of Study: 1997-

2006 

Location: NR (National 

Health Interview Survey as 

aggregated in the 

Integrated Health Interview 

Series served as data 

source) 

Health Outcome: Respiratory 

morbidity 

Study Design: Cross-sectional study 

Statistical Analyses: SPSS version 

14.0, univariate linear regression 

analysis 

Age Groups Analyzed: 18+ yr (avg: 

45.2 yr) 

Sample Description: Hay fever, 

weak/failing kidneys, sinusitis all in 

past 12 mo 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): 2.209-4.157ppm 

(decreased with increasing yr) 

Copollutant: NR 

 

Increment: NR 

Linear regression analysis for disease 

condition prevalence: Hayfever: Standardized 

B- 0.012, p-value- <0.001; Sinusitis: 

Standardized B- 0.027, p-value- <0.001; 

Kidney Weak/Failin: Standardized B- -0.001, pvalue- <0.001 

Lags examined: NR 

Author: Chen et al. (1999, 

011149) 

Period of Study:

5/1995-1/1996 

Location:

3 Taiwan communities 

Health Outcome: Lung function (FVC, 

FEV1, FEV1/FVC, FEF25-75%, PEF) 

Study Design: Cross-sectional survey 

Statistical Analyses: 

Multivariate linear model 

Population: 

941 children (Boys: 453; Girls: 488) 

Age Groups Analyzed: 8-13 yr 

Pollutant: CO 

Averaging Time: 1-h max; 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): 

1-h max: (0.4, 3.6) 

Copollutant correlation:

NO2: r = 0.86 – 0.98 

Note: To represent the 

schoolchildren’s exposure the 

daytime avg and peak concentrations 

were measured from 0800 to 1800. 

Increment: NR 

β Coefficient (SE); lag: 

FVC (mL) 

24-h avg 

-66.6 (40.73); 1 

-147.71 (64.48); 2 

2.2 (48.13); 7 

1-h max 

-33.25 (20.74); 1 

-16.48 (19.67); 2 

-5.18 (16.48); 7 

FEV1 (mL) 

24-h avg 

 20.55 (38.24); 1 

-82.42 (60.95); 2 

48.23 (45.58); 7 

1-h max 

1.2 (19.48); 1 

-1.44 (18.57); 2 

20.96 (15.67); 7 

Author: Chen et al. (2000, 

011931) 

Period of Study: 

8/1996-6/1998 

Location: 

Washoe County, NV 

Health Outcome: School absenteeism

Study Design: Time series 

Statistical Analyses: Maximum 

likelihood 

Population: 1st to 6th grade children: 

27,793 

Age Groups Analyzed: 1st to 6th 

grade children 

Pollutant: CO 

Averaging Time: 1-h max 

Mean (SD) unit: 

2.73 (1.154) ppm 

Range (Min, Max): (0.65, 2.73) 

Copollutant correlation: 

PM10: r = 0.721 

O3: r = -0.204 

Increment: 1.0 ppm 

% Increase (Lower CI, Upper CI); lag: 

3.79% (1.04-6.55); 0 

January 2010 C-35 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: de Hartog et al. 

(2003, 001061) 

Period of Study: 

1998-1999 

Location:

Amsterdam, Netherlands; 

Erfurt, Germany; 

Helsinki, Finland 

Health Outcome: Respiratory 

symptoms (shortness of breath, being 

awakened by breathing problems, 

phlegm, wheezing, tripping heart) 

Study Design: Time series 

Statistical Analyses: 

Logistic regression 

Population: 

Nonsmoking individuals with CHD: 

Amsterdam: 37 

Erfurt: 47 

Helsinki: 47 

Age Groups Analyzed: ≥ 50 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Amsterdam: 0.6 mg/m3

Erfurt: 0.4 mg/m3

Helsinki: 0.4 mg/m3

Range (Min, Max):

Amsterdam: (0.4, 1.6) 

Erfurt: (0.1, 2.5) 

Helsinki: (0.1, 1.0) 

Copollutant: 

PM2.5; 

NO2

Increment: 0.25 mg/m3

Odds Ratio (Lower CI, Upper CI); lag: 

Incidence of symptoms 

Shortness of breath 

1 (0.92-1.1); 0 

0.96 (0.88-1.05); 1 

1 (0.92-1.09); 2 

1.07 (0.98-1.16); 3 

1.03 (0.9-1.18); 0-4 

Being awakened by breathing problems 

1.02 (0.92-1.14); 1 

1.03 (0.93-1.15); 2 

1.11 (1-1.22); 3 

1.16 (0.98-1.37); 0-4 

Phlegm 

1.05 (0.93-1.19); 0 

1.02 (0.91-1.14); 1 

1.08 (0.96-1.22); 2 

1.09 (0.97-1.22); 3 

1.13 (0.94-1.35); 0-4 

Prevalence of symptoms 

Shortness of breath 

1 (0.94-1.06); 0 

0.99 (0.94-1.05); 1 

0.99 (0.93-1.05); 2 

1.01 (0.95-1.07); 3 

0.98 (0.9-1.07); 0-4 

Being awakened by breathing problems 

1.01 (0.93-1.1); 1 

0.99 (0.91-1.08); 2 

1.1 (1.02-1.19); 3 

1.13 (1-1.29); 0-4 

Author: Delfino et al. 

(2003, 050460) 

Period of Study: 

11/1999-1/2000 

Location:

Los Angeles, CA 

Health Outcome: 

Asthma symptoms (Cough, wheeze, 

sputum production, shortness of 

breath, chest tightness) (symptom 

scores >1, symptoms scores >2); Lung 

function (PEF) 

Study Design: Panel study 

Statistical Analyses: 

Asthma symptoms: GEE 

Lung function: Generalized linear 

mixed model 

Population: 

22 asthmatic Hispanic children 

Age Groups Analyzed: 10-15 yr 

Pollutant: CO 

Averaging Time: 

1-h max; 8-h max 

Mean (SD) unit: 

1-h max: 7.7 (3.1) ppb 

8-h max: 5.0 (2.0) ppb 

Range (Min, Max):

1-h max: (2, 17) 

8-h max: (1, 10) 

Copollutant correlation: 

NO2: r = 0.65; O3: r = -0.17; 

Acetaldehyde: r = 0.51; 

Acetone: r = 0.28; 

Formaldehyde: r = 0.41; 

Benzene: r = 0.50; 

Ethylbenzene: r = 0.62; 

Tetrachloroethylene: r = 0.63; 

Toluene: r = 0.71; 

m,p - Xylene: r = 0.72; 

PM10: r = 0.50; 

EC: r = 0.60; 

OC: r = 0.55; 

SO2: r = 0.69 

Increment: 5.0 ppb & 3.0 ppb 

Odds Ratio (Lower CI, Upper CI); lag: 

1-max 

Increment: 5.0 ppb 

Symptom scores >1 

0.95 (0.52-1.75); 0 

1.11 (0.75-1.65); 1 

Symptom scores >2 

0.48 (0.07-3.53); 0 

.28 (0.53-3.12); 1 

8-h max 

Increment: 3.0 ppb 

Symptom scores >1 

0.95 (0.55-1.62); 0 

1.2 (0.77-1.86); 1 

Symptom scores >2 

0.53 (0.10-2.92); 0 

1.43 (0.41-5.00); 1 

Author: Estrella et al. 

(2005, 099124) 

Period of Study:

1/2000-4/2000 

Location:

Quito, Ecuador 

Health Outcome: 

Acute respiratory infection 

Study Design: Prospective study 

Statistical Analyses: 

Logistic regression; Poisson 

Population: 960 children 

Age Groups Analyzed: 6-11 yr 

Pollutant: CO 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NR 

Odds Ratio (Lower CI, Upper CI); lag: 

Acute respiratory infection 

ARI in children COHb >2.5% vs. COHb <2.5%: 

Adjusted Logistic Regression Model 

3.25 (1.65-6.38) 

ARI in children COHb >2.5% vs. COHb <2.5%: 

Crude Logistic Regression Model 

2.06 (1.30-3.20) 

Log-Linear Model (Each Percent Increase in 

COHb above 2.5%) 

1.15 (1.03-1.28) 

January 2010 C-36 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Fischer et al. 

(2002, 025731) 

Period of Study: NR 

Location: 

Utrecht, Netherlands 

Health Outcome: 

Lung function (FVC, FEV1, PEF, 

MMEF) 

Study Design: Panel study 

Statistical Analyses: 

Restricted max likelihood linear model 

Population: 68 children 

Age Groups Analyzed: 10-11 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 921 μg/m3

Range (Min, Max): (319, 1540) 

Copollutant: 

PM10; BS; NO2; NO 

Increment: 100 μg/m3

mL (SE); lag: 

FVC: 0.5 (0.4); 1; 0.1 (0.2); 2 

FEV1: -0.4 (0.5); 1; -0.2 (0.2); 2 

m/s (SE); lag: 

PEF: -1.1 (2.8); 1; -0.6 (1.1); 2 

MMEF: -0.5 (1.4); 1; -0.3 (0.6); 2 

Author: Ho et al. (2007, 

093265) 

Period of Study: 

Oct 1995-Mar 1996 

Location:

Taipei, Taiwan 

Health Outcome: Asthma 

Study Design: Panel 

Statistical Analyses: Logistic 

regression (GEE) 

Age Groups Analyzed: 10-17 yr 

Sample Description:

A stratified cluster random sample of 

students (n=69,367) from 1,139,452 

students sampled nationwide 

Averaging Time: 8 h 

Mean (SD) unit: NR 

Range (min, max): NR 

Copollutant: 

NO, NO2, NOX, O3, SO2, PM10, PSI 

Increment: very high, high, med, low, very low 

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: NR 

Females: 1.984 (1.536, 2.561) 

Males: 1.780 (1.377, 2.302) 

Monthly attack rate vs single air pollutant 

concentrations 

Estimate (p-value): 0.0750 (0.3336) 

Author: Lagorio et al. 

(2006, 089800) 

Period of Study: 

5/1999-6/1999; 

11/1999-12/1999 

Location:

Rome, Italy 

Health Outcome:

Lung function (FVC, FEV1) 

Study Design: 

Time-series panel study 

Statistical Analyses: 

Generalized estimating equations 

(GEE) 

Population: 

COPD panel: 11 

Asthma panel: 11 

IHD panel: 7 

Age Groups Analyzed: 

COPD panel: 50-80 yr 

Asthma panel: 18-64 yr 

IHD panel: 40-64 yr 

Notes: Asthma panel was restricted to 

never smokers, while COPD and IHD 

panels include former smokers if 

smoking cessation occurred at least 

1 yr prior to enrollment. 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Overall: 7.4 (6.2) mg/m3 Spring: 2.1 

(0.3) mg/m3

 Winter: 12.3 (4.9) mg/m3

Range (Min, Max): 

Overall: (1.6, 28.9) 

Copollutant correlation: 

PM2.5: r = 0.67 

PM10-2.5: r = -0.09 

PM10: r = 0.55 

NO2: r = 0.05 

O3: r = -0.87 

SO2: r = 0.65 

Increment: 1 mg/m3

β Coefficient (SE); lag: 

COPD panel 

FVC (% of predicted) 

-0.14 (0.15);0 

-0.13 (0.18); 0-1 

0.15 (0.23); 0-2 

FEV1 (% of predicted) 

-0.05 (0.13); 0 

-0.12 (0.16); 0-1 

-0.03 (0.2); 0-2 

Asthma panel 

FVC (% predicted) 

0.02 (0.12); 0 

-0.001 (0.13); 0-1 

-0.06 (0.16); 0-2 

FEV1 (% predicted) 

-0.05 (0.14); 0 

-0.16 (0.15); 0-1 

-0.28 (0.18); 0-2 

IHD panel 

FVC (% of predicted) 

0.176 (0.101); 0 

0.132 (0.120); 0-1/ 

0.132 (0.165); 0-2 

FEV1 (% of predicted) 

0.204 (0.120); 0 

0.114 (0.142); 0-1 

0.159 (0.194); 0-2 

Author: Moon et al. (2009, 

190297) 

Period of Study: Apr 2003-May 2003 

Location:

Seoul, Incheon, Busan, & 

Jeju, Korea 

Health Outcome: Respiratory 

symptoms 

Study Design: Panel 

Statistical Analyses: Logistic 

regression (GEE) 

Age Groups Analyzed: < 13 yr 

Sample Description: 696 children 

Averaging Time: 24h 

Mean (SD) unit: NR 

IQ Range: 0.12ppm 

Copollutant: 

PM10, SO2, NO2, O3

Increment: 0.12 ppm (IQR) 

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: lag days 0-3 

 Lower resp. symptoms: 

1.005 (1.003, 1.008), lag 0 

Upper resp. symptoms: 

1.006 (1.003, 1.008), lag 0-2 

Irritation symptoms: 

1.004 (1.001, 1.006), lag 1-3 

January 2010 C-37 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Mortimer et al. 

(2008, 187280) 

Period of Study: 

Nov 2000-Apr 2005 

Location:

Fresno, California 

Health Outcome: Allergic sensitization

Study Design: Panel 

Statistical Analyses: Multistep 

modeling 

Age Groups Analyzed: 6-11 yr 

Sample Description: 170 children 

with physician diagnosed asthma 

Averaging Time: 24-h avg, 24-h 

max, 8-h max 

Mean (SD) unit: NR 

IQ Range (24-h avg, 24-h max, 8-h 

max): 0.28, 0.79, 0.52 

Copollutant: entire prenatal 

correlation 

NO2: r = 0.74 

O3: r = -0.40 

PM10: r = 0.32 

Increment: IQR 

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: NR 

Entire Pregnancy: 

CO 24-h avg: 1.45 (1.02, 2.07) 

CO 24-h max: 1.53 (1.01, 2.33) 

CO 24-h avg: 1.55 (1.01, 2.37) 

Author: Nkwocha et al. 

(2008, 190304) 

Period of Study: 

Feb 2005-Jul 2006 

Location:

Port Harcourt, Nigeria 

Health Outcome: Respiratory 

symptoms 

Study Design: Panel 

Statistical Analyses: Mixed Effects 

models 

Age Groups Analyzed: 0-5 yr 

Sample Description: 250 children 

Averaging Time: 8 h 

Mean (SD) unit: NR 

Range (min, max):

1.3 μg/m3, 1.83 μg/m3

Copollutant: NO2, SO2, PM10

Increment: NR 

Lags examined: NR 

R Estimate: 

Dry season: 0.13 

Wet season: 0.25 

Author: O’Connor et al. 

(2008, 156818) 

Period of Study: 

Aug 1998-Jul 2001 

Location:

Boston, MA; the Bronx, 

NY; Chicago, IL; Dallas, 

TX; New York, NY; Seattle, 

WA; Tuscon, AZ 

Health Outcome: respiratory 

symptoms 

Study Design: panel 

Statistical Analyses: Mixed Effects 

Models 

Age Groups Analyzed: 5-12 yr 

Sample Description:

861 children with persistent asthma 

and atopy living in low-income census 

tracts 

Averaging Time: 8 h 

Mean (SD) unit: NR 

Range (10th-90th): 872.1 ppb 

Copollutant: 

PM10, SO2, NO2, O3

Increment: 872.1 ppb 

Lags examined: NR 

Change Estimate [Lower CI, Upper CI]: 

FEV1: -0.56 (-1.31, 0.20) 

PEFR: -0.49 (-1.24, 0.27) 

Pollution Impact*[Lower CI, Upper CI]: 

Wheeze-cough: 1.26 (1.03, 1.55) 

Nighttime asthma: 1.35 (1.07, 1.71) 

Slow play: 1.28 (1.04, 1.59) 

OR [Lower CI, Upper CI]: 

Missed School: 1.08 (0.76, 1.53) 

*Coefficients from the negative binomial model 

and indicate the multiplicative effect per unit 

change 

Author: Park et al. (2002, 

093798) 

Period of Study: 

3/1996-12/1999 

Location:

Seoul, Korea 

Health Outcome: School absenteeism

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Population: 

~1,264 children (671 Boys, 593 girls) 

Age Groups Analyzed: 

1st through 6th grade students 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.11 (0.40) ppm 

Range (Min, Max): (0.39, 2.97) 

Copollutant correlation: 

PM10: r = 0.56; 

NO2: r = 0.70; 

SO2: r = 0.67; 

O3: r = -0.46 

Increment: 0.52 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Total Absences: 

0.95 (0.94-0.97); 0 

Non-Illness Related Absences: 

0.99 (0.96-1.02); 0 

Illness-Related Absences: 

0.96 (0.94-0.98); 0 

Author: Park et al. (2005, 

088673) 

Period of Study: 

3/2002-6/2002 

Location:

Incheon, Korea 

Health Outcome:

Lung function (PEF variability (>20%), 

Mean PEF); Respiratory symptoms 

(night respiratory symptoms, cough, 

inhaler use) 

Study Design: Panel study 

Statistical Analyses: 

GEE; Poisson GAM 

Population: 64 bronchial asthmatics 

Age Groups Analyzed: 16-75 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Control days: 0.6368 (0.1522) ppm 

Dust days: 0.6462 (0.0945) ppm 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NR 

Relative Risk (Lower CI, Upper CI); lag: 

PEF variability (>20%): 1.43 (0.54-3.75) 

Night respiratory symptoms: 

0.98 (0.51-1.86) 

β Coefficient (SE); lag: 

PEF variability (>20%): 0.9737 (0.3187) 

Mean PEF (L/min): -10.103 (2.7146) 

Night respiratory symptoms: 

 -0.018 (0.3654) 

Cough: 0.0855 (0.1826) 

Inhaler Use: 0.0796 (0.1733) 

January 2010 C-38 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Penttinen et al. 

(2001, 030335) 

Period of Study:

11/1996-4/1997 

Location:

Helsinki, Finland 

Health Outcome: 

Lung function (PEF) 

Study Design: Panel study 

Statistical Analyses: 

First order autoregressive linear model 

Population: 

57 nonsmoking adult asthmatics 

Age Groups Analyzed: NR 

Pollutant: CO 

Averaging Time: 24-h avg 

Median unit: 0.4 mg/m3

Range (Min, Max): (0.1, 1.1) mg/m3

Copollutant correlation: 

PM10: r = -0.03 

PM10-2.5: r = -0.30 

PM2.5: r = 0.32 

PM1: r = 0.39 

PNC: r = 0.44 

NC0.01-0.1: r = 0.43 

NC0.1-1: r = 0.47 

NO: r = 0.60 

NO2: r = 0.44 

Increment: 0.2 mg/m3

β Coefficient (SE); lag: 

PEF Deviations (L/min) 

Morning 

0.27 (0.38); 0 

-1.08 (0.36); 1 

0.23 (0.38); 2 

-1.11 (1.19); 5-day avg 

Afternoon 

-0.4 (0.43); 0 

-0.13 (0.41); 1 

-0.71 (0.41); 2 

-3.03 (1.06); 5-day avg 

Evening 

-0.7 (0.45); 0; 

-0.31 (0.44); 1 

0.3 (0.44); 2 

-3.62 (1.19); 5-day avg 

Co-pollutant models with PNC 

Morning: -0.67 (0.64); 1 

Afternoon: -0.46 (0.69); 0 

Evening: -0.46 (0.73); 0 

Author: Rabinovitch et al. 

(2004, 096753) 

Period of Study:

11/1999-3/2000; 

11/2000-3/2001; 

11/2001-3/2002 

Location:

Denver, CO 

Health Outcome:

Lung function (FEV1); asthma 

exacerbation; bronchodilator use 

Study Design: Panel study 

Statistical Analyses: 

Pulmonary function: Mixed effects 

model; Asthma exacerbation and 

medication use: GLM 

Population: 

Urban poor asthmatic children: 

1999-2000: 41 

2000-2001: 63 

2001-2002: 43 

Age Groups Analyzed: 6-12 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.0 (0.4) ppm 

Range (Min, Max): (0.3, 3.5) 

Copollutant: 

PM2.5; PM10; NO2; SO2; O3

Increment: 0.4 ppm 

β Coefficient (SE); lag: FEV1 

AM: -0.001 (0.008); 3-day ma 

PM: 0.015 (0.01); 3-day ma 

Odds Ratio (Lower CI, Upper CI); lag: 

Asthma exacerbation: 

1.012 (0.913-1.123); 3-day ma 

Bronchodilator use: 

1.065 (1.001-1.133); 3-day ma 

Author: Ranzi et al. (2004, 

089500) 

Period of Study: 

2/1999-5/1999 

Location:

Emilia-Romagna, Italy 

Health Outcome:

Lung function; respiratory symptoms, 

medication use 

Study Design: Panel study 

Statistical Analyses: GLM 

Population: 120 “asthma-like” school 

children 

Age Groups Analyzed: 6-11 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Urban area: 1.54 mg 

Rural area: 1.22 mg 

Range (Min, Max): NR 

Copollutant: NO2; TSP; PM2.5

The study did not present quantitative results 

for CO. 

Author: Rodriguez et al. 

(2007, 092842) 

Period of Study: 

1996-2003 

Location:

Perth, Australia 

Health Outcome:

Respiratory symptoms (body 

temperature, cough, wheeze/rattle 

chest, runny/blocked nose) 

Study Design: Panel study 

Statistical Analyses: 

Logistic regression, GEE 

Population: 263 children at high risk 

of developing asthma 

Age Groups Analyzed: 0-5 yr 

Pollutant: CO 

Averaging Time: 8-h avg 

Mean (SD) unit: 1.408 ppm 

Range (Min, Max): (0.012, 8.031) 

Copollutant: NR 

Increment: NR 

Odds Ratio (Lower CI, Upper CI); lag: 

Body Temperature 

1.024 (0.911-1.151); 0 

1.056 (0.943-1.184); 5 

0.991 (0.962-1.021); 0-5 

Cough 

1.001 (0.996-1.005); 0 

1.064 (0.941-1.02); 5 

1.028 (0.996-1.061); 0-5 

Wheeze/Rattle Chest 

1.089 (0.968-1.226); 0 

1.136 (1.016-1.26); 5 

1.035 (1.005-1.066); 0-5 

Runny/Blocked Nose 

1.094 (0.824-1.453); 0 

1.38 (1.028-1.853); 5 

1.101 (1.025-1.183); 0-5 

January 2010 C-39 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Schildcrout et al. 

(2006, 089812) 

Period of Study: 

11/1993-9/1995 

Location:

8 North American cities: 

Albuquerque, NM 

Baltimore, MD 

Boston, MA 

Denver, CO 

San Diego, CA 

Seattle, WA 

St. Louis, MO 

Toronto, ON, Canada 

Health Outcome:

Asthma symptoms; rescue inhaler use 

Study Design: Panel study 

Statistical Analyses: 

Asthma symptoms: Logistic 

regression; Rescue Inhaler Use: 

Poisson regression 

Population: 990 asthmatic children 

Age Groups Analyzed: 5-12 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

NO2; O3; PM10; SO2

Increment: 1.0 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Asthma Symptoms 

1.08 (1.01-1.14); 0 

1.07 (0.99-1.16); 1 

1.08 (1.02-1.15); 2 

1.05 (1.01-1.09); 0-2 

Asthma Symptoms 

+ 20 ppb increase in NO2

1.07 (1-1.14); 0 

 1.04 (0.96-1.11); 1 

1.09 (1.02-1.16); 2 

1.04 (1-1.08); 0-2 

+ 25 μg/m3

 increase in PM10

1.08 (1.01-1.15); 0 

1.06 (0.99-1.14); 1 

1.08 (1.02-1.14); 2 

1.05 (1.01-1.08); 0-2 

+ 10 ppb increase in SO2

1.07 (0.99-1.16); 0 

1.06 (0.96-1.19); 1 

1.1 (1.02-1.18); 2 

1.05 (1-1.09); 0-2 

Rescue Inhaler Use 

1.07 (1.01-1.13); 0 

1.05 (0.99-1.1); 1 

1.06 (1.01-1.1); 2 

1.04 (1.01-1.07); 0-2 

Rescue Inhaler Use 

+ 20 ppb increase in NO2

1.05 (0.99-1.12); 0 

1.04 (0.98-1.11); 1 

1.07 (1.02-1.12); 2 

1.04 (1-1.07); 0-2 

+ 25 μg/m3

 increase in PM10

1.06 (0.99-1.13); 0 

1.05 (0.99-1.11); 1 

1.05 (1.01-1.09); 2 

1.03 (1-1.07); 0-2 

+ 10 ppb increase in SO2

1.04 (0.96-1.12); 0 

1.04 (0.97-1.1); 1 

1.08 (1.03-1.13); 2 

1.04 (1-1.08); 0-2 

Author: Silkoff et al. 

(2005, 087471) 

Period of Study:

11/11/1999-3/31/2000; 

11/1/2000-3/16/2001 

Location:

Denver, CO 

Health Outcome:

Lung function (FEV1, PEF); recorded 

symptoms; rescue medication use 

Study Design: Panel study 

Statistical Analyses: 

Rescue medication use and total 

symptom score: GEE; 

Lung function: Mixed effects model 

Population: 

1st winter: 16 with a history of more 

than 10 pack yr of tobacco use, airflow 

limitation with FEV1 of less than 70% 

of predicted value, and FEV1/ FVC 

ratio of less than 60% 

2nd winter: 18 with a history of more 

than 10 pack yr of tobacco use, airflow 

limitation with FEV1 of less than 70% 

of predicted value, and FEV1/ FVC 

ratio of less than 60% 

Age Groups Analyzed: ≥ 40 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

1999-2000: 1.2 (0.555) ppm 

2000-2001: 1.1 (0.5) ppm 

Range (Min, Max):

1999-2000: (0.340, 3.790) 

2000-2001: (0.360, 2.810) 

Copollutant: NR 

The study did not present quantitative results 

for CO. 

January 2010 C-40 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: Slaughter et al. 

(2003, 086294) 

Period of Study: 

12/1994-8/1995 

Location:

Seattle, WA 

Health Outcome:

Asthma severity; medication use 

Study Design: Panel study 

Statistical Analyses: 

Asthma severity: Ordinal logistic 

regression; Medication use: Poisson 

Population: 133 mild-to-moderate 

asthmatic children 

Age Groups Analyzed: 5-13 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Median unit: 1.47 ppm 

IQR (25th, 75th): (0.23, 1.87) 

Copollutant: NR 

Increment: 

Increased asthma attack severity: 0.67 ppm 

Increased rescue inhaler use: 1.0 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Increased asthma attack severity: 

Without transition: 1.21; 1 

With transition: 1.17; 1 

Increased rescue inhaler use: 

Without transition: 1.09 (1.03-1.16); 1 

With transition: 1.06 (1.01-1.1); 1 

Author: Steerenberg et al. 

(2001, 017157) 

Period of Study: NR 

Location:

Bilthoven and Utrecht, 

the Netherlands 

Health Outcome:

Lung function (PEF); exhaled nitric 

oxide; inflammatory nasal markers 

Study Design: Panel study 

Statistical Analyses: 

Restricted max likelihood linear model 

Population: 126 children 

Age Groups Analyzed: 8-13 yr 

Notes: The study was only conducted 

for a two mo period: February and 

March. 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Utrecht: 0.8 mg/m3

Bilthoven: 0.5 mg/m3

Range (Min, Max):

Utrecht: (0.3, 2.3) 

Bilthoven: (0.3, 0.9) 

Copollutant: NR 

The study did not present quantitative results 

for CO. 

Increment: 0.32 mg/m3

β Coefficient (SE); lag: 

Exercise induced responsiveness 

Author: Timonen et al. 

(2002, 025653) 

Period of Study:

2/1994-4/1994 

Location:

Kuopio, Finland 

Health Outcome:

Exercise induced bronchial 

responsiveness; Lung function (FVC, 

FEV1, MMEF, AEFV) 

Study Design: Panel study 

Statistical Analyses: Linear 

regression 

Population: 33 children with chronic 

respiratory symptoms 

Age Groups Analyzed: 7-12 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.6 mg/m3

Range (Min, Max): (0.1, 2.8) 

Copollutant correlation: 

PM10: r = 0.52 

BS: r = 0.80 

PNC0.01-0.03: r = 0.81 

PNC0.03-0.1: r = 0.87 

PNC0.1-0.3: r = 0.71 

PNC0.3-1.0: r = 0.60 

PNC1.0-3.2: r = 0.84 

PNC3.2-10: r = 0.79 

NO2: r = 0.85 

ΔFEV1 (%) 

-0.081 (0.647); 0 

0.03 (0.262); 1 

0.087 (0.26); 2 

-0.091 (0.275); 3 

0.19 (0.599); 0-3 

ΔMMEF (%) 

0.442 (1.79); 0 

0.52 (0.723); 1 

0.313 (0.719); 2 

-0.616 (0.75); 3 

0.096 (1.64); 0-3 

ΔAEFV (%) 

0.287 (1.19); 0 

0.281 (0.482); 1 

0.904 (0.474); 2 

0.15 (0.483); 3 

1.6 (1.05); 0-3 

FVC (mL) 

0.064 (10.9); 0 

-4.79 (4.51); 1 

-9.78 (4.24); 2 

-13.9 (4.7); 3 

-29.4 (10.1); 0-3 

FEV1 (mL) 

19.2 (13.2); 0 

-9.04 (5.45); 1 

-9.15 (5.21); 2 

-11.7 (5.77); 3 

-17.5 (12.5); 0-3 

MMEF (mL/s) 

22.2 (36.9); 0 

-23 (15.2); 1 

-4.63 (14.7); 2 

-30.9 (16); 3 

 -24.9 (34.8); 0-3 

AEFV (L2/s) 

-0.093 (0.088); 0 

-0.068 (0.036); 1 

 -0.06 (0.035); 2 

-0.05 (0.039); 3 

-0.076 (0.083); 0-3 

January 2010 C-41 
Study Design Concentrations CO Effect Estimates (95% CI) 

Author: von Klot et al. 

(2002, 034706) 

Period of Study: 

9/1996-3/1997 

Location:

Erfurt, Germany 

Health Outcome: Asthma symptoms; 

medication use 

Study Design: Panel study 

Statistical Analyses: Logistic 

regression 

Population: 53 adults with asthma or 

asthma symptoms 

Age Groups Analyzed: 37-77 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.9 mg/m3

Range (Min, Max): (0.3, 3.0) 

Copollutant correlation: 

NC0.01-0.1: r = 0.66 

NC0.1-0.5: r = 0.79 

NC0.5-2.5: r = 0.46 

MC0.1-0.5: r = 0.66 

MC0.01-2.5: r = 0.65 

PM2.5-10: r = 0.42 

PM10: r = 0.69 

NO2: r = 0.82 

SO2: r = 0.32 

Increment: 

0 and 5-day avg lag: 0.6 mg/m3

14-day avg lag: 0.54 mg/m3 

Odds Ratio (Lower CI, Upper CI); lag: 

Prevalence: Inhaled β2-agonist use 

0.98 (0.93-1.03); 0 

1.04 (0.97-1.12); 0-4 

0.93 (0.86-1.01); 0-13 

Prevalence: Inhaled corticosteroid use 

1.05 (1-1.11); 0 

1.25 (1.17-1.34); 0-4 

1.06 (0.97-1.15); 0-13 

Prevalence: Wheezing 

1.03 (0.97-1.08); 0 

1.13 (1.05-1.22); 0-4 

1.14 (1.05-1.25); 0-13 

Co-pollutant models 

Inhaled β2-agonist use 

CO+MC0.01-2.5: 

1 (0.91-1.11); 0-4 

CO+NC00.01-0.1: 

1.01 (0.91-1.11); 0-4 

Inhaled corticosteroid use 

CO+MC0.01-2.5: 

0.89 (0.81-0.98); 0-13 

CO+NC: 0.01-0. 

1: 0.81 (0.72-0.91); 0-13 

Wheezing 

CO+MC0.01-2.5: 

1.15 (1.04-1.27); 0-4 

CO+NC0.01-0.1: 

1.09 (0.98-1.22); 0-4 

Author: Yu et al. (2000, 

013254) 

Period of Study: 

11/1993-8/1995 

Location:

Seattle, Washington 

Health Outcome:

Asthma symptoms (Wheezing, 

coughing, chest tightness, shortness of 

breath) 

Study Design: Panel study 

Statistical Analyses: 

Repeated measures logistic regression 

models (GEE) 

Population: 133 mild-to-moderate 

asthmatics 

Age Groups Analyzed: 5-13 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.6 ppm 

Range (Min, Max): (0.65, 4.18) 

Copollutant correlation: 

PM1.0: r = 0.82 

PM10: r = 0.86 

SO2: r = 0.31 

Increment: 1.0 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Marginal GEE 

1.22 (1.03-1.45); 0 

1.3 (1.11-1.52); 1 

1.26 (1.09-1.46); 2 

Transition GEE 

1.18 (1.02-1.37); 0 

1.25 (1.1-1.42); 1 

1.18 (1.04-1.33); 2 

Table C-5. Studies of short-term CO exposure and respiratory hospital admissions and ED visits. 

Study Design Concentrations Effect Estimates (95% CI) 

Author: Abe et al. 

(2009, 190536) 

Period of Study:

January 1-December 

31, 2005 

Location: Tokyo, 

Japan 

ED Visits 

Health Outcome: Asthma 

Study Design: Time-series 

Statistical Analyses: Bivariate 

Pearson correlation 

coefficitnes, ARIMA model 

Age Groups Analyzed:

Children: ≤14 yr, Adults: ≤ 15 yr 

Sample Description: Data 

from daily number of 

ambulance transports to ED for 

asthma 

Averaging Time: NR 

Mean (SD) unit: 11.5ppm 

Range (Min, Max): 3-44ppm 

Copollutant: NR 

 

Increment: 0.1ppm 

ARIMA model for ambulance transports to ED for asthma 

exacerbation among adults: β coefficient: 0.151, SE: 

0.098, t statistic: 1.537, P value: .125 

ARIMA model for ambulance transports to ED for asthma 

exacerbation among children: β coefficient: 0.019, SE: 

0.034, t statistic: 0.549, P value: 0.583 

Lags examined: 0 

On the day with the highest CO the number of transports 

was 25. The number of transports for adults and CO had 

significant bivariate correlations. The fitted ARIMA model 

had no significant associations. 

January 2010 C-42 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Anderson et 

al. (2001, 017033) 

Period of Study:

10/1994-12/1996 

Location:

West Midlands; U.K. 

Hospital Admission 

Health Outcome (ICD9):

Respiratory diseases 

asthma (493) 

COPD (490-492, 494-496) 

Study Design: Time series 

Statistical Analyses:

Regression with quasilikelihood approach and GAM 

Age Groups Analyzed: 

All ages 

0-14 yr 

15-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit: 0.8 (0.7) ppm 

Range (Min, Max): (0.2, 10) 

Copollutant: correlation 

PM10: r = 0.55; 

PM2.5: r = 0.54; 

PM2.5-10: r = 0.10; 

BS: r = 0.77; 

SO4

2-: r = 0.17; 

NO2: r = 0.73; 

O3: r = -0.29; 

SO2: r = 0.49 

Increment: 1.0 ppm 

% Increase (Lower CI, Upper CI); lag: 

Respiratory Diseases 

Age Group 

All ages: 0.3% (-1.10 to 1.70); 0-1 

0-14: 1.50% (-0.60 to 3.60); 0-1 

15-64: -0.70% (-3.60 to 2.30); 0-1 

≥ 65: 0.00% (-2.10 to 2.10); 0-1 

Asthma 

Age Group 

0-14: 3.90% (-0.50 to 8.50); 0-1 

15-64: -4.90% (-10.60 to 1.10); 0-1 

COPD 

Age Group 

≥ 65: 1.00% (-2.50 to 4.60); 0-1 

Author: Andersen et 

al. (2007, 093201) 

Period of Study:

1/1999-12/2004 

Location:

Copenhagen, 

Denmark 

Hospital Admission 

Health Outcome (ICD10):

Respiratory diseases: chronic 

bronchitis (J41-42), 

emphysema (J43), COPD 

(J44), asthma (j45), status 

asthmaticus (j46), pediatric 

asthma (j45), pediatric 

asthmaticus (j46) 

Study Design: Time-series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 5-18 

yr; ≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.3 (0.1) ppm 

IQR (25th, 75th): (0.22, 0.34) 

Copollutant; correlation: 

PM10: r = 0.45 

Increment: 0.12 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Respiratory Disease 

Age Group: ≥ 65 

CO: 1.024 (0.997-1.053); 0-4 

CO, PM10: 1.001 (0.961-1.042); 0-4 

Asthma 

Age Group: 5-18 

CO: 1.104 (1.018-1.198); 0-5 

CO, PM10: 1.023 (0.911-1.149); 0-5 

Author: Atkinson et al. 

(1999, 007882) 

Period of Study:

1/1992-12/1994 

Location: 

London, 

U.K. 

ED Visits 

Health Outcome (ICD9): 

Respiratory complaints: 

wheezing, inhaler request, 

chest infection, chronic 

obstructive lung disease 

(COLD), difficulty breathing, 

cough, other respiratory 

complaints. e.g., croup, 

pleurisy, noisy breathing; 

Asthma (493) 

Study Design: Time-series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

All ages 

0-14 yr 

15-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.8 (0.4) ppm 

Range (Min, Max): (0.2, 5.6) 

Copollutant; correlation: 

NO2

O3

SO2

PM10

BS 

Increment: 0.8 ppm 

% Increase (Lower CI, Upper CI); lag: 

Respiratory complaints 

Age Group 

All ages: 0.76% (-0.83, 2.38); 1 

0-14: 2.92% (0.60, 5.30); 1 

15-64: 2.15% (-0.27, 4.63); 1 

≥ 65: 4.29% (1.15, 7.54); 0 

Asthma visits: 

Single-pollutant model 

Age Group: 

All ages: 3.32% (0.56, 6.16); 1 

0-14: 4.13% (-0.11, 8.54); 0 

15-64: 4.41% (0.46, 8.52); 1 

Multi-pollutant model 

Age Group: 

0-14 

CO, NO2: 2.05% (-2.25, 6.54); 0 

CO, O3: 4.48% (0, 9.16); 0 

CO, SO2: 2.34% (-1.94, 6.81); 0 

CO, PM10: 2.93% (-1.53, 7.58); 0 

CO, BS: 4.19% (-0.04, 8.60); 0 

January 2010 C-43 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Bedeschi et 

al. (2007, 090712) 

Period of Study: 

1/2001-3/2002 

Location: 

Reggio Emilia, 

Italy 

ED Visits 

Health Outcome (ICD9): 

Asthma (493); Asthma-like 

disorders, i.e., asthma, 

bronchiolitis, dyspnea/ 

shortness of breath; Other 

respiratory disorders (i.e., upper 

and lower respiratory illness 

including sinusitis, bronchitis, 

and pneumonia) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM, penalized splines 

Age Groups Analyzed: <5 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.4 (0.7) mg/m3

Range (Min, Max): (0.4, 4.6) 

Copollutant; correlation: 

PM10: r = 0.61 

TSP: r = 0.61 

SO2: r = 0.71 

NO2: r = 0.77 

The study did not provide quantitative results for CO. 

Author: Bell et al. 

(2008, 091268) 

Period of Study:

1/1995-12/2002 

Location: 

Taipei, Taiwan 

Hospital Admissions 

Health Outcome (ICD9):

Pneumonia (486); asthma (493) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed:

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SE) unit: 0.9 ppm 

Range (Min, Max): (0.3, 3.6) 

Copollutant: NR 

Increment: 0.5 ppm 

% Increase (Lower CI, Upper CI); lag 

Asthma (avg correlation between monitor pairs = 0.75 (13 

monitors)) 

3.29% (-0.74 to 7.49); 0 

.49% (-4.25 to 3.41); 1 

-0.84% (-4.43 to 2.88); 2 

0.48% (-4.02 to 3.18); 3 

0.74% (-4.62 to 6.4); 0-3 

Pneumonia (avg correlation between monitor pairs = 0.75 

(13 monitors)) 

1.91% (-1.97 to 5.95); 0 

0.03% (-3.65 to 3.85); 1 

0.36% (-3.2 to 4.04); 2 

-1.29% (-4.77 to 2.32); 3 

0.21% (-5.03 to 5.73); 0-3 

Asthma (avg correlation between monitor pairs = 0.88 (5 

monitors)) 

1.68% (-1.68 to 5.15); 0 

-1.19% (-4.29 to 2.01); 1 

-0.83% (-3.83 to 2.26); 2 

-0.35% (-3.32 to 2.71); 3 

-0.31% (-4.9 to 4.5); 0-3 

Pneumonia (avg correlation between monitor pairs = 0.88 

(5 monitors)) 

1.24% (-2.02 to 4.6); 0 

-0.01% (-3.06 to 3.13); 1 

0.57% (-2.4 to 3.62); 2 

-0.85% (-3.78 to 2.16); 3 

0.31% (-4.23 to 5.06); 0-3 

Asthma (monitors with ≥ 0.75 between monitor 

correlations (11 monitors), avg correlation between 

monitor pairs = 0.81) 

2.87% (-0.91 to 6.79); 0 

-0.71% (-4.2 to 2.91); 1 

-0.73% (-4.08 to 2.73); 2 

-0.41% (-3.72 to 3.01); 3 

0.51% (-4.6 to 5.89); 0-3 

Pneumonia (monitors with ≥ 0.75 between monitor 

correlations (11 monitors) to avg correlation between 

monitor pairs = 0.81) 

0.98% (-1.68 to 5.76); 0 

-0.12% (-3.54 to 3.42); 1 

0.37% (-2.95 to 3.8); 2 

-1.08% (-4.34 to 2.3); 3 

0.3% (-4.71 to 5.57); 0-3 

January 2010 C-44 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Bellini et al. 

(2007, 097787) 

Period of Study:

1996-2002 

Location: 

15 Italian cities 

Hospital Admissions 

Health Outcome:

Respiratory conditions 

Study Design: 

Time-series; Meta-analysis 

Statistical Analyses: 

1. GLM for city-specific 

estimates 

2. Bayesian random-effects for 

meta analysis 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: correlation NR 

Increment: 1 mg/m3

% Increase (Lower CI, Upper CI); Lag 

Respiratory conditions 

All ages: 

Season: 

Winter: 0.58%; 0-1 

Summer: 3.47%; 0-1 

All Season: 1.25%; 0-3 

Note: Estimates from Biggeri et al. (2004) 

Author: Braga et al. 

(2001, 016275) 

Period of Study:

1/1993-11/1997 

Location: 

Sao Paulo, Brazil 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory (460-519) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: 

≤ 2 yr 

3-5 yr 

6-13 yr 

14-19 yr 

0-19 yr 

Pollutant: CO 

Averaging Time: 

Maximum 8-h avg 

Mean (SD) unit: 4.8 (2.3) ppm 

Range (Min, Max): (0.6, 19.1) 

Copollutant: correlation 

PM10: r = 0.60 

O3: r = -0.07 

SO2: r = 0.47 

Increment: 3 ppm 

% Increase (Lower CI, Upper CI); lag: 

Respiratory 

Age Group: 

≤ 2: 5.00% (3.30-6.80); 0-6 

3-5: 4.90% (1.40-8.50); 0-6 

6-13: 1.00% (-2.50 to4.60); 0-6 

14-19: 11.30% (5.90-16.80); 0-6 

0-19: 4.90% (3.50-6.40); 0-6 

Author: Burnett et al. 

(1999, 017269) 

Period of Study: 

1/1980-12/1994 

Location: 

Toronto, ON, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493); COPD (490-492, 

496); respiratory infection 

(464, 466, 480-487, 494) 

Study Design: Time-series 

Statistical Analyses: Poisson 

GAM, LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.18 ppm 

IQR (25th, 75th): (0.9, 1.4) 

Copollutant: correlation 

PM2.5: r = 0.49 

PM10-2.5: r = 0.20 

PM10: r = 0.43 

NO2: r = 0.55 

SO2: r = 0.37 

O3: r = -0.23 

Increment: 1.18 ppm 

% Increase (t-value); lag: 

Asthma: 5.35% (3.92); 0 

COPD: 2.93% (1.48); 0 

Respiratory Infection: 5.00% (4.25); 0 

Asthma: 

Multipollutant model 

CO, SO2, O3: 5.15% 

CO, PM2.5, SO2, O3: 4.63% 

CO, PM10-2.5, SO2, O3: 5.25% 

CO, PM10, SO2, O3: 4.80% 

CO, PM10-2.5, O3: 4.00% 

COPD: 

Multipollutant model 

CO, SO2, O3: 3.02% 

CO, PM2.5, SO2, O3: 2.46% 

CO, PM10-2.5, SO2, O3: 3.00% 

CO, PM10, SO2, O3: 2.75% 

CO, PM10-2.5, O3: 3.00% 

Author: Burnett et al. 

(2001, 093439) 

Period of Study:

1/1980-12/1994 

Location: 

Toronto, ON, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493); Acute bronchitis/ 

bronchiolitis (466); croup 

(464.4) ; pneumonia (480-486) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM 

Age Groups Analyzed: <2 yr 

Pollutant: CO 

Averaging Time: 1-h avg 

Mean (SD) unit: 1.9 ppm 

IQR (25th, 75th): (1.3, 2.3) 

Copollutant: correlation 

O3: r = 0.24 

Increment: 1.9 ppm 

% Increase (Lower CI, Upper CI); lag 

Respiratory problems 

CO: 19.20%; 0-1 

CO, O3: 14.30%; 0-1 

January 2010 C-45 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Cakmak et al. 

(2006, 093272) 

Period of Study:

4/1993-3/2000 

Location:

10 Canadian cities 

Hospital Admissions 

Health Outcome (ICD9):

Actue bronchitis/bronchiolitis 

(466); pneumonia (480-486); 

chronic/ unspecified bronchitis 

(490, 491); emphysema (492); 

asthma (493); bronchiectasis 

(494); chronic airway 

obstruction (496) 

Study Design: Time series 

Statistical Analyses: 1. Poisson 

2. Restricted Maximum 

Likelihood Method 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.8 ppm 

Range (Min, Max): (0.0, 6.5) 

Copollutant: correlation 

SO2

NO2

O3

Increment: 0.8 ppm 

% Increase (Lower CI, Upper CI); lag: 

Respiratory disease 

CO: 0.60% (0.20, 1); 2.8 

CO, SO2, NO2, O3: -0.20% (-0.70- 0.30); 2.8 

Author: Cheng et al. 

(2007, 093034) 

Period of Study: 

1996-2004 

Location: 

Kaohsiung, Taiwan 

Hospital Admissions 

Health Outcome (ICD9): 

Pneumonia (480-486) 

Study Design: Bidirectional 

case-crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.76 ppm 

Range (Min, Max): (0.14, 1.72) 

Copollutant: correlation 

PM10

SO2

NO2

O3

Increment: 0.31 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

OR for pneumonia and exposure to various pollutants for 

all ages in areas ≥ 25°C or <25°C 

Pollutant and Temperature 

CO, ≥ 25 oC: 1.18 (1.14-1.23); 0-2 

CO, <25 oC: 1.47 (1.41-1.53); 0-2 

CO, PM10, ≥ 25 oC: 1.15 (1.11-1.2); 0-2 

CO, PM10, <25 oC: 1.28 (1.21-1.35); 0-2 

CO, SO2, ≥ 25 oC: 1.22 (1.17-1.27); 0-2 

CO, SO2, <25 oC: 1.49 (1.42-1.56); 0-2 

CO, NO2, ≥ 25 oC: 1.2 (1.15-1.27); 0-2 

CO, NO2, <25 oC: 1.01 (0.95-1.08); 0-2 

CO, O3, ≥ 25 oC: 1.16 (1.12-1.2); 0-2 

CO, O3, <25 oC: 1.44 (1.38-1.5); 0-2 

Author: Chiu et al. 

(2009, 190249) 

Period of Study: 

1996-2004 

Location:

Taipei, Taiwan 

Hospital Admissions 

Health Outcome: pneumonia 

HA 

Study Design: case-crossover 

Statistical Analyses:

Conditional Logistic regression 

Age Groups Analyzed: 

All ages 

Sample Description:

152,594 HA for 47 hospitals in 

Taipei city 

Averaging Time: 24h 

Mean (SD) unit: 1.26 ppm 

Range (min, max): 0.12, 3.66 

Copollutant: correlation 

PM10: r = 0.34 

SO2: r = 0.57 

NO2: r = 0.69 

O3: r = -0.31 

Increment: 0.57 ppm (IQR) 

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: one wk before to one wk after 

CO: 

≥23°C: 1.25 (1.21, 1.29) 

<23°C: 1.12 (1.09, 1.15) 

CO + PM10: 

≥23°C: 1.23 (1.19, 1.27) 

<23°C: 1.05 (1.02, 1.09) 

CO + SO2: 

≥23°C: 1.25 (1.21, 1.30) 

<23°C: 1.27 (1.22,1.31) 

CO + NO2: 

≥23°C: 0.97 (0.93, 1.02) 

<23°C: 1.14 (1.09, 1.20) 

CO + O3: 

≥23°C: 1.24 (1.20, 1.28) 

<23°C: 1.21 (1.17, 1.24) 

January 2010 C-46 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Cho et al. 

(2000, 099051) 

Period of Study: 

1/1996-12/1996 

Location: 

3 South Korea cities: 

Hospital Admissions 

Health Outcome (ICD9): 

Bronchial asthma; COPD; 

bronchitis 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM, LOESS 

Age Groups Analyzed: 

All Ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Daejeon: 1.424 (0.611) ppm 

Ulsan: 0.950 (0.211) ppm 

Suwon: 1.270 (0.549) ppm 

Range (Min, Max): 

Daejeon: (.364, 3.504) 

Ulsan: (.380, 1.675) 

Suwon: (.250, 3.616) 

Copollutant: correlation 

Daejeon 

SO2: r = 0.280; NO2: r = 0.041; 

TSP: r = 0.193; O3: r = -0.101; 

O3 Max: r = -0.069 

Ulsan 

SO2: r = 0.108; NO2: r = 0.446; 

TSP: r = 0.286; O3: r = -0.195; 

O3 Max: r = -0.107 

Suwon 

SO2: r = 0.556; NO2: r = 0.291; 

TSP: r = 0.496; O3: r = -0.371; 

O3 Max: r = -0.365 

Increment: 1,000 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Estimates obtained using dummy variables to apply 

environmental indicators to the model 

Daejeon 

CO: 1.26 (1.08-1.47) 

TSP, SO2, NO2, O3: 1.21 (1.02-1.44) 

Ulsan 

CO: 3.55 (1.65-7.63) 

TSP, SO2, NO2, O3: 2.51 (1.06-5.93) 

Suwon 

CO: 1.24 (0.97-1.59) 

TSP, SO2, NO2, O3: 1.19 (0.88-1.61) 

Estimates obtained using actual measured integrated 

environmental pollution indicator values 

Daejeon 

CO: 1.34 (1.14-1.58) 

Ulsan 

CO: 1.27 (0.94-1.71) 

Suwon 

CO: 3.55 (1.27-9.93) 

Author: Delfino et al. 

(2008, 156390) 

Period of Study:

January 1, 

2000-December 31, 

2003 

Location: Orange 

County, California 

ED Visits 

Health Outcome: Asthma 

Study Design: Longitudinal, 

Cohort 

Statistical Analyses:

Proportional hazards models in 

SAS version 9.2 

Age Groups Analyzed: 0-18 yr 

Sample Description: Various 

gender, race, insurance status, 

income, poverty level, 

residence distance to treating 

hospital 

Averaging Time: NR 

Mean (SD) unit: Cool season:

0.114 (0.052), Warm season: 0.103 

(0.048) 

Range (Min, Max): 

Cool season: 0.014 -0.378, 

Warm season: 0.013-0.482 

Copollutant: NOX

 

Increment: 0.056 ppm 

HR (95% CI): Unadjusted: 1.072 (1.016 – 1.131), 

Adjusted: 1.073 (1.013 – 1.137), Male: 1.054 (0.978 – 

1.137), Female: 1.100 (1.011 – 1.197), 0 yr: 1.158 (1.041 – 

1.289), 1-5 yr: 1.021 (0.933 – 1.117), 6-18 yr: 1.076 (0.972 

– 1.191), Median or less poverty: 1.054 (0.979 – 1.134), 

Greater than the median poverty: 1.094 (1.006 – 1.190), 

Greater than the median income: 1.120 (1.034 – 1.213), 

Median or less income: 1.041 (0.959 – 1.129), Private 

insurance: 1.102 (1.006 – 1.206), Government sponsored 

or self-pay insurance: 1.061 (0.989 – 1.138), Unknown 

insurance: 0.913 (0.591 – 1.412), White: 1.113 (1.027 – 

1.205), Hispanic: 1.081 (0.996 – 1.173), Non-Hispanic 

nonwhite: 0.804 (0.601 – 1.074) 

Lags examined: NR 

The point estimates for CO are stronger in girls than in boy 

and in infants than in older children. There is little 

difference in coefficients between adjusted and unadjusted 

CO models. There were significant increased risks of 

repeated hospital encounters of 7% to 10% per IQR 

increase in traffic-related CO exposure. 

Author: Farhat et al. 

(2005, 089461) 

Period of Study: 

8/1996-8/1997 

Location: 

Sao Paulo, Brazil 

Hospital Visits & ED Visits 

Health Outcome (ICD9):

Pneumonia/bronchopneumonia 

(480-486); asthma (493); 

bronchiolitis (466) 

Study Design: Time-series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit: 3.8 (1.6) ppm 

Range (Min, Max): (1.1, 11.4) 

Copollutant: correlation 

PM10: r = 0.72; 

SO2: r = 0.49; 

NO2: r = 0.59; 

O3: r = -0.8 

Increment: 1.8 ppm 

% Increase (Lower CI, Upper CI); lag: 

Lower Respiratory Tract Disease ED Visits 

CO, PM10: -0.10% (-5.60 to 5.30); 0-2 

CO, NO2: -1.20% (-6.70 to 4.20); 0-2 

CO, SO2: 3.70% (-1.00 to 8.40); 0-2 

CO, O3: 4.80% (0.50-9.10); 0-2 

CO, PM10, NO2, SO2, O3:- 0.64% (-6.90 to 5.60); 0-2 

Pneumonia/ Bronchopneumonia Hospital Admissions 

CO, PM10: 4.40% (-7.90 to 16.70); 0-2 

CO, NO2: 4.40% (-88.70 to 17.50); 0-2 

CO, SO2: 7.80% (-2.50 to 18.20); 0-2 

CO, O3: 9.60% (-0.50 to 19.70); 0-2 

CO, PM10 to NO2, SO2, O3:5.10% (-9.60 to 19.70); 0-2 

Asthma/ Bronchiolitis Hospital Admissions 

CO, PM10: 6.10% (-14.90 to 27.10); 0-2 

CO, NO2: 2.40% (-16.90 to 21.70); 0-2 

CO, SO2: 10.60% (-6.60 to 27.80); 0-2 

CO, O3: 12.40% (-3.60 to 28.40); 0-2 

CO, PM10 to NO2, SO2, O3: 8.80% (-15.60 to 33.30); 0-2 

January 2010 C-47 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Fung et al. 

(2006, 089789) 

Period of Study: 

6/1995-3/1999 

Location: 

Vancouver, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory Illness 

Study Design: 

1. Dewanji and Moolgavkar 

2. Time-series 

3. Bidirectional case-crossover 

Statistical Analyses: 

1. Dewanji and Moolgavkar 

2. Poisson 

3. Conditional logistic 

regression 

Age Groups Analyzed: ≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.69 0.25) ppm 

Range (Min, Max): (0.28, 2.03) 

Copollutant: correlation 

CoH: r = 0.85; O3: r = -0.53; 

NO2: r = 0.74; SO2: r = 0.61; 

PM10: r = 0.46; PM2.5: r = 0.23; 

PM10-2.5: r = 0.51 

Increment: 0.24 ppm 

Relative Risk (Lower CI, Upper CI); lag 

Dewanji and Moolgavkar 

1.008 (0.997-1.02); 0 

1.012 (0.999-1.025); 0-2 

1.010 (0.995-1.025); 0-4 

1.009 (0.991-1.026); 0-6 

Time-series 

1.012 (1.000-1.023); 0 

1.017 (1.003-1.032); 0-2 

1.017 (1.001-1.035); 0-4 

1.016 (0.996-1.036); 0-6 

Bidirectional case-crossover 

1.010 (0.006-1.023); 0 

1.012 (0.996-1.027); 0-2 

1.012 (0.995-1.03); 0-4 

1.010 (0.991 1.031; 0-6 

Author: Fusco et al. 

(2001, 020631) 

Period of Study:

1/1995 10/1997 

Location: 

Rome, 

Italy 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory conditions (460-

519, excluding 470-478); acute 

respiratory infections plus 

pneumonia (460-466, 480-486); 

COPD (490-492, 494-496) 

asthma (493) 

Study Design: Time-series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 

All ages 

0-14 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 3.6 (1.2) mg/m3

IQR (25th, 75th): (2.8, 4.3) 

Copollutant: correlation 

All Year 

SO2: r = 0.56 

NO2: r = 0.31 

O3: r = -0.57 

Cold Season 

SO2: r = 0.37 

NO2: r = 0.41 

O3: r = -0.44 

Warm Season 

SO2: r = 0.44 

NO2: r = 0.59 

O3: r = -0.38 

Increment: 1.5 mg/m3

% Increase (Lower CI, Upper CI); lag: 

Age Group: All Ages 

Respiratory conditions 

2.80% (1.30-4.30); 0 

1.80% (0.20-3.30); 1 

0.20% (-1.30 to 1.80); 2 

0.50% (-2.00 to 1.10); 3 

0.70% (-0.80 to 2.20); 4 

CO, NO2: 2.30% (0.60-4.00); 0 

Acute Respiratory Infections plus pneumonia 

2.20% (0.00-4.40); 0 

2.10% (-0.10 to 4.40); 0 

1.70% (-0.50 to 4.00); 2 

-0.90% (-3.00 to 1.30); 3 

1.50% (-0.70 to 3.70); 4 

CO, NO2: 0.00% (-2.30 to 2.40); 0 

Asthma 

5.50% (0.90-10.40); 0 

0.80% (-3.80 to 5.70); 1 

-1.30% (-5.90 to 3.50); 2 

-3.00% (-7.40 to 1.60); 3 

0.60% (-4.00 to 5.30); 4 

CO, NO2: 4.80% (0.30-9.50); 0 

COPD 

4.30% (1.60-7.10); 0 

-0.20% (-2.90 to 2.50); 1 

-0.20% (-2.90 to 2.60); 2 

-0.30% (-3.00 to 2.40); 3 

-0.10% (-2.80 to 2.60); 4 

CO, NO2: 4.80% (0.90-7.90); 0 

Warm Season 

Respiratory Conditions: 

10.80% (6.70-14.80); 0 

Acute respiratory infections plus pneumonia: 

8.60% (2.90-14.60); 0 

COPD: 

13.90% (6.80-21.50); 0 

Age Group: 0-14 

Respiratory conditions 

2.50 (-0.30 to 5.50); 0 

0.80 (-2.10 to 3.80); 1; 

0.20 (-2.70 to 3.10); 2 

-1.00 (-3.70 to 1.90); 3 

3.20 (0.40- 6.20); 4 

CO, NO2: 4.10 (-1.20 to 9.80); 1 

Acute Respiratory Infections plus Pneumonia 

2.50 (-0.80 to 5.80); 0 

-0.10 (-3.40 to 3.20); 1 

0.90 (-2.30 to 4.30); 2 

-2.00 (-5.10 to 1.20); 3 

3.20 (0.00-6.60); 4 

CO, NO2: 6.90 (0.80-13.40); 1 

Asthma 

6.30 (-0.50 to 13.50); 0 

8.20 (1.10-15.70); 1; 

-0.70 (-7.30 to 6.30); 2 

January 2010 C-48 
Study Design Concentrations Effect Estimates (95% CI) 

3.50 (-3.20 to 10.60); 3; 

4.80 (-1.90 to 12.00); 4 

CO, NO2: 3.30 (-4.20 to 11.30); 1 

Author: Gouveia and 

Fletcher (2000, 

010436) 

Period of Study:

11/1992-9/1994 

Location: Sao Paulo, 

Brazil 

Hospital Admissions 

Health Outcome (ICD9): All 

respiratory diseases 

Pneumonia (480-486); asthma 

(493); bronchitis (466, 490, 

491) 

Study Design: Time-series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

<1 yr; <5 yr 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit: 5.8 (2.4) ppm 

Range (Min, Max): (1.3, 22.8) 

Copollutant: correlation 

PM10: r = 0.63 

SO2: r = 0.65 

NO2: r = 0.35 

Increment: 6.9 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

All respiratory diseases 

Age Group: 

<5: 1.017 (0.971-1.065); 0 

Pneumonia 

Age Group: 

<5: 1.015 (0.961-1.071); 0; 

<1: 1.035 (0.975-1.099); 2 

Asthma 

Age Group: 

<5: 1.081 (0.98-1.192); 0 

Author: Hajat et al. 

(1999, 000924) 

Period of Study:

1/1992-12/1994 

Location:

London, 

U.K. 

General Practitioner Visits 

Health Outcome (ICD9): 

Asthma (493); lower respiratory 

diseases (464, 466, 476, 480-

483, 485-487, 490-492, 494-

496, 500, 501, 503-505, 510-

515, 518, 519, 786) 

Study Design: Time-series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

All ages 

0-14 yr 

15-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

All yr: 0.8 (0.4) ppm 

Warm Season 

(April-September): 0.7 (0.3) ppm 

Cool Season 

(October-March): 1.0 (0.5) ppm 

Range (10th, 90th):

All Year: (0.5, 1.3) 

Warm Season: (0.4, 1.0) 

Cool Season: (0.5, 1.6) 

Copollutant: correlation 

All Year 

NO2: r = 0.72; 

SO2: r = 0.51; 

BS: r = 0.85; 

O3: r = -0.40; 

PM10: r = 0.56 

Warm Season 

NO2: r = 0.70; 

SO2: r = 0.32; 

BS: r = 0.65; 

O3: r = -0.12; 

PM10: r = 0.58 

Cool Season 

NO2: r = 0.84; 

SO2: r = 0.58; 

BS: r = 0.87 

Increment: 0.8 & 0.7 ppm 

% Increase (Lower CI, Upper CI); Lag 

All Year: 

Asthma – Single Day Lags 

Increment: 0.8 ppm 

Age Group 

0-14: 4.10% (-0.10 to 8.40); 2 

15-64: 0.90% (-2.10 to 4.10); 0 

≥ 65: 7.50% (0.50-14.90); 2 

All ages: 1.60% (-1.20 to 4.60); 2 

Asthma – Cumulative exposure 

Increment: 0.7 ppm 

Age Group 

0-14: 6.90% (1.30-12.90); 0-3 

15-64: 1.00% (-3.20 to 5.40); 0-2 

≥ 65: 8.20% (0.40-16.60); 0-2 

All ages: 1.80% (-1.50 to 5.20); 0-2 

Lower Respiratory Diseases – Single Day Lags 

Increment: 0.8 ppm 

Age Group 

0-14: 4.40 (1.70-7.10); 2 

15-64: 1.10 (-0.70 to 3.00); 2 

≥ 65: -2.60 (-4.80 to -0.30); 3 

All ages: 2.00 (0.50-3.40); 2 

Lower Respiratory Diseases – Cumulative exposure 

Increment: 

0.7 ppm for 0-2 and 0-3; 0.8 for 0-1 

Age Group 

0-14: 3.00% (-1.00 to 7.20); 0-3 

15-64: -0.70% (-2.90 to 1.50); 0-1 

≥ 65: -1.60% (-5.10 to 2.00); 0-3 

All ages: 1.80% (0.10-3.60); 0-2 

Warm or Cold Seasons: 

Asthma, Increment: 0.8 ppm 

Age Group & Season 

0-14 & Warm Season: 11.40% (3.30-20.00); 2 

0-14 & Cold Season: 2.90% (-3.20 to 9.40); 2 

15-64 & Warm Season: 4.80% (-0.60 to 10.60); 0 

15-64 & Cold Season: -0.30% (-4.80 to 4.50); 0 

≥ 65 & Warm Season: 15.60% (3.10-29.60); 2 

≥ 65 & Cold Season: 4.20% (-6.00 to 15.60); 2 

Lower Respiratory Diseases, Increment: 0.8 ppm 

Age Group & Season 

0-14 & Warm Season: 2.70% (-2.90 to 8.60); 2 

0-14 & Cold Season: 6.20% (2.30-10.20); 2 

15-64 & Warm Season: 6.20% (2.30-10.20); 2 

15-64 & Cold Season: 2.40% (-1.20 to 6.10); 2 

≥ 65 & Warm Season: 1.00% (-1.60 to 3.80); 2 

≥ 65 & Cold Season: -2.20% (-6.50 to 2.40); 3 

January 2010 C-49 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Hajat et al. 

(2002, 030358) 

Period of Study: 

1/1992-12/1994 

Location:

London, U.K. 

General Practitioner Visits 

Health Outcome (ICD9):

Upper respiratory diseases 

(URD) 

Study Design: Time-series 

Statistical Analyses: 

Poisson, GAM, LOESS 

Age Groups Analyzed: 

0-14 yr 

15-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

All yr: 0.8 (0.4) ppm 

Warm Season (April-September): 

0.7 (0.3) ppm 

Cool Season (October-March): 

1.0 (0.5) ppm 

Range (10th, 90th): 

All Year: (0.5, 1.3) 

Warm Season: (0.4, 1.0) 

Cool Season: (0.5, 1.6) 

Copollutant: NR 

Increment: 0.6 ppm, 0.8 ppm, & 1.1 ppm 

% Increase (Lower CI, Upper CI); lag: 

Warm Season, Increment: 0.6 ppm 

Age Group 

0-14: 2.90% (-0.60 to 6.40); 1 

14-64: 7.90% (4.80-11.10); 1 

≥ 65: 4.90% (-1.80 to 12.10); 3 

Cold Season, Increment: 1.1 ppm 

Age Group 

0-14: -2.50% (-4.90 to 0.10); 1 

14-64: 0.60% (-1.60 to 2.90); 1 

≥ 65: 5.60% (0.90-10.60); 3 

All Year, Increment: 0.8 ppm 

Age Group 

0-14: -2.20% (-4.00 to -0.30); 1 

14-64: 2.70% (0.10-5.50); 1 

≥ 65: 5.80% (2.40 to 9.30); 3 

Author: Hapcioglu et 

al. (2006, 093263) 

Period of Study: 

1/1997-12/2001 

Location: 

Istanbul, 

Turkey 

Hospital Admissions 

Health Outcome (ICD9): 

COPD (490-492, 494-496) 

Study Design: Cross sectional 

Statistical Analyses: 

Pearson Correlation Coefficient 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Monthly 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Correlation Coefficient: 

Between CO exposure and COPD: 0.57 

Between CO exposure and COPD when controlling for 

temperature: 0.25 

Author: Hinwood et 

al. (2006, 088976) 

Period of Study: 

1/1992-12/1998 

Location: 

Perth, 

Australia 

Hospital Admissions 

Health Outcome (ICD9):

COPD (490.00-496.99 

excluding asthma); pneumonia/ 

influenza (480.00-489.99); 

Asthma (493) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit:

All Year: 2.3 (1.3) ppm; 

November-April: 2.2 (1.3) ppm; 

May-October: 2.4 (1.2) ppm 

Range (10th, 90th):

All Year: (0.9, 4.2) 

November-April: (0.8, 4.2) 

May-October: (1.1, 4.2) 

Copollutant: correlation 

All Year: 

NO2: r = 0.57 

O3: r = 0.00 

November-April: 

NO2: r = 0.55 

O3: r = 0.00 

May-October: 

NO2: r = 0.57 

O3: r = 0.16 

Increment: 2.3 ppm 

Odds Ratio (Lower CI, Upper CI); Lag 

Pneumonia 

0.99999 (0.9737-1.0268); 0 

1.00650 (0.9806-1.0331); 1 

1.00351 (0.9779-1.0298); 2 

1.00424 (0.9790-1.0301); 3 

1.00581 (0.9752-1.0374); 0-1 

1.01005 (0.9755-1.0458); 0-2 

1.00805 (0.9701-1.0474); 0-3 

COPD 

0.99915 (0.9693-1.0297); 0 

1.00205 (0.9727-1.0323); 1 

0.98630 (0.9577-1.0158); 2 

0.98970 (0.9619-1.0182); 3 

0.99960 (0.9647-1.0357); 0-1 

0.99260 (0.9538-1.0329); 0-2 

0.99160 (0.9493-1.0357); 0-3 

Author: Hwang and 

Chan (2002, 023222) 

Period of Study: 

1998 

Location:

50 communities in 

Taiwan 

Clinic Visits 

Health Outcome (ICD9): 

Lower respiratory tract 

infections (466, 480-486) 

Study Design: Time series 

Statistical Analyses: 

1. General linear regression 

2. Bayesian hierarchical 

modeling 

Age Groups Analyzed: 

All Ages 

0-14 yr 

15-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit: 1.00 (0.30) ppm 

Range (Min, Max): (0.51, 1.71) 

Copollutant: NR 

Increment: 0.1 ppm 

% Increase (Lower CI, Upper CI); Lag 

Age Group: All Ages 

0.80% (0.60-1.00); 0 

0.10% (-0.10 to 0.30); 1 

0.10% (-0.10 to 0.30); 2 

Age Group: 0-14 

0.70% (0.50-1.00); 0 

0.10% (-0.20 to 0.30); 1 

0.20% (-0.10 to 0.40); 2 

Age Group: 15-64 

0.90% (0.60-1.10); 0 

0.20% (0.00-0.50); 1 

0.20% (-0.10 to 0.40); 2 

Age Group: ≥ 65 

1.10% (0.80-1.50); 0 

0.60% (0.30-1.00); 1 

0.40% (0.10-0.80); 2 

January 2010 C-50 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Ito et al. 

(2007, 091262) 

Period of Study: 

1999-2002 

Location: 

New York City, NY 

ED Visits 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses: Poisson 

GLM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit:

All Season: 1.31 (0.43) ppm 

Warm Months (April-September): 

1.22 (0.32) ppm 

Cold Months (October-March): 

1.41 (0.5) ppm 

Range (5th, 95th):

All season: (0.77, 2.11) 

Warm months (April-September): 

(0.75, 1.82) 

Cold months (October-March): 

(0.78, 2.33) 

Copollutant: NR 

Increment: 1.3 ppm 

Relative Risk (Lower CI, Upper CI); Lag 

Warm months: 1.15 (1.07-1.25); 0-1 

Author: Jayaraman et 

al. (2008, 180352) 

Period of Study: 

2004-2005 

Location:

New Delhi, India 

Hospital Admissions 

Health Outcome: respiratory 

Study Design: time series 

Statistical Analyses: Poisson 

regression (GAM) 

Age Groups Analyzed: 

All ages 

Sample Description: 

daily HA for respiratory unit of 

Safdarjung hospital 

Averaging Time: 24-h 

Mean (SD) unit: 

2,379.14 (1,289.18) μg/m3

Range (min, max): 588, 8458 

Copollutant: 

SO2: r = 0.217* 

NO2: r = 0.204* 

SPM: r = 0.071 

RSPM: r = 0.120 

O3: r = 0.063 

*p < 0.05 

Increment: 10 μg/m3

RR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: lag days 0-3 

 Single Pollutant: 0.9989 (0.985, 2.715), 2 

Multi-pollutant: 0.998 (0.993, 1.004), 2 

Winter, all ages: 1.027 (1.004, 1.051), 2 

Winter, males 50-69: 2.625 (1.048, 1.158) 

Author: Karr et al. 

(2007, 090719) 

Period of Study: 

1995-2000 

Location:

South Coast Air Basin, 

CA 

Hospital Admissions 

Health Outcome (ICD9): 

Acute bronchiolitis (466.1) 

Study Design: Matched case 

control 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: 

Infants: 3 wk to 1 yr 

Pollutant:CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Chronic: 1,770 ppb 

Subchronic: 1,720 ppb 

Range (Min, Max): 

Chronic: (120, 8300) 

Subchronic: (130, 5070) 

Copollutant: NR 

Increment: 910 ppb, 960 ppb 

Odds Ratio (Lower CI, Upper CI); lag: 

Increment: 910 ppb 

Subchronic broncholitis: 1 (0.97-1.03) 

Increment: 960 ppb 

Chronic broncholitis: 1 (0.97-1.03) 

Author: Karr et al. 

(2006, 088751) 

Period of Study: 

1995-2000 

Location:

South Coast Air Basin, 

CA 

Hospital Admissions 

Health Outcome (ICD9): 

Acute bronchiolitis (466.1) 

Study Design: Case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed:

Infants: 3 wk to1 yr 

Pollutant:CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

1-day lag: 

Index*: 1,730 ppb 

Referent*: 1,750 ppb 

 4-day lag: 

Index*: 1,760 ppb 

Referent*: 1,790 ppb 

Range (Min, Max):

Lag 1: 

Index*: (4, 9600) Referent*: (4, 9600) 

Lag 4: 

Index* (4, 8710) Referent* (4, 9600) 

Copollutant: NR 

* Index days: days lagged in 

reference to date of hospitalization of 

a case. 

Referent days: are for each case and 

includes all days that are the same 

day of wk and in the same mo as the 

index day for that case for CO. 

Increment: 1361, 1400 ppb 

Odds Ratio (Lower CI, Upper CI); Lag 

Increment: 1361 ppb 

Age Group: 

Overall: 0.99 (0.96-1.02); 1 

25-29 wk: 0.86 (0.68-1.1); 1 

29 1/7 – 34 wk: 1 (0.86-1.15); 1 

34 1/7 – 37 wk: 0.95 (0.87-1.04); 1 

37 1/7 – 44 wk: 1 (0.97-1.03); 1 

Increment: 1400 ppb 

Age Group: 

Overall: 0.97 (0.94-1); 4 

25-29 wk: 0.93 (0.72-1.2); 4 

29 1/7 – 34 wk: 0.89 (0.77-1.03); 4 

34 1/7 – 37 wk: 0.98 (0.90-1.08); 4 

37 1/7 – 44 wk: 0.97 (0.94-1); 4 

January 2010 C-51 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Kim et al. 

(2007, 092837) 

Period of Study: 

2002 

Location: 

Seoul, 

Korea 

Hospital Admissions 

Health Outcome (ICD10):

Asthma (J45 and J46) 

Study Design: 

Bidirectional case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: 

All Ages 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit:

Daily Concentration: 8.6 (4.6) ppm 

Relevant Concentration: 

2.8 (2.8) ppm 

Range (Min, Max):

Daily Concentration: (0.8, 44.0) 

Relevant Concentration: (0.0, 30.4) 

Copollutant: NR 

Relative Risk (Lower CI, Upper CI); lag: 

Individual Level SEP 

Quintile 1: 1.06 (1.02-1.09); 1-3 ma 

Quintile 2: 1.05 (1.02-1.09); 1-3 ma 

Quintile 3: 1.05 (1.01-1.08); 1-3 ma 

Quintile 4: 1.07 (1.03-1.11); 1-3 ma 

Quintile 5: 1.05 (1.00-1.09); 1-3 ma 

Regional Level SEP 

Quintile 1: 0.99 (0.92-1.07); 1-3 ma 

Quintile 2: 1.06 (1.02-1.11); 1-3 ma 

Quintile 3: 1.04 (1.02-1.07); 1-3 ma 

Quintile 4: 1.10 (1.06-1.15); 1-3 ma 

Quintile 5: 1.06 (1.03-1.09); 1-3 ma 

Overall: 1.06 (1.04-1.07); 1-3 ma 

Relative Effect Modification for SES 

Individual Level SEP 

Quintile 1: 1 

Quintile 2: 1 (0.95.1.04); 1-3 ma 

Quintile 3: 0.99 (0.94-1.03); 1-3 ma 

Quintile 4: 1.02 (0.97-1.06); 1-3 ma 

Quintile 5: 0.99 (0.94-1.04); 1-3 ma 

Regional Level SEP 

Quintile 1: 1 

Quintile 2: 1.05 (0.97-1.14); 1-3 ma 

Quintile 3: 1.03 (0.96-1.11); 1-3 ma 

Quintile 4: 1.08 (1-1.16); 1-3 ma 

Quintile 5: 1.05 (0.97-1.13); 1-3 ma 

Author: Kontos et al. 

(1999, 011326) Period 

of Study: 

1/1987-12/1992 

Location: 

Piraeus, Greece 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory conditions 

(laryngitis, bronchiolitis, 

tonsillitis, acute 

rhinopharyngitis, otitis, 

bronchopneumonia, 

pneumonia, asthma) 

Study Design: Time series 

Statistical Analyses:

Stochastic dynamical system 

approach 

Age Groups Analyzed: 0-14 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean Range (SD) unit:

1987: 4.2 mg/m3 

1992: 3.6 mg/m3

Range (Min, Max): NR 

Copollutant: correlation 

1987-1989 

Smoke: r = 0.2979; 

SO2: r = 0.2166; 

NO2: r = 0.1913 

1990-1992 

Smoke: r = 0.5383; 

SO2: r = 0.43283; 

NO2: 0.5223 

This study did not present quantitative results for CO. 

Author: Lee et al. 

(2002, 034826) 

Period of Study:

12/1997-12/1999 

Location: 

Seoul, Korea 

Hospital Admissions 

Health Outcome (ICD10):

Asthma (J45, J46) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: <5 yr 

Pollutant: CO 

Averaging Time: 1-h max 

Mean Range (SD) unit: 

1.8 (0.7) ppm 

IQR (25th, 75th): (1.2, 2.2) 

Copollutant: correlation 

PM10: r = 0.598 

SO2: r = 0.812 

NO2: r = 0.785 

O3: r = -0.388 

Increment: 1.0 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

RR for asthma and exposure to various pollutants for 

children under 15 yr old 

Pollutant: 

CO: 1.16 (1.10-1.22); 2-3 avg 

CO, PM10: 1.13 (1.07-1.20); 2-3 avg 

CO, SO2: 1.17 (1.08-1.27); 2-3 avg 

CO, NO2: 1.04 (0.95-1.14); 2-3 avg 

CO, O3: 1.16 (1.11-1.22); 2-3 avg 

CO, O3, PM10: 1.148 (1.084-1.217); 2-3 avg 

CO, O3, PM10, SO2: 1.168 (1.075-1.269); 2-3 avg 

CO, O3, PM10, SO2, NO2: 1.098 (0.994-1.214); 2-3 avg 

January 2010 C-52 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Lee et al. 

(2006, 098248) 

Period of Study: 

1/2002-12/2002 

Location: 

Seoul, 

Korea 

Hospital Admissions 

Health Outcome (ICD10):

Asthma (J45-46) 

Study Design: Time series 

Statistical Analyses: 

GAM with stringent parameters 

Age Groups Analyzed: <15 yr 

Pollutant: CO 

Averaging Time: 

Maximum 2-h avg 

Mean (SD) unit: 

High SES: 6.08 (2.10) ppb 

Moderate SES: 6.35 (2.44) ppb 

Low SES: 6.67 (2.59) ppb 

Range (Min, Max): NR 

Copollutant: correlation 

NO2: r = 0.55 

SO2: r = 0.72 

PM10: r = 0.28 

O3: r = -0.36 

Increment: 3.01 ppb, 0.26 ppb, 4.52 ppb, 3.68 ppb 

Relative Risk (Lower CI, Upper CI); lag: 

Increment: 3.01 ppb 

Overall: 1.07 (0.96-1.20); 0 

Increment: 0.26 ppb 

High SES: 1.06 (0.96-1.17); 0 

Increment: 4.52 ppb 

Moderate SES: 0.96 (0.84-1.10); 0 

Increment: 3.68 ppb 

Low SES: 1.02 (0.85-1.24); 0 

Author: Lee et al. 

(2007, 090707) 

Period of Study: 

1996-2003 

Location: 

Kaohsiung, Taiwan 

Hospital Admissions 

Health Outcome (ICD9): 

COPD (490-492, 494, 496) 

Study Design: Bidirectional 

case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.77 ppm 

Range (Min, Max): (0.23, 1.72) 

Copollutant: 

PM10

SO2

NO2

O3

Increment: 0.29 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

CO 

<25°C: 1.398 (1.306-1.496); 0-2 

≥ 25°C: 1.189 (1.123-1.259); 0-2 

CO. PM10

<25°C: 1.257 (1.152-1.371); 0-2 

≥ 25°C: 1.149 (1.079-1.224); 0-2 

CO, SO2

<25°C: 1.396 (1.295-1.504); 0-2 

≥ 25°C: 1.241 (1.161-1.326); 0-2 

CO, NO2

<25°C: 0.973 (0.877-1.080); 0-2 

≥ 25°C: 1.196 (1.104-1.297); 0-2 

CO, O3

<25°C: 1.378 (1.286-1.477); 0-2 

≥ 25°C: 1.170 (1.105-1.239); 0-2 

Author: Lin et al. 

(1999, 040437) 

Period of Study: 

5/1991-4/1993 

Location: 

Sao Paulo, Brazil 

ED Visits 

Health Outcome (ICD9):

Respiratory illness (lower 

respiratory illness, upper 

respiratory illness, wheezing) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: <3 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 5 ppm 

Range (Min, Max): (1, 12) 

Copollutant: correlation 

PM10: r = 0.50 

NO2: r = 0.35 

SO2: r = 0.56 

O3: r = 0.04 

Increment: NR 

Relative Risk (Lower CI, Upper CI); lag: 

Overall Respiratory Illnesses 

CO: 1.206 (1.066-1.364); 0-5 

CO, PM10, O3, SO2, NO2: 0.945 (0.808-1.105); 0-5 

Lower Respiratory Illness 

CO: 1.203 (0.867-1.669); 0-5 

CO, PM10, O3, SO2, NO2: 0.971 (0.641-1.472); 0-5 

Upper Respiratory Illness 

CO: 1.237 (1.072-1.428); 0-5 

CO, PM10, O3, SO2, NO2: 0.944 (0.785-1.135); 0-5 

Wheezing 

CO: 0.813 (0.606-1.091); 0-5 

CO, PM10, NO2, SO2, O3: 0.74 (0.505-1.085); 0-5 

January 2010 C-53 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Lin et al. 

(2003, 042549) 

Period of Study: 

1/1981-12/1993 

Location: 

Toronto, ON, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 6-12 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.18 (0.50) ppm 

Range (Min, Max): (0, 6.10) 

Copollutant: correlation 

SO2: r = 0.37 

NO2: r = 0.55 

O3: r = -0.16 

PM2.5: r = 0.45 

PM10-2.5: r = 0.17 

PM10: r = 0.38 

Increment: 0.5 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Boys: 

Adjusting for Daily Weather Variables 

1.05 (1-1.11); 1 / 1.07 (1.01-1.14); 2 

1.08 (1.01-1.16); 3 / 1.08 (1-1.17); 4 

1.07 (0.99-1.16); 5 / 1.07 (0.98-1.17); 6 

1.07 (0.98-1.17); 7 

Adjusting for PM and Daily Weather Variables 

1.05 (0.99-1.11); 1 / 1.08 (1.01-1.16); 2 

1.09 (1.01-1.18); 3 / 1.10 (1.02-1.20); 4 

1.09 (1.00-1.18); 5 / 1.09 (0.99-1.19); 6 

1.09 (0.99-1.20); 7 

Girls: 

Adjusting for Daily Weather Variables 

1.00 (0.93-1.06); 1 / 1.01 (0.94-1.10); 2 

1.00 (0.91-1.09); 3 / 0.98 (0.89-1.09); 4 

1.01 (0.91-1.13); 5 / 1.03 (0.92-1.16); 6 

1.04 (0.93-1.17); 7 

Adjusting for PM and Daily Weather Variables 

1.00 (0.93-1.07); 1 / 1.01 (0.92-1.10); 2 

0.99 (0.90-1.09); 3 / 0.97 (0.87-1.08); 4 

0.99 (0.89-1.11); 5 / 1.02 (0.90-1.15); 6 

1.05 (0.93-1.20); 7 

Author: Lin et al. 

(2004, 055600) 

Period of Study: 

1/1987-12/1998 

Location: 

Vancouver, BC 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses: 

GAM, LOESS 

Age Groups Analyzed: 6-12 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.96 (0.52) ppm 

Range (Min, Max): (0.23, 4.90) 

Copollutant: correlation 

SO2: r = 0.67 

NO2: r = 0.73 

O3: r = -0.35 

Increment: 0.5 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Boys 

High SES: 

1.06 (0.98-1.14); 1 / 1.06 (0.97-1.15); 2 

1.07 (0.97-1.17); 3 / 1.03 (0.93-1.14); 4 

1.01 (0.91-1.12); 5 / 1.01 (0.91-1.13); 6 

1.06 (0.94-1.18); 7 

Low SES: 

1.06 (0.99-1.14); 1 / 1.03 (0.95-1.12); 2 

1.01 (0.93-1.11); 3 / 0.99 (0.90-1.09); 4 

0.96 (0.87-1.06); 5 / 0.98 (0.88-1.08); 6 

0.98 (0.88-1.09); 7 

Girls 

High SES: 

1.05 (0.94-1.16); 1 / 1.02 (0.90-1.15); 2 

0.97 (0.85-1.11); 3 / 0.95 (0.83-1.10); 4 

0.93 (0.80-1.08); 5 / 0.95 (0.82-1.11); 6 

1.01 (0.87-1.19); 7 

Low SES: 

1.01 (0.92-1.11); 1 / 0.98 (0.89-1.10); 2 

0.99 (0.88-1.11); 3 / 1.05 (0.93-1.19); 4 

1.07 (0.94-1.21); 5 / 1.07 (0.94-1.23); 6 

1.04 (0.91-1.20); 7 

Author: Lin et al. 

(2005, 087828) 

Period of Study: 

1998-2001 

Location: 

Toronto, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory infections (464, 

466, and 480-487) 

Study Design: 

Bidirectional case crossover 

Statistical Analyses: 

Conditional logistic regression 

Age Groups Analyzed: <5 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.16 (0.38) ppm 

Range (Min, Max): (0.38, 2.45) 

Copollutant: correlation 

PM2.5: r = 0.10 

PM10-2.5: r = 0.06 

PM10: r = 0.10 

SO2: r = 0.12 

NO2: r = 0.20 

O3: r = -0.11 

Increment: 0.44 ppm 

Odds Ratio (Lower CI, Upper CI); Lag 

Boys 

No adjustment: 

1.11 (1.01-1.22); 0-3 / 1.10 (1.00-1.22); 0-5 

Adjustment for weather variables: 

1.13 (1.03-1.24); 0-3 / 1.13 (1.02-1.25); 0-5 

Adjustment for weather variables and PM: 

1.08 (0.98-1.20); 0-3 / 1.08 (0.97-1.20); 0-5 

Girls 

No adjustment: 

0.99 (0.89-1.10); 0-3 / 1.00 (0.89-1.13); 0-5 

Adjustment for weather variables: 

1.02 (0.92-1.14); 0-3: / 1.05 (0.93-1.18); 0-5 

Adjustment for weather variables and PM: 

1.01 (0.90-1.13); 0-3 / 1.02 (0.90-1.15); 0-5 

Total 

No adjustment: 

1.06 (0.98-1.14); 0-3 / 1.06 (0.98-1.15); 0-5 

Adjustment for weather variables: 

1.09 (1.01-1.17); 0-3 / 1.10 (1.01-1.19); 0-5 

Adjustment for weather variables and PM: 

1.05 (0.97-1.14); 0-3 / 1.06 (0.97-1.15); 0-5 

January 2010 C-54 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Linn et al. 

(2000, 002839) 

Period of Study: 

1992-1995 

Location:

Los Angeles, CA 

Hospital Admissions 

Health Outcome (ICD9): 

APR-DRG Codes: Pulmonary 

(75-101); COPD (88) 

ICD9 Codes: Asthma (493) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

0-29 yr; ≥ 30 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Winter 1.7 (0.8) ppm 

Spring 1.0 (0.3) ppm 

Summer 1.2 (0.4) ppm 

Fall 2.1 (0.8) ppm 

Range (Min, Max):

Winter: (0.5, 5.3) 

Spring: (0.4, 2.2) 

Summer: (0.3,2.7) 

Fall: (0.6, 4.3) 

Copollutant: correlation 

Winter 

NO2: r = 0.89; PM10: r = 0.78; 

O3: r = -0.43 

Spring 

NO2: r = 0.92; PM10: r = 0.54; 

O3: r = 0.29 

Summer 

NO2: r = 0.94; PM10: r = 0.72; 

O3: r = 0.03 

Fall 

NO2: r = 0.84; PM10: r = 0.58; 

O3: r = -0.36 

Increment: 1.0 ppm 

β (SE); lag: 

Pulmonary 

Age Group: ≥ 30 

All Year: 0.007 

Winter: 0.016 

Spring: 0.014 

Summer: 0.020 

Fall: 0.020 

Asthma 

Age Group 0-29 

All Year: 0.036 

Asthma 

Age Group: ≥ 30; 

All Year: 0.028 

Winter: 0.045 

Fall: 0.039 

COPD 

Age Group: ≥ 30 

All Year: 0.019 

Winter: 0.035 

Fall: 0.029 

January 2010 C-55 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Luginaah et 

al. (2005, 057327) 

Period of Study: 

4/1995-12/2000 

Location: 

Windsor, ON, Canada 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory illness (460-519) 

Study Design: 

Time series and case crossover 

Statistical Analyses: 

1. Time-series: Poisson 

2. Case-crossover: conditional 

logistic regression 

Age Groups Analyzed: 

All ages 

0-14 yr 

15-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 1-h max 

Mean (SD) unit: 1.3 (1.0) ppm 

Range (Min, Max): (0, 11.82) 

Copollutant: correlation 

NO2: r = 0.38 

SO2: r = 0.16 

O3: r = 0.10 

CoH: r = 0.31 

PM10: r = 0.21 

Increment: 1.17 ppm 

Relative Risk (Lower CI, Upper CI); Lag 

Females and Case-crossover study design 

Age Group: All ages: 

1.037 (0.968-1.111); 1 

1.063 (0.976-1.158); 2 

1.087 (0.982-1.203); 3 

Age Group: 0-14: 

1.147 (1.006-1.307); 1 

1.186 (1.020-1.379); 2 

1.221 (1.022-1.459); 3 

Age Group: 15-64: 

1.005 (0.884-1.141); 1 

1.007 (0.859-1.181); 2 

1.032 (0.858-1.240); 3 

Age Group: ≥ 65: 

1.014 (0.922-1.116); 1 

1.024 (0.907-1.156); 2 

1.035 (0.893-1.200); 3 

Males and Case-crossover study design 

Age Group: All Ages: 

0.950 (0.884-1.020); 1 

0.945 (0.862-1.036); 2 

0.965 (0.866-1.075); 3 

Age Group: 0-14: 

1.003 (0.904-1.113); 1 

0.997 (0.871-1.141); 2 

0.970 (0.824-1.141); 3 

Age Group: 15-64: 

1.036 (0.870-1.233); 1 

1.033 (0.821-1.299); 2 

0.991 (0.760-1.293); 3 

Age Group: ≥ 65: 

0.867 (0.775-0.970); 1 

0.865 (0.752-0.994); 2 

0.946 (0.807-1.109); 3 

Female and Time-series study design 

Age Group: All Ages: 

1.049 (0.993-1.108); 1 

1.032 (0.993-1.188); 2 

1.051 (0.993-1.112); 3 

Age Group: 0-14: 

1.077 (0.979-1.184); 1 

1.068 (1.001-1.139); 2 

1.100 (0.997-1.213); 3 

Age Group: 15-64: 

1.072 (0.962-1.195); 1 

1.025 ( 0.944-1.112); 2 

1.081 (0.963-1.213); 3 

Age Group: ≥ 65: 

1.029 (0.957-1.118); 1 

1.030 (0.928-1.144); 2 

1.013 (0.899-1.142); 3 

Male and Time-series study design 

Age Group: All Ages: 

0.989 (0.932-1.049); 1 

0.986 (0.946-1.029); 2 

0.987 (0.929-1.048); 3 

Age Group: 0-14: 

1.034 (0.949-1.126); 1 

0.996 (0.933-1.062); 2 

0.968 (0.881-1.064); 3 

Age Group: 15-64: 

0.994 (0.854-1.157); 1 

0.988 (0.884-1.104); 2 

0.951 (0.806-1.121); 3 

Age Group: ≥ 65: 

0.901 (0.817-0.994); 1 

0.904 (0.803-1.019); 2 

0.963 (0.845-1.098); 3 

January 2010 C-56 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Martins et al. 

(2002, 035059) 

Period of Study: 

5/1996-9/1998 

Location: 

Sao Paulo, Brazil 

ED Visits 

Health Outcome (ICD10):

Chronic lower respiratory 

disease (CLRD: J40-47) for 

chronic bronchitis, emphysema, 

other COPD, asthma, and 

bronchiectasia 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: >64 yr 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Mean (SD) unit: 3.7 (1.7) ppm 

Range (Min, Max): (1.0, 12.6) 

Copollutant: correlation

NO2: r = 0.62; 

SO2: r = 0.51; 

PM10: r = 0.73; 

O3: r = 0.07 

Increment: 1.63 ppm 

β (SE); lag: 

Chronic Lower Respiratory Diseases 

Age Group 

>64: 0.0489 (0.0274); 2 

Author: Masjedi et al. 

(2003, 052100) 

Period of Study: 

9/1997-2/1998 

Location: 

Tehran, Iran 

ED Visits 

Health Outcome (ICD9): 

Total acute respiratory 

conditions; asthma (493); 

COPD (490-492, 494, 496) 

Study Design: Time series 

Statistical Analyses: 

Multiple step-wise regression 

Age Groups Analyzed: Adults 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 8.85 ppm 

Range (Min, Max): (2.15, 23.8) 

Copollutant: NR 

Increment: NR 

β (p-value); lag; 

Asthma: -0.779 (0.12) 

COPD: 0.012 (0.71) 

Acute Respiratory conditions: -0.086 (0.400) 

Correlation coefficients: 

Mean 3-day CO levels and asthma: -0.300 (0.149) 

Mean weekly CO level and asthma: -0.14 (0.2) 

Mean 10-day CO levels and asthma: -0.05 (0.43) 

Author: McGowan et 

al. (2002, 030325) 

Period of Study:

6/1988- 12/1998 

Location: 

Christchurch, 

New Zealand 

Hospital Admissions 

Health Outcome (ICD9):

Pneumonia (480-487); acute 

respiratory infections (460-466); 

chronic lung diseases (491-492, 

494-496); asthma (493) 

Study Design: Time series 

Statistical Analyses: 

Generalized Additive Model 

Age Groups Analyzed: 

<15 yr; >64 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.16 (1.51) mg/m3

Range (Min, Max): (0, 15.7) 

Copollutant: NR 

This study did not provide quantitative results for CO. 

Author: Migliaretti et 

al. (2007, 193772) 

Period of Study: 

1/1997-12/1999 

Location: 

Turin, Italy 

Hospital Admissions 

Health Outcome (ICD9): 

Respiratory illness (chronic 

bronchitis, emphysema, and 

other COPD) 

(490-496) 

Study Design: Case control 

Statistical Analyses: 

Multiple logistic regression 

Age Groups Analyzed: 

≥ 15 yr 

15-64 yr 

>64 yr 

Pollutant: CO 

Averaging Time: 8-h median 

Median (SD) unit: 3.36 (1.57) mg/m3

Range (Min, Max): NR 

Copollutant: correlation 

TSP 

Increment: 1 mg/m3 

Odds Ratio (Lower CI, Upper CI); lag: 

CO 

Age Group 

≥ 15: 1.053 (1.030-1.070) 

15-64: 1.040 (0.987-1.085) 

>64: 1.054 (1.027-1.083) 

CO , TSP 

Age Group 

≥ 15: 1.058 (1.024-1.096) 

15-64: 1.062 (0.993-1.135) 

>64: 1.054 (1.011-1.099) 

January 2010 C-57 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Moolgavkar 

(2000, 010274) 

Period of Study: 

1987-1995 

Location: 

3 U.S. counties: 

Los Angeles 

County,CA 

Cook County, IL 

Maricopa County, AZ 

Hospital Admissions 

Health Outcome (ICD9): 

COPD plus asthma (490-496) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM 

Age Groups Analyzed: 

All Ages 

0-19 yr 

20-64 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h median 

Median unit: 

Cook: 993 ppb 

LA: 1347 ppb 

Maricopa: 1240 ppb 

Range (Min, Max):

Cook: (224, 3912) 

LA:(237,5955) 

Maricopa: (269, 4777) 

Copollutant: correlation 

Cook County: 

NO2: r = 0.63; SO2: r = 0.35; 

O3: r = -0.28 

LA County: 

NO2: r = 0.80; SO2: r = 0.78; 

O3: r = -0.52 

Maricopa County: 

NO2: r = 0.66; SO2: r = 0.53; 

O3: r = -0.61 

Increment: 1.0 ppm 

% Increase (t-statistic); lag: 

Age Group: ≥ 65 

Cook County 

CO: 

2.60 (1.9); 0; / 3.00 (2.2); 1; / 1.30 (1.0); 2; 

1.40 (1.1); 3; / 1.10 (0.8); 4; / 2.30 (1.8); 5 

Los Angeles County 

CO: 

5.40 (11.3); 0; / 4.90 (10.1); 1; / 5.00 (10.2); 2; 

4.90 (10.1); 3; / 4.00 (8.3); 4; / 4.30 (8.6); 5; 

CO, PM10: 

4.30 (3.3); 0; / 5.30 (4.2); 1; / 5.10 (4.0); 2; 

6.80 (5.6); 3; / 6.90 (5.4); 4; / 6.30 (4.7); 5; 

CO, PM2.5: 

3.00 (1.9); 0; / 3.90 (2.5); 1; / 4.20 (2.6); 2; 

6.50 (4.4); 3; / 5.80 (3.8); 4; / 5.10 (3.1); 5 

Maricopa County 

CO: 

1.40 (1.0); 0; / 0.80 (0.6); 1; / 1.20 (0.9); 2; 

1.20 (0.9); 3; / 1.50 (1.1); 4; / 4.90 (3.8); 5 

Age Group: 0-19 

Los Angeles County 

CO: 

8.20 (14.4); 0; / 9.00 (15.9); 1; / 9.20 (16.4); 2; 

8.50 (15.0); 3; / 7.00 (12.1); 4; / 4.80 (8.1); 5; 

CO, PM10: 

7.50 (14.4); 0; /: 7.40 (5.2); 1; / 6.40 (4.3); 2; 

8.00 (5.5); 3; / 6.30 (4.0); 4; / 5.30 (3.5); 5; 

CO, PM10-2.5: 

5.70 (3.4); 0; / 7.50 (4.9); 1; / 5.60 (3.3); 2; 

5.40 (3.5); 3; / 4.40 (2.7); 4; / 1.80 (1.1); 5 

Age Group: 20-64 

Los Angeles County 

CO: 

3.70 (8.6); 0; / 3.90 (9.1); 1; / 4.50 (10.6); 2; 

3.50 (8.3); 3; / 3.40 (7.9); 4; / 3.50 (7.9); 5; 

CO, PM10: 

5.00 (4.6); 0; / 3.00 (2.7); 1; / 3.10 (2.8); 2; 

5.20 (4.7); 3; / 5.90 (5.1); 4; / 4.90 (4.4); 5; 

CO, PM2.5: 

3.50 (2.5); 0; / 0.60 (0.4); 1; / 1.10 (0.8); 2; 

5.70 (4.1); 3; / 4.70 (3.3); 4; / 3.90 (2.8); 5; 

CO, PM10-2.5: 

2.80 (2.2); 0; / 2.50 (2.0); 1;/ 0.60 (0.5); 2; 

3.90 (3.2); 3; / 3.40 (2.8); 4; / 4.00 (3.4); 5 

Author: Moolgavkar 

(2003, 042864) 

Period of Study:

1987-1995 

Location: 

2 U.S. counties: 

Los Angeles County, 

CA, and Cook County, 

IL 

Hospital Admissions 

Health Outcome (ICD9): 

COPD plus asthma (490-496) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, Poisson GLM 

with natural splines 

Age Groups Analyzed: 

All Ages; 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h median 

Median unit:

Cook: 993 ppb 

LA: 1347 ppb 

Maricopa: 1240 ppb 

Range (Min, Max): 

Cook: (224, 3912) 

LA: (237,5955) 

Copollutant: correlation 

Cook County: 

NO2: r = 0.63; SO2: r = 0.35; 

O3: r = -0.28 

Los Angeles County: 

NO2: r = 0.80; SO2: r = 0.78; 

O3: r = -0.52 

Increment: 1 ppm 

% Increase (t-statistic); lag: 

COPD–Los Angeles County 

CO: 

GAM-30 (10-8): 

5.48 (17.67); 0; / 5.67 (18.22); 1; / 5.90 (19.01); 2; 

5.28 (16.94); 3; / 4.59 (14.50); 4; / 4.10 (12.80); 5 

GAM-100 (10-8): 

2.37 (8.67); 0; / 2.41 (8.73); 1; / 2.41 (8.76); 2; 

1.81 (6.58); 3; / 1.38 (4.94); 4; / 1.07 (3.82); 5 

NS-100: 

2.28 (5.65); 0; / 2.29 (5.50); 1; / 2.32 (5.33); 2; 

1.74 (4.10); 3; / 1.30 (3.16); 4; / 1.00 (2.46); 5 

COPD–Cook County 

CO: 

GAM-100 (10-8): 

2.11 (1.62); 0; / 2.85 (2.16); 1; / 1.14 (0.86); 2; 

1.05 (0.79); 3; / 0.43 (0.33); 4; / 0.34 (0.26); 5 

January 2010 C-58 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Neidell et al. 

(2004, 057330) 

Period of Study:

1992-1998 

Location: 

California 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses: 

Linear Regression 

Age Groups Analyzed: 

0-1 yr 

1-3 yr 

3-6 yr 

6-12 yr 

12-18 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.777 (1.037) ppm 

Range (Min, Max): NR 

Copollutant: correlation 

O3

PM10

NO2

Increment: NR 

β (SE); lag; 

Single-pollutant model 

Age Group 

0-1: -0.007 (0.009); 

1-3: 0.027 (0.009); 

3-6: 0.053 (0.010); 

6-12: 0.047 (0.009); 

12-18: 0.025 (0.008) 

Fixed effect controlling for O3, PM10, and NO2

Age Group 

0-1: -0.01 (0.01); 

1-3: 0.024 (0.011); 

 3-6: 0.049 (0.011); 

6-12: 0.023 (0.011); 

12-18: 0.021 (0.009) 

Fixed effect controlling for O3, PM10, NO2 

and avoidance behavior 

Age Group 

0-1: -0.010 (0.010); 

1-3: 0.027 (0.011); 

3-6: 0.051 (0.011); 

6-12: 0.025 (0.011); 

12-18: 0.021 (0.009) 

Author: Norris et al. 

(1999, 040774) 

Period of Study: 

9/1995- 12/1996 

Location: 

Seattle, WA 

ED Visits 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses:

Semiparametric Poisson GAM 

Age Groups Analyzed: <8 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.6 (0.5) ppm 

Range (Min, Max): (0.6, 4.1) 

Copollutant: correlation

PM10: r = 0.74 

NO2 (1-h max): r = 0.47 

NO2 (24-h avg.): r = 0.66 

SO2 (1-h max): r = 0.15 

SO2 (24-h avg.): r = 0.32 

Increment: 0.6 ppm 

Relative Risk (Lower CI, Upper CI); Lag 

High Utilization: 1.04 (0.93-1.16); 1 

Low Utilization: 1.15 (1.05-1.28); 1 

All: 1.10 (1.02-1.19); 1 

Author: Peel et al. 

(2005, 056305) 

Period of Study:

1/1993- 8/2000 

Location: 

Atlanta, GA 

ED Visits 

Health Outcome (ICD9):

Asthma (493, 786.09); COPD 

(491, 492, 496); URI (460-466, 

477); pneumonia (480-486) 

Study Design: Time series 

Statistical Analyses: 

1. Poisson GEE or asthma, 

URI, all respiratory 

2. Poisson GLM for pneumonia 

and COPD 

Age Groups Analyzed:

Primary Analysis: All Ages 

Secondary Analysis: 2-18 yr 

Pollutant: CO 

Averaging Time: 1-h max 

Mean (SD) unit: 1.8 (1.2) ppm 

Range (10th, 90th): (0.5, 3.4) 

Copollutant: NR 

Increment: 1.0 ppm 

Relative Risk (Lower CI, Upper CI); Lag 

Health Condition 

All respiratory illnesses: 1.011 (1.004-1.019); 0-2 

URI: 

1.012 (1.003-1.021); 0-2 / 1.066 (1.045-1.087); 0-13 

Asthma: 

1.010 (0.999-1.022); 0-2 

1.076 (1.047-1.105); 0-13 

Pneumonia: 

1.009 (0.996-1.021); 0-2 

1.045 (1.011-1.080); 0-13 

COPD: 

1.026 (1.004-1.048); 0-2 

1.032 (0.975-1.092); 0-13 

RR for asthma and exposure to CO for children age 2-18: 

1.019 (1.004-1.035); 0-2 

RR for all respiratory illnesses and CO exposure for all 

ages 

AQS (1/1/93- 8/31/00): 1.011 (1.004-1.019); 0-2 

AQS (8/1/98- 8/31/00): 1.010 (1.000-1.021); 0-2 

ARIES (8/1/98- 8/31/00): 1.018 (1.003-1.033); 0-2 

January 2010 C-59 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Sauerzapf et 

al. (2009, 180082) 

Period of Study: 

Jan 2006-Feb 2007 

Location:

Norfolk county, 

England 

Hospital Admissions 

Health Outcome: COPD 

Study Design: Case crossover 

Statistical Analyses: Logistic 

Regression 

Age Groups Analyzed: 

18+ yr (90% of patients 60+ yr) 

Sample Description:

1,050 COPD admissions 

Averaging Time: 24 h 

Mean (SD) unit: 

Control days: 194.46 (80.93) 

Case days: 204.73 (119.97) 

Range (min, max):

Control days: 105.20, 408.10 

Case days: 108.70, 432.20 

Copollutant: 

NO, NO2, NOX, O3

 * Control days = 7 days prior to 

admission; Case days = day of 

admission 

Increment: 10 μg/m3

Lags examined: 0-8 

OR Estimate [Lower CI, Upper CI]; lag: 

Unadjusted: 1.010 (1.001, 1.019); lag 0-7 

Adjusted: 1.015 (1.005, 1.025); lag 0-7 

Unadjusted: 1.013 (1.001, 1.025); lag 1-8 

Adjusted: 1.018 (1.005, 1.031); lag 1-8 

Author: Sheppard et 

al. (1999, 086921) 

Period of Study:

1987-1994 

Location:

Seattle, WA 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: <65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1831 ppb 

IQR (25th, 75th): (1277, 2201) 

Copollutant: correlation 

PM10: r = 0.83; PM2.5: r = 0.78; 

PM10-2.5: r = 0.56; O3: r = -0.18; 

SO2: r = 0.24 

Increment: 924 ppb 

% Increase (Lower CI, Upper CI); Lag 

CO: 6% (3, 9); 3 

CO, PM2.5: 5% (1, 8); 3 

Author: Slaughter et 

al. (2005, 073854) 

Period of Study:

1/1995-6/2001 

Location:

Spokane, WA 

Hospital Admissions & ED Visits 

Health Outcome (ICD9):

Respiratory causes (460-519) 

Asthma (493); COPD (491, 

492, 494, 496) acute respiratory 

tract infections not including 

colds and sinusitis (464-466, 

490) 

Study Design: Time series 

Statistical Analyses: 

Poisson GLM, Natural Splines 

Age Groups Analyzed: 

All ages, 

Adults 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (5th, 95th): (1.25, 3.05) 

Copollutant: correlation 

PM1: r = 0.63 

PM2.5: r = 0.62 

PM10: r = 0.32 

PM10-2.5: r = 0.32 

Increment: 1.0 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

ED Visits 

All Respiratory Illnesses 

Age Group: All Ages: 

0.99 (0.96-1.02); 1 / 1.01 (0.98-1.04); 2 

1.03 (1.00-1.06); 3 

Asthma 

Age Group: All Ages: 

1.00 (0.95-1.06); 1 / 1.01 (0.96-1.07); 2 

1.06 (1.00-1.11); 3 

COPD 

Age Group: Adults: 

0.92 (0.85-1.00); 1 / 0.99 (0.91-1.08); 2 

1.01 (0.93-1.10); 3 

Hospital Admissions: 

All Respiratory Illnesses 

Age Group: All Ages: 

0.99 (0.95-1.02); 1 / 1.00 (0.96-1.04); 2 

0.99 (0.96-1.03); 3 

Asthma 

Age Group: All Ages: 

1.02 (0.92-1.13); 1 / 1.06 (0.96-1.17); 2 

1.00 (0.91-1.11); 3 

COPD 

Age Group: Adults: 

0.94 (0.86-1.03); 1 / 1.04 (0.95-1.13); 2 

0.97 (0.88-1.06); 3 

January 2010 C-60 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Stieb et al. 

(2000, 011675) 

Period of Study:

7/1992- 3/1996 

Location:

Saint John, 

Canada 

ED Visits 

Health Outcome (ICD9):

Asthma; COPD; respiratory 

infections; all respiratory 

illnesses 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 

24-h avg 

1-h max 

Mean (SD) unit:

All yr: 0.5 (0.3) ppm 

May-September: 0.6 (0.3) ppm 

All yr: 1.6 (1.1) ppm, 

May-September: 1.7 (0.9) ppm 

Range (Min, Max): NR 

Copollutant: correlation

H2S: r = -0.10; NO2: r = 0.68; 

O3: r = -0.05; SO2: r = 0.31; 

TRS: r = 0.07; PM10: r = 0.28; 

PM2.5: r = 0.27; H+: r = 0.23; 

SO4

2-: r = 0.27; CoH: r = 0.55 

Increment: 0.5 & 1.7 ppm 

Al% Increase (Lower CI, Upper CI); lag: 

Respiratory Illnesses 

Increment: 0.5 ppm 

All Year: -3.40; 7 

Increment: 1.7 ppm 

May- September: -5.70 

Author: Sun et al. 

(2006, 090768) 

Period of Study:

1/2004- 12/2004 

Location: 

Taiwan 

ED Visits 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Cross sectional 

Statistical Analyses: 

Pearson correlation analysis 

Age Groups Analyzed: 

<16 yr; 16-55 yr 

Pollutant: CO 

Averaging Time: Monthly 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NR 

Correlation Coefficient: 

Asthma 

Age Group: 

<16: 0.653 

16-55: 0.425 

Author: Tenias et al. 

(2002, 026077) 

Period of Study:

1/1994- 12/1995 

Location: 

Valencia, Spain 

ED Visits 

Health Outcome (ICD9): 

COPD (491, 492, 494, 496) 

Study Design: Time series 

Statistical Analyses: 

1. Poisson autoregressive 

2. Sensitivity: GAM, LOESS 

Age Groups Analyzed: >14 yr 

Pollutant: CO 

Averaging Time: 

24-h avg 

1-h max 

Mean (SD) unit:

24-h avg 

All yr: 3.1 mg/m3

Warm Months: 2.5 mg/m3

 

Cold Months: 3.7 mg/m3

1-h avg 

All yr: 6.7 mg/m3

 

Warm Months: 5.4 mg/m3 

Cold Months: 8.0 mg/m3

Range (Min, Max):

24-h avg: (0.9, 7.1) 

1-h max: (1.6, 17.2) 

Copollutant: correlation 

SO2: r = 0.734; NO2: r = 0.180; 

O3: r = -0.517 

Increment: 1 mg/m3

Relative Risk (Lower CI, Upper CI); Lag 

24-h avg 

All Year: 1.074 (0.998- 1156); 1 

Cold Months: 1.070 (0.991-1.156); 1 

Warm Months: 1.129 (0.960-1.329); 1 

1-h max 

All Year: 1.039 (1.014-1.066); 1 

Cold Months: 1.037 (1.010-1.064); 1 

Warm Months: 1.058 (0.994-1.127); 1 

All Year: sinusoidal terms: 

1.039 (1.010-1.066); 1 

All Year: humidity and temperature variables: 

1.040 (1.014-1.067); 1 

All Year: GAM, LOESS: 

1.042 (1.019-1.066); 1 

Author: Thompson et 

al. (2001, 073513) 

Period of Study:

1/1993- 12/1995 

Location:

Belfast, 

Northern Ireland 

ED Visits 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed:

Children 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Warm Season: 0.57 (0.41) ppm 

Cold Season: 0.74 (0.73) ppm 

IQR (25th, 75th):

Warm Season: (0.3, 0.7) 

Cold Season: (0.4, 0.8) 

Copollutant: correlation 

SO2 (log): r = 0.64; 

PM10 (log): r = 0.57; 

O3: r = -0.52; NOX (log): r = 0.74; 

NO (log): r = 0.71; NO2: r = 0.69 

Increment: NR 

Relative Risk (Lower CI, Upper CI); lag: 

Temperature included in the model: 

1.04 (1.00-1.09); 0 / 1.07 (1.02-1.12); 0-1 

1.06 (1.00-1.12); 0-2 / 1.07 (1.00-1.14); 0-3 

Warm Season: 1.06 (0.98-1.16); NR 

Cold Season: 1.07 (1.01-1.14); NR 

Adjusted for benzene level: 

0.92 (0.83-.02); 0-1 avg. 

Note: The increment the study uses to calculate effect 

estimates is a doubling in CO levels, but The study did not 

provide this value. 

January 2010 C-61 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Tolbert et al. 

(2007, 090316) 

Period of Study:

1/1993- 12/2004 

Location:

Atlanta, GA 

ED Visits 

Health Outcome (ICD9):

Respiratory disease: asthma 

(493, 786.07, 786.09); COPD 

(491, 492, 496); URI (460-465, 

460.0, 477); pneumonia (480-

496); bronchiolitis 

(466.1, 466.11, 466.19)) 

Study Design: Time series 

Statistical Analyses: 

Poisson GLM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 1-h max 

Mean (SD) unit: 1.6 ppm 

Range (Min, Max): (0.1, 7.7) 

Copollutant: correlation

PM10: r = 0.51; O3: r = 0.27; 

NO2: r = 0.70; SO2: r = 0.28; 

Coarse PM: r = 0.38; PM2.5: r = 0.47; 

SO4: r = 0.14;EC: r = 0.66; 

OC: r = 0.59; TC: r = 0.63; 

OHC: r = 0.29 

Increment: 1.22 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Respiratory Diseases: 1.016 (1.009-1.022); 3 

Note: The study only provides results of the multi-pollutant 

models in figures, not quantitatively. 

Author: Trapasso and 

Keith (1999, 180127) 

Period of Study:

1/1994- 12/1994 

Location:

Bowling Green, KY 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Time series 

Statistical Analyses: 

Spearman Rank Correlation 

Coefficient 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NR 

Correlation Coefficient (lag) 

CO Mean: r = 0.19;0 

CO Mean: r = 0.27; 1 

CO Mean: r = 0.21; 2 

CO Max: r = 0.26; 0 

CO Max: r = 0.36; 1 

CO Max: r = 0.24; 2 

Author: Tsai et al. 

(2006, 089768) 

Period of Study:

1996-2003 

Location:

Kaohsiung, Taiwan 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.77 ppm 

Range (Min, Max): (0.23, 1.72) 

Copollutant: 

PM10

SO2

NO2

O3

Increment: 0.29 ppm 

Odds Ratio (Lower CI, Upper CI); lag 

OR for getting asthma and exposure to various pollutants 

for all ages at either <25°C or ≥ 25°C 

CO 

<25°C: 1.414 (1.300-1.537); 0-2 

≥ 25°C: 1.222 (1.138-1.312); 0-2 

CO, PM10

<25°C: 1.251 (1.125-1.393); 0-2 

≥ 25°C: 1.178 (1.088-1.274); 0-2 

CO, SO2

<25°C: 1.207 (1.076-1.354); 0-2 

≥ 25°C: 1.290 (1.188-1.400); 0-2 

CO, NO2

<25°C: 0.916 (0.807-1.039); 0-2 

≥ 25°C: 1.249 (1.127-1.384); 0-2 

CO, O3

<25°C: 1.396 (1.282-1.520); 0-2 

≥ 25°C: 1.195 (1.113-1.284); 0-2 

Author: Vigotti et al. 

(2007, 090711) 

Period of Study:

1/2000- 12/2000 

Location: 

Pisa, Italy 

ED Visits 

Health Outcome (ICD9):

Respiratory disease: asthma 

(493); dry cough (468); acute 

bronchitis (466) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: <10 yr; 

>65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.5 (0.7) ug/m3

Range (Min, Max): (0.3, 3.5) 

Copollutant: correlation 

NO2: r = 0.62 

PM10: r = 0.70 

Increment: 1mg/m3

% Increase (Lower CI, Upper CI); lag 

Age Group 

<10: 18.60% (-6.90 to 51.10); 1 

>65: 26.50% (3.40-54.80); 4 

January 2010 C-62 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Villeneuve et 

al. (2006, 091179) 

Period of Study: 

1995-2000 

Location:

Toronto, ON, 

Canada 

Physician Visits 

Health Outcome (ICD9): 

Allergic rhinitis (177) 

Study Design: Time series 

Statistical Analyses: Poisson 

GLM 

Age Groups Analyzed: >65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.1 (0.4) ppm 

Range (Min, Max): (0.0, 2.2) 

Copollutant: 

PM2.5

PM10

PM10-2.5

SO2

NO2

O3

Increment: 0.4 ppm 

Odds Ratio (Lower CI, Upper CI); Lag 

The study did not present quantitative results for CO. 

Author: Xirasagar et 

al. (2006, 093267) 

Period of Study:

1998- 2001 

Location: 

Taiwan 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Cross sectional 

Statistical Analyses: 

Spearman Rank Correlations 

Age Groups Analyzed: 

0-14 yr; <2 yr; 2-5 yr; >5 yr 

Pollutant: CO 

Averaging Time: Monthly 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NR 

Correlation Coefficient (Lag) 

Age Group: 

<2: r = -0.208 

2-5: r = -0.281 

>5: r = -0.134 

Author: Yang et al. 

(2007, 092848) 

Period of Study:

1996-2003 

Location: 

Taipei, 

Taiwan 

Hospital Admissions 

Health Outcome (ICD9):

Asthma (493) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.33 ppm 

Range (Min, Max): (0.32, 3.62) 

Copollutant: 

PM10

SO2

NO2

O3

Increment: 0.53 ppm 

Odds Ratio (Lower CI, Upper CI); Lag 

CO 

<25°C: 1.076 (1.019-1.136); 0-2 

≥ 25°C: 1.277 (1.179-1.383); 0-2 

CO, PM10

<25°C: 1.050 (0.983-1.122); 0-2 

≥ 25°C: 1.332 (1.216-1.459); 0-2 

CO, SO2

<25°C: 1.131 (1.059-1.207); 0-2 

≥ 25°C: 1.278 (1.174-1.392); 0-2 

CO, NO2

<25°C: 0.915 (0.839-0.997); 0-2 

≥ 25°C: 1.177 (1.049-1.320); 0-2 

CO, O3

<25°C: 1.169 (1.102-1.240); 0-2 

≥ 25°C: 1.275 (1.177-1.382); 0-2 

Author: Yang et al. 

(2007, 092847) 

Period of Study:

1996-2003 

Location: 

Taipei, Taiwan 

Hospital Admissions 

Health Outcome (ICD9):

COPD: (490-492, 494, 496) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.33 ppm 

Range (Min, Max): (0.32, 3.66) ppm 

Copollutant: 

PM10

SO2

NO2

O3

Increment: 0.53 ppm 

Odds Ratio (Lower CI, Upper CI); Lag 

CO 

<20°C: 0.975 (0.921,1.033); 0-2 

≥ 20°C: 1.227 (1.178-1.277); 0-2 

CO, PM10

<20°C: 0.925 (0.863-0.992); 0-2 

≥ 20°C: 1.177 (1.123-1.235); 0-2 

CO, SO2 

<20°C: 0.895 (0.832-0.962); 0-2 

≥ 20°C: 1.274 (1.219-1.331); 0-2 

CO, NO2

<20°C: 1.000 (0.910-1.099); 0-2 

≥ 20°C: 1.061 (0.998-1.129); 0-2 

CO, O3

<20°C: 0.935 (0.875-0.999); 0-2 

≥ 20°C: 1.234 (1.185-1.285); 0-2 

January 2010 C-63 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Yang et al. 

(2005, 090184) 

Period of Study:

1/1994- 12/1998 

Location:

Vancouver, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

COPD (490-492, 494, 496) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: .71 (0.28) ppm 

Range (Min, Max): (0.30, 2.48) 

Copollutant: correlation 

O3: r = -0.56 

NO2: r = 0.73 

SO2: r = 0.67 

PM10: r = 0.50 

Increment: 0.3 ppm 

Relative Risk (Lower CI, Upper CI); lag 

CO 

1.03 (1.00-1.06); 0 / 1.04 (1.01-1.08); 0-1 

1.05 (1.01-1.09); 0-2 / 1.05 (1.00-1.10); 0-3 

1.06 (1.01-1.11); 0-4 / 1.07 (1.02-1.12); 0-5 

1.08 (1.02-1.13); 0-6 

MultiPollutant: 

CO, O3: 1.11 (1.04-1.18); 0-6 

CO, NO2: 1.04 (0.95-1.14); 0-6 

CO, SO2: 1.11 (1.01-1.22); 0-6 

CO, PM10: 1.02 (0.93-1.12); 0-6 

CO, PM10, O3, NO2, SO2: 1.08 (0.96-1.22); 0-6 

CO, O3, NO2, SO2: 1.10 (0.98-1.23); 0-6 

Author: Yang et al. 

(2003, 055621) 

Period of Study:

1/1986- 12/1998 

Location:

Vancouver, BC, 

Canada 

Hospital Admissions 

Health Outcome (ICD9):

Respiratory diseases (460-519) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

<3 yr; ≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.98 (0.54) ppm 

IQR (25th, 75th): (0.62, 1.16) 

Copollutant: correlation

O3: r = -0.52 

CoH 

NO2

SO2

Increment: 0.54 ppm 

Odds Ratio (Lower CI, Upper CI); lag 

OR for respiratory diseases and exposure to various 

pollutants for people <3 and ≥ 65 

Age Group: <3 

CO alone: 1.04 (1.01-1.07); 1 

CO, O3: 1.04 (1.01-1.07); 1 

CO, O3, CoH, NO2, SO2: 1.02 (0.96-1.08); 1 

Age Group: ≥ 65 

CO alone: 1.02 (1.00-1.04); 1 

CO, O3: 1.02 (1.00-1.04); 1 

CO, O3, CoH, NO2, SO2: 0.96 (0.93-1.00); 1 

Author: Yang et al. 

(2004, 087488) 

Period of Study:

6/1/1995-3/31/1999 

Location:

Vancouver, Canada 

Hospital Admissions 

Health Outcome (ICD9): 

Respiratory diseases (460-

519); pneumonia (480-486); 

asthma (493) 

Study Design: Case control 

Statistical Analyses: 

Pearson’s correlation coefficient 

Age Groups Analyzed: <3 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.70 (0.30) ppm 

IQR (25th, 75th): (0.50, 0.80) 

Copollutant: correlation 

PM10: r = 0.46; PM2.5: r = 0.24; 

PM10-2.5: r = 0.33; O3: r = -0.53; 

NO2: r = 0.74; SO2: r = 0.61 

This study did not present quantitative results for CO. 

Author: Zanobetti and 

Schwartz (2006, 

090195) 

Period of Study: 

1995-1999 

Location:

Boston, MA 

Hospital Admissions 

Health Outcome (ICD9):

Pneumonia (480-487) 

Study Design: Case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

IQR (25th, 75th): (0.39, 0.60) 

Copollutant: correlation 

PM2.5: r = 0.52; BC: r = 0.82; 

NO2: r = 0.67; O3: r = -0.30 

Increment: 0.475 ppm 

% Increase (Lower CI, Upper CI); lag: 

5.45 (1.10, 9.51); 0 

5.12 (0.83, 9.16); 0-1 

January 2010 C-64 
Table C-6. Studies of long-term CO exposure and respiratory morbidity. 

Study Design Concentrations Effect Estimates (95% CI) 

Author: Goss et al. 

(2004, 055624) 

Period of Study: 

1999-2000 

Location: U.S. 

Health Outcome: Lung function 

(FEV1, cystic fibrosis pulmonary 

exacerbation) 

Study Design: Cohort 

Statistical Analyses: 

Logistic regression 

Population: 11,484 cystic fibrosis 

patients 

Age Groups Analyzed: >6 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 0.692 (0.295) ppm 

IQR (25th, 75th): (0.48, 0.83) 

Copollutant: NR 

Increment: 1.0 ppm 

Odds Ratio (Lower CI, Upper CI); lag: Two or more pulmonary exacerbations during 2000 

1.02 (0.85-1.22) 

Author: Guo et al. 

(1999, 010937) 

Period of Study:

10/1995-5/1996 

Location: Taiwan 

Health Outcome: Asthma 

Study Design: Cohort 

Statistical Analyses: 

Logistic regression 

Population: 

331,686 nonsmoking children 

Age Groups Analyzed: 

Middle-school children 

(mean age = 13.8 yr) 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 853 (277) ppb 

Range (Min, Max): (381, 1610) 

Copollutant: NR 

Increment: 326 ppb 

% Increase (Lower CI, Upper CI); lag: 

Boys 

Physician-diagnosed asthma: 

1.17% (0.63-1.72) 

Questionnaire-diagnosed asthma: 

1.10% (0.45-1.75) 

Girls 

Physician-diagnosed asthma: 

0.84% (0.45-1.22) 

Questionnaire-diagnosed asthma: 

1% (0.44-1.56) 

January 2010 C-65 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Hirsch et al. 

(1999, 003537) 

Period of Study:

Population: 

9/1995-6/1996 

Air: 

4/1994-4/1995 

Location:

Dresden, Germany 

Health Outcome: 

Asthma symptoms in the past 

12 mo (wheeze, morning cough); 

Doctor's diagnosis (asthma, 

bronchitis); Lung function 

(bronchial hyperresponsiveness 

(BHR), FEV1 <85% pred., 

FEF25-75% <70% pred.) 

Study Design: Cross sectional 

Statistical Analyses: 

Multiple logistic regression 

Population: 

5-7: 2,796; 9-11: 2,625 

Age Groups Analyzed: 

5-7 and 9-11 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 0.69 mg/m3

Range (Min, Max): (0.32, 1.54) 

Copollutant: NR 

Increment: 0.2 μg/m3

Prevalence Odds Ratio (Lower CI, Upper CI); lag: 

Symptoms in the past 12 mo: Wheeze 

Home Exposure 

Age Groups: 5-7; 9-11: 1.05 (0.93-1.18) 

Home/School Exposure 

Age Groups: 9-11: 1.02 (0.85-1.22) 

Morning Cough 

Home Exposure 

Age Groups: 5-7; 9-11: 1.12 (1.01-1.23) 

Age Group: 9-11: 1.13 (0.98-1.3) 

Doctor’s diagnosis: Asthma 

Home Exposure 

Age Groups: 5-7; 9-11: 1.07 (0.94-1.21) 

Age Groups: 9-11: 1.16 (0.97-1.38) 

Doctor’s diagnosis: Bronchitis 

Age Groups: 5-7; 9-11: 1.19 (1.11-1.27) 

Age Group: 9-11: 1.24 (1.12-1.38) 

Lung function: BHR 

Age Groups: 5-7; 9-11: 0.79 (0.63-0.99) 

Age Group: 9-11: 0.77 (0.6-0.99) 

Lung function: FEV1 <85% pred. 

Age Groups: 5-7; 9-11: 1.09 (0.81-1.47) 

Age Group: 9-11: 1.01 (0.73-1.41) 

Lung function: FEV25-75% <70% pred. 

Age Groups: 5-7; 9-11: 1.15 (0.94-1.39) 

Age Group: 9-11: 1.07 (0.86-1.34) 

Symptoms in the past 12 mo: Wheeze 

Age Groups: 5-7; 9-11 

Atopic children: 1 (0.81-1.24) 

Nonatopic children: 1.05 (0.83-1.31) 

Morning cough 

Age Groups: 5-7; 9-11 

Atopic children: 1.03 (0.82-1.29) 

Nonatopic children: 1.22 (1.05-1.41) 

Doctor’s diagnosis: Asthma 

Atopic children: 1.05 (0.83-1.32) 

Nonatopic children: 1.29 (1.05-1.59) 

Doctor’s diagnosis: Bronchitis 

Age Groups: 5-7; 9-11 

Atopic children: 1 (0.86-1.16) 

Nonatopic children: 1.21 (1.1-1.33) 

Notes: Atopic Children were defined as those children 

with specific IgE to aeroallergens >0.7 kU-L-1; 

Nonatopic Children were defined as those children with 

specific IgE to aeroallergens ≤ 0.7 kU-L-1. 

Author: Hwang et al. 

(2006, 088971) 

Period of Study: 

2001 

Location: Taiwan 

Health Outcome: Allergic rhinitis 

Study Design: Cross sectional 

Statistical Analyses: 

Two-stage hierarchical model 

(logistic and linear regression) 

Population: 

32,143 Taiwanese school children 

Age Groups Analyzed: 6-15 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 664 (153) ppb 

Range (Min, Max): (416, 964) 

Copollutant: correlation 

NOX: r = 0.88 

O3: r = -0.37 

PM10: r = 0.27 

SO2: r = 0.40 

Increment: 100 ppb 

Adjusted Odds Ratio (Lower CI, Upper CI); lag: 

Physician-diagnosed allergic rhinitis 

1.05 (1.04-1.07) 

CO, SO2: 1.04 (1.02-1.06) 

CO, PM10: 1.05 (1.03-1.07) 

CO, O3: 1.07 (1.05-1.09) 

Male: 1.06 (1.03-1.08); Female: 1.05 (1.02-1.08) 

Parental atopy: Yes: 1.05 (1.02-1.08) 

Parental atopy: No: 1.06 (1.03-1.08) 

Parental Education: <6: 1 (0.91-1.09) 

Parental Education: 6-8: 1.07 (1.02-.12) 

Parental Education: 9-11: 1.05 (1.02-1.08) 

Parental Education: ≥ 12: 1.06 (1.03-1.09) 

ETS: Yes: 1.06 (1.03-1.08); ETS: No: 1.05 (1.02-1.08) 

Visible Mold: Yes: 1.07 (1.03-1.11) 

Visible Mold: No: 1.05 (1.03-1.07) 

January 2010 C-66 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Hwang et al. 

(2005, 089454) 

Period of Study: 

2001 

Location: Taiwan 

Health Outcome: Asthma 

Study Design: Cross sectional 

Statistical Analyses: 

Two-stage hierarchical model 

(logistic and linear regression) 

Population: 

32,672 Taiwanese school children 

Age Groups Analyzed: 6-15 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 664 (153) ppb 

Range (Min, Max): (416, 964) 

Copollutant: correlation 

NOX: r = 0.88 

O3: r = -0.37 

PM10: r = 0.27 

SO2: r = 0.40 

Increment: 100 ppb 

Adjusted Odds Ratio (Lower CI, Upper CI); lag: 

Physician-diagnosed asthma: 1.045 (1.017-1.074) 

CO, SO2: 1.066 (1.034-1.099) 

CO, PM10: 1.079 (1.047-1.112) 

CO, O3: 1.063 (1.1-1.474) 

CO, SO2, O3: 1.111 (1.074-1.15) 

CO, PM10, O3: 1.119 (1.084-1.155) 

Male: 1.49 (1.37-1.63); Female: 1 

Parental atopy: Yes: 1 

Parental atopy: No: 2.72 (2.5-2.97) 

Parental Education: <6: 1 

Parental Education: 6-8: 1.17 (0.9-1.52) 

Parental Education: 9-11: 1.61 (1.26-2.05) 

Parental Education: ≥ 12: 2.43 (1.9-3.09) 

ETS: Yes: 0.85 (0.78-0.92); ETS: No: 1 

Visible Mold: Yes: 1.27 (1.16-1.4); Visible Mold: No: 1 

Maternal smoking during pregnancy: 

Yes: 1.18 (0.89-1.56) 

Maternal smoking during pregnancy: No: 1 

Cockroaches noted monthly: 

Yes: 1.15 (1.03-1.29) 

Cockroaches noted monthly: No: 1 

Water damage: Yes: 0.96 (0.81-1.12) 

Water damage: No: 1 

Author: Lee et al. 

(2003, 049201) 

Period of Study:

10/1995-5/1996 

Location: Taiwan 

Health Outcome: Allergic rhinitis 

Study Design: Cohort 

Statistical Analyses: 

Multiple logistic regression 

Population: 

331,686 nonsmoking children 

Age Groups Analyzed: 12-14 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 853 (277) ppb 

Range (Min, Max): (381, 1610) 

Copollutant: NR 

The study did not present quantitative results for CO. 

Author: Meng et al. 

(2007, 093275) 

Period of Study:

11/2000-9/2001 

Location:

Los Angeles County 

and San Diego 

County, California 

Health Outcome: Asthma 

Study Design: Cohort 

Statistical Analyses: 

Logistic regression 

Population: 

1,609 physician-diagnosed 

asthmatics 

Age Groups Analyzed: ≥ 18 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: correlation 

Traffic: r = -0.04; O3: r = -0.55; 

PM10: r = 0.42; PM2.5: r = 0.52; 

NO2: r = 0.55 

The study did not present quantitative results for CO. 

January 2010 C-67 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Mortimer et 

al. (2008, 122163) 

Period of Study: 

1989-2000 

Location:

San Joaquin Valley, 

CA 

Health Outcome: Lung function 

(FVC, FEV1, PEF, FEF25-75, 

FEV1/FVC, FEF25-75/FVC, 

FEF25, FEF75) 

Study Design: Cohort 

Statistical Analyses: 

1. DSA algorithm 

2. GEE 

Population: 232 asthmatic 

children 

Age Groups Analyzed: 6-11 yr 

Pollutant: CO 

Averaging Time:

8-h max monthly mean 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant; correlation: 

Lifetime 

NO2 (24-h avg): r = 0.68 

O3 (8-h max): r = -0.40 

PM10 (24-h avg): r = 0.05 

Prenatal 

CO (8-h max): r = 0.52 

NO2 (24-h avg): r = 0.37 

O3 (8-h max): r = -0.16 

PM10 (24-h avg): r = -0.05 

Increment: NR 

Effect Size per IQR Increase in Pollutant (SE): 

FEF25-75: 

24-h avg CO exposure during 1st trimester 

0.90% (0.0113) 

FEV1/FVC 

Daily max CO exposure during ages 0 to 3 

-2.50% (0.0016) 

FEF25-75/FVC 

24-h avg CO exposure during ages 0 to 6 and 

diagnosed with asthma <2 yr old 

-4.80% (0.0446) 

FEF25 

24-h avg CO exposure during ages 0 to 6 and 

diagnosed with asthma <2 yr old plus 24-h avg PM10

exposure during 2nd trimester and mother smoked 

when pregnant 

-6.70% (0.015) 

Coefficient (SE): 

FVC 

24-h avg CO exposure during 2nd trimester 

-0.0878 (0.0415) 

FEF25-75 

Lifetime 24-h avg CO exposure 

-0.94454 (0.3975) 

FEF25-75/FVC 

-0.1090 (0.0303) 

FEV1/FVC 

Prenatal 8-h max CO exposure: 0.1711 (0.0653) 

Lifetime 1-h max CO exposure: -0.3242 (0.0919) 

24-h avg CO exposure during ages 0-3 and diagnosed 

with asthma <2 yr old: -0.1814 (0.0599) 

FEF25 

24-h avg CO exposure during ages 0-6 and diagnosed 

with asthma <2 yr old: -1.0460 (0.1953) 

FEF75 

Lifetime 8-h max CO exposure: -0.4214 (0.1423) 

Author: Singh et al. 

(2003, 052686) 

Period of Study: NR 

Location: 

Jaipur, India 

Health Outcome: Lung function 

Study Design: Panel study 

Statistical Analyses: Parametric 

statistical methods 

Population: 

Campus panel: 142 

Commuter panel: 158 

Age Groups Analyzed: ~20 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 

Roadside: 3,175 μg/m3

Campus: 2,150 μg/m3

Range (Min, Max): NR 

Copollutant: NR 

The study did not present quantitative results for CO. 

January 2010 C-68 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Sole et al. 

(2007, 090706) 

Period of Study: 

Location:

Sao Paulo West, Sao 

Paulo South, Santo 

Andre, Curitba, & 

Porto Alegre, Brazil 

Health Outcome: Symptoms of 

asthma, rhinitis, and eczema 

Study Design: Panel 

Statistical Analyses: Logistic 

Regression 

Age Groups Analyzed: 

13-14 yr 

Averaging Time: Annual 

Mean (SD) unit: 

Sao Paulo West: 7.70 ppm 

Sao Paulo South: 7.50 ppm 

Santo Andre: 9.80 ppm 

Curitba: 7.90 ppm 

Porto Alegre: 1.51 ppm 

Range (min, max): NR 

Copollutant: NO2, SO2, O3

Increment: Risk in relation to center w/ lowest annual 

mean (Porto Alegre = ref) 

OR Estimate [Lower CI, Upper CI]: 

Lags examined: NR 

Current Wheezing: 

Sao Paulo West: 1.26 (1.11, 1.42) 

Sao Paulo South: 1.03 (0.91, 1.18) 

Santo Andre: 1.36 (1.20, 1.56) 

Curitba: 1.05 (0.93, 1.19) 

Severe Asthma: 

Sao Paulo West: 1.20 (0.95, 1.50) 

Sao Paulo South: 0.59 (0.45, 0.78) 

Santo Andre: 0.62 (0.48, 0.81) 

Curitba: 0.64 (0.50, 0.82) 

Nighttime Coughing: 

Sao Paulo West: 1.06 (0.95, 1.17) 

Sao Paulo South: 0.93 (0.84, 1.03) 

Santo Andre: 0.91 (0.82, 1.02) 

Curitba: 0.99 (0.89, 1.10) 

Rhinoconjunctivitis: 

Sao Paulo West: 1.31 (1.15, 1.15) 

Sao Paulo South: 0.73 (0.64, 0.85) 

Santo Andre: 0.85 (0.74, 0.97) 

Curitba: 1.10 (0.96, 1.25) 

Severe Rhinits: 

Sao Paulo West: 1.01 (0.91, 1.49) 

Sao Paulo South: 0.68 (0.59, 0.77) 

Santo Andre: 0.73 (0.64, 0.83) 

Curitba: 1.03 (0.91, 1.16) 

Eczema: 

Sao Paulo West: 1.45 (1.20, 1.74) 

Sao Paulo South: 1.03 (0.85, 1.25) 

Santo Andre: 1.03 (0.85, 1.25) 

Curitba: 0.90 (0.75, 1.10) 

Flexural Eczema: 

Sao Paulo West: 1.42 (1.15, 1.76) 

Sao Paulo South: 0.71 (0.56, 0.91) 

Santo Andre: 0.68 (0.53, 0.87) 

Curitba: 0.73 (0.57, 0.92) 

Severe Eczema: 

Sao Paulo West: 1.08 (0.86, 1.35) 

Sao Paulo South: 0.42 (0.31, 0.56) 

Santo Andre: 0.38 (0.28, 0.51) 

Curitba: 0.30 (0.22, 0.41) 

Author: Wang et al. 

(1999, 008105) 

Period of Study:

10/1995-6/1996 

Location:

Kaohsiung and 

Pintong, Taiwan 

Health Outcome: Asthma 

Study Design: Cross sectional 

Statistical Analyses: 

Multiple logistic regression 

Population: 

165,173 high school students 

Age Groups Analyzed: 11-16 yr 

Pollutant: CO 

Averaging Time: Annual median 

Median (SD) unit: 0.80 ppm 

Range (Min, Max): NR 

Copollutant: NR 

Increment: NR 

Adjusted Odds Ratio (Lower CI, Upper CI); lag: 

CO Concentrations: <0.80 ppm: 1.0 

CO Concentrations ≥ 0.80 ppm: 1.23 (1.19-1.28) 

Multivariate analysis with variables for exercise, 

smoking, alcohol, incense use, ETS: 1.15 (1.1-1.2) 

Author: Wilhelm et al. 

(2008, 191912) 

Period of Study: 

2000-2001 

Location:

Los Angeles County 

or San Diego County, 

California 

Health Outcome: Asthma 

symptoms/ED visit/HA 

Study Design: Panel 

Statistical Analyses: Logistic 

regression 

Age Groups Analyzed: 0-17 yr 

Sample Description:

612 children who reported a 

physician diagnosis of asthma at 

some point in their lives 

Averaging Time: annual 

Mean (SD) unit: 1.0 ppm 

Range (min, max): 0.34, 1.8 

Copollutant: correlation 

O3: r= -0.67 

PM10: r= 0.41 

PM2.5: r= 0.60 

NO2: r= 0.57 

traffic density: r= 0.02 

Increment: NR 

OR Estimate [Lower CI, Upper CI] ; lag: 

Lags examined: NR 

No associations observed between asthma symptom 

outcome measures (no results shown) 

January 2010 C-69 
Table C-7. Studies of short-term CO exposure and mortality. 

Study Design Concentrations Effect Estimates (95% CI) 

Author: Anderson et al. 

(2001, 017033) 

Period of Study:

10/1994-12/1996 

Location: 

West Midlands, 

United Kingdom 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800); 

cardiovascular (390-459); 

respiratory (460-519) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Max 8-h ma 

Mean (SD) unit: 0.8 (0.7) ppm 

Range (Min, Max): (0.2, 10.0) 

Copollutant correlation: 

PM10: r = 0.55; PM2.5: r = 0.54; 

PM10-2.5: r = 0.10; BS: r = 0.77; 

SO4

2-: r = 0.17; NO2: r = 0.73; 

O3: r = -0.29; SO2: r = 0.49 

Increment: 1.0 ppm 

% Increase (Lower CI, Upper CI); lag: 

All-cause 

0.8% (-0.6 to 2.2); 0-1 

Cardiovascular 

2.5% (0.4-4.6); 0-1 

Respiratory 

1.2% (-2.1 to 4.6); 0-1 

Author: Bellini et al. (2007, 

097787) 

Period of Study: 1996-2002 

Location: 

15 Italian cities 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800); 

cardiovascular (390-459); 

respiratory (460-519) 

Study Design: Meta-analysis 

Statistical Analyses: 

Poisson GLM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

SO2

NO2

O3

PM10

Increment: 1 mg/m3

% Increase (Lower CI, Upper CI); lag: 

All-cause 

1.19% (0.61-1.72); 0-1 

Respiratory 

0.66% (-1.46 to 2.88); 0-1 

Cardiovascular 

0.93% (-0.10 to 1.77); 0-1 

Author: Berglind et al. 

(2009, 190068) 

Period of Study: 1992-2002 

Location: Augsburg, 

Germany; Barcelona, Spain; 

Helsinki, Finland; Rome, 

Italy; Stockholm, Sweden 

Health Outcome: Mortality 

Study Design: Cohort 

Statistical Analyses: Poisson 

regression analysis 

Age Groups Analyzed: ≥ 35 yr 

Sample Description: Firsttime MI patients 

Averaging Time: 24 h 

Mean (SD) unit: Median calculated 

from daily 24-h means: 

Augsburg: 0.85 

Barcelona: 0.75 

Helsinki: 0.36 

Rome: 1.66 

Stockholm: 0.38 

Range (IQR): Augsburg: 0.43 

Barcelona: 0.75 

Helsinki: 0.36 

Rome: 1.11 

Stockholm: 0.38 

Copollutant: NR 

Increment: 0.2 mg/m3

% Change in Daily Nontrauma Deaths [Lower CI, 

Upper CI]: Mean of Lag 0 and 1: 2.61 (-0.26-5.56) 

Mean of Lag 0-4: 3.82 (1.00-6.72) 

Mean of Lag 0-14: 4.92 (2.11-7.81) 

Lags examined: 0, 1, 4, 14 

CO had a trend towards or positive associations with 

all cities for 2-day mean effects on daily mortality. 

CO was associated with risk for the 5-day avg. The 

strongest association was observed for the 15-day 

avg. 

January 2010 C-70 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Biggeri et al. (2005, 

087395) 

Period of Study: 1990-1999 

Location: 

8 Italian Cities (Turin, Milan, 

Verona, Bologna, Ravenna, 

Florence, Rome, and 

Palermo) 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800); 

cardiovascular (390-459); 

respiratory (460-519); cardiorespiratory 

Study Design: Meta-analysis 

Statistical Analyses: Poisson 

GLM, cubic splines 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Max 8-h ma 

Mean (SD) unit:

Turin, 1991-1994: 5.8 mg/m3

Turin, 1995-1998: 4.0 mg/m3

Milan, 1990-1994: 5.9 mg/m3

Milan, 1995-1997: 4.0 mg/m3

Verona, 1995-1999: 2.5 mg/m3

Ravenna, 1991-1995: 1.8 mg/m3

Bologna, 1996-1998: 2.4 mg/m3

Florence, 1996-1998: 2.7 mg/m3

Rome, 1992-1994: 6.5 mg/m3

Rome, 1995-1997: 5.4 mg/m3

Palermo, 1997- 1999: 2.1 mg/m3

Range (Min, Max): 

Turin, 1991-1994: (NR, 24.7) 

Turin, 1995-1998: (NR, 19.8) 

Milan, 1990-1994: (NR, 26.5) 

Milan, 1995-1997: (NR, 12.3) 

Verona, 1995-1999: (NR, 10.2) 

Ravenna, 1991-1995: (NR, 7.0) 

Bologna, 1996-1998: (NR, 11.1) 

Florence, 1996-1998: (NR, 8.7) 

Rome, 1992-1994: (NR, 22.3) 

Rome, 1995-1997: (NR, 18.5) 

Palermo, 1997- 1999: (NR, 8.0) 

Copollutant: NR 

Increment: 1.0 mg/m3

% Increase (Lower CI, Upper CI); lag: 

Non-accidental 

Fixed: 0.93 (0.50-1.36); 0-1 

Random: 0.93 (0.50-1.36); 0-1 

Cardiovascular 

Fixed: 1.29 (0.62-1.96); 0-1 

Random: 1.29 (0.62-1.96); 0-1 

Respiratory 

Fixed: 2.44 (0.74-4.17); 0-1 

Random: 2.47 (0.14-4.85); 0-1 

Author: Botter et al. (2002, 

011922) 

Period of Study: 1991-1993 

Location: 

São Paulo, Brazil 

Health Outcome (ICD9):

Mortality 

Study Design: 

Longitudinal study 

Statistical Analyses: 

State space model 

Age Groups Analyzed: ≥ 65 yr

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: TSP; NO2; O3; SO2

Increment: NR 

β (SE): 

Model 1: 0.0053 (0.0036) 

Model 2: 0.0046 (0.0028) 

Model 3: 0.0040 (0.0028) 

Model 4: 0.0032 (0.0028) 

Author: Bremner et al. 

(1999, 007601) 

Period of Study: 

1/1992–12/1994 

Location: 

London, U.K. 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800); 

cardiovascular (390-459); 

respiratory (460-519) 

Study Design: Time series 

Statistical Analyses: Poisson, 

cubic splines 

Age Groups Analyzed: 

All ages 

0-64 yr 

≥ 65 yr 

65-74 yr 

≥ 75 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.8 (0.4) ppm 

Range (Min, Max): (0.2, 5.6) 

Copollutant: 

NO2; 

O3; 

SO2; 

PM10; 

BS 

Increment: 0.8 ppm 

% Increase (Lower CI, Upper CI); lag: 

All-cause 

Age Group: 

All ages: 0.9% (-0.2 to 2.0); 1 

0-64: 1.2% (-1.0 to 3.5); 1 

≥ 65: 0.8% (-0.4 to 1.9); 2 

65-74: 0.8% (-1.2 to 2.8); 3 

≥ 75: 0.9% (-0.4 to 2.2); 2 

Respiratory 

Age Group: 

All ages: 2.0% (-0.3 to 4.5); 3 

0-64: 7.8% (0.2-15.9); 3 

≥ 65: 0.7% (-1.7 to 3.2); 3 

65-74: 7.5% (2.1-13.2); 3 

≥ 75: 2.3% (-0.5 to 5.3); 0 

Multipollutant: 

CO, SO2: 1.90% (0.18-3.64); 3 

CO, PM10: 1.25% (0.04-2.47); 3 

CO, BS: 2.41% (-0.65 to 5.57); 3 

Cardiovascular 

Age Group: 

All ages: 1.4% (-0.1 to 3.0); 1 

0-64: 2.1% (-1.7 to 6.0); 2 

≥ 65: 1.1% (-0.4 to 2.8); 2 

65-74: 2.4% (-0.6 to 5.5); 2 

≥ 75: 1.9% (0.0-3.9); 2 

Multipollutant: 

CO, NO2: 2.55% (0.40-4.75); 1 

CO, O3: 3.98% (0.85-7.21); 1 

CO, PM10: 0.62% (-0.59 to 1.85); 1 

CO, BS: 1.29% (-1.53 to 4.19); 1 

January 2010 C-71 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Burnett et al. (2000, 

010273) 

Period of Study: 1986-1996 

Location: 

8 Canadian cities 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800) 

Study Design: Time series 

Statistical Analyses:

1. Single-pollutant models: 

Poisson GAM, LOESS 

2. Multi-pollutant models: 

Principal component regression 

analysis 

Age Groups Analyzed: All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.9 ppm 

Range (Max): 7.2 ppm 

Copollutant: correlation 

O3: r = -0.05 

SO2: r = 0.42 

PM2.5: r = 0.44 

PM10-2.5: r = 0.29 

PM10: r = 0.45 

Increment: 0.9 ppm 

% Increase (t-value); lag: 

Temporally filtered daily nonaccidental mortality 

(days in which PM10 data available) 

CO: 0.4 (0.4); 0; 2.0 (2.3); 1 

CO, PM2.5: -0.7 (-0.7); 0; 1.1 (1.1); 1 

CO, PM10-2.5: 0.1 (0.2); 0; 1.8 (2.1); 1 

CO, PM10: -0.5 (-0.6); 0; 1.2 (1.3); 1 

Daily filtered non-accidental mortality 

Single-pollutant model: 2.1 (2.1) 

Multi-pollutant models: 

Model 1: CO, PM2.5, PM10-2.5, O3, NO2, SO2: 0.7 (1.9)

Model 2: CO, SO4, Ni, Fe, Zn, O3, NO2: 0.7 (1.7) 

Author: Burnett et al. (2004, 

086247) 

Period of Study: 1981-1999 

Location: 12 Canadian cities 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800) 

Study Design: Time series 

Statistical Analyses:

1. Poisson, natural splines 

2. Random effects regression 

model 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.02 ppm 

Range (Min, Max): NR 

Copollutant: 

NO2; 

O3; 

SO2; 

PM2.5; 

PM10-2.5

Increment: 1.02 ppm 

% Increase (t-value); lag: 

0.68% (3.12); 1 

CO, NO2: 0.07% (0.30); 1 

Author: Cakmak et al. 

(2007, 091170) 

Period of Study:

1/1997-12/2003 

Location:

Chile-7 cities 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental) (<800); CVDs 

(390-459); respiratory diseases 

(460-519) 

Study Design: Time series 

Statistical Analyses: Poisson; 

Random effects regression 

model 

Age Groups Analyzed: 

All ages 

≤ 64 yr 

65-74 yr 

75-84 yr 

≥ 85 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.29 ppm 

Range (Min, Max): NR 

Copollutant correlation: 

O3: r = -0.55 to -0.01 

SO2: r = 0.31 to 0.67 

PM10: r = 0.49 to 0.82 

Note: Correlations are between 

pollutants for seven monitoring 

stations. 

Increment: 1.29 ppm 

% Increase (t-value); lag: 

Nonaccidental: 

5.88% (6.42); 1; 9.39% (6.89); 0-5 

CO+PM10+O3+SO2: 6.13% (4.34); 1 

Age Group: ≤ 64 

4.10% (2.52); 1; / 4.76% (2.19); 0-5 

Age Group: 65-74 

6.24% (3.17); 1; / 8.12% (3.88); 0-5 

Age Group: 75-84 

8.64% (4.82); 1; / 13.12% (5.12); 0-5 

Age Group: ≥ 85 

8.58% (4.45); 1; / 13.20% (4.82); 0-5 

April-September 

7.09% (4.02); 1; / 9.65% (4.50); 0-5 

October-March 

5.45% (1.14); 1; / 7.80% (1.89); 0-5 

Cardiac 

7.79% (4.56); 1; / 11.22% (4.8); 0-5 

Respiratory 

12.93% (5.78); 1; / 21.31% (6.34); 0-5 

Author: Chock et al. (2000, 

010407) 

Period of Study:

1989-1991 

Location:

Pittsburgh, PA 

Health Outcome (ICD9):

Mortality: Respiratory (480-486, 

490-496, 507); cardiovascular 

(390-448); influenza (487) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM; Cubic B-spline 

basis functions 

Age Groups Analyzed: 

All ages 

<75 yr 

>75 yr 

Pollutant: CO 

Averaging Time: 1-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

PM10; 

PM2.5; 

O3; 

SO2; 

NO2

Increment: NR 

β (SE); lag: 

Age Group: <75 

CO alone: 0.0080 (1.56); 0 

PM10, CO: 0.0030 (0.48); 0 

PM10, NO2, CO: 0.0079 (1.14); 0 

PM10, O3, SO2, NO2, CO: 0.072 (1.02); 0 

CO 

-0.00738 (-1.42); -3; / 0.00133 (0.23); -2; 

-0.00219 (-0.38); -1; / 0.00809 (1.48); 0; 

-0.00129 (-0.22); 1; / 0.00512 (0.90); 2; 

-0.00974 (-1.87); 3 

CO, PM10, O3, SO2, NO2 

-0.01103 (-1.48); -3; / -0.00097 (-0.13); -2; 

0.00514 (0.67); -1; / 0.00853 (1.15); 0; 

-0.00404 (-0.52); 1; / -0.00296 (-0.39); 2; 

-0.00346 (-0.46); 3 

Season 

CO 

Winter: 0.00539 (0.78); 0 

Spring: 0.01655 (1.90); 0 

Summer: 0.00155 (0.14); 0 

Fall: 0.00797 (1.14); 0 

January 2010 C-72 
Study Design Concentrations Effect Estimates (95% CI) 

CO, PM10

Winter: -0.00563 (-0.50); 0 

Spring: 0.01233 (0.99); 0 

Summer: -0.00712 (-0.48); 0 

Fall: 0.00661 (0.73); 0 

CO, PM10, O3, SO2, NO2

Winter: -0.01326 (-0.95); 0 

Spring: 0.02501 (1.54); 0 

Summer: 0.01874 (0.92); 0 

Fall: 0.01011 (0.88); 0 

Age Group:>75 

CO Alone: -0.0035 (-0.67); 0 

CO, PM10: -0.0104 (-1.67); 0 

CO, PM10, NO2: -0.0128 (-1.80); 0 

CO, PM10, O3, SO2, NO2: -0.0144 (-1.99); 0 

CO 

-0.00025 (-0.05); -3; / -0.00242 (-0.42); -2; 

-0.00238 (-0.41); -1; / -0.00302 (-0.54); 0; 

-0.00116 (-0.20); 1; / -0.00508 (-0.88); 2; 

-0.00251 (-0.48); 3 

CO, PM10, O3, SO2, NO2 

-0.00123 (-0.17); -3; / -0.00876 (-1.13); -2; 

-0.00682 (-0.88); -1; / -0.01248 (-1.66); 0; 

-0.00672 (-0.86); 1; / -0.00181 (-0.23); 2; 

-0.00515 (-0.69); 3 

Season 

CO 

Winter: -0.00304 (-0.43); 0 

Spring: 0.00482 (0.54); 0 

Summer: 0.01178 (1.07); 0 

Fall: -0.01011 (-1.43); 0 

CO, PM10

Winter: -0.02303 (-2.03); 0 

Spring: -0.00517 (-0.40); 0 

Summer: 0.00735 (0.50); 0 

Fall: -0.01042 (-1.14); 0 

CO, PM10, O3, SO2, NO2

Winter: -0.03370 (-2.41); 0 

Spring: -0.00652 (-0.39); 0 

Summer: 0.01258 (0.61); 0 

Fall: -0.01250 (-1.07); 0 

January 2010 C-73 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Cifuentes et al. 

(2000, 010351) 

Period of Study:

1988-1996 

Location:

Santiago, Chile 

Health Outcome (ICD9):

Mortality: All causes 

(nonaccidental) (<800) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM, GAM with filtered 

variables & GLM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 1-h avg 

Mean (SD) unit: 2.5 ppb 

Range (5th, 95th): (0.6, 6.2) 

Copollutant correlation: 

PM2.5: r = 0.80 

PM10-2.5: r = 0.47 

SO2: r = 0.62 

NO2: r = 0.65 

O3: r = -0.01 

Increment: 

All yr: 2.5 ppm 

Winter: 3.6 ppm 

Summer: 1.3 ppm 

Relative Risk (t-ratio); Lag

All Year 

CO: 1.041 (7.2); 0-1 

CO, PM2.5: 1.025 (3.5); 0-1 

CO, PM10-2.5: 1.035 (4.9); 0-1 

CO, SO2: 1.038 (6.0); 0-1 

CO, NO2: 1.026 (3.9); 0-1 

CO, O3: 1.036 (4.8); 0-1 

Winter 

CO: 1.052 (5.9); 0-1 

CO, PM2.5: 1.025 (2.1); 0-1 

CO, PM10-2.5: 1.049 (4.3); 0-1 

CO, SO2: 1.049 (5.0); 0-1 

CO, NO2: 1.027 (2.6); 0-1 

CO, O3: 1.051 (4.4); 0-1 

Summer 

CO: 1.053 (6.0); 0-1 

CO, PM2.5: 1.053 (5.3); 0-1 

CO, PM10-2.5: 1.053 (5.3); 0-1 

CO, SO2: 1.050 (5.2); 0-1 

CO, NO2: 1.047 (5.2); 0-1 

CO, O3: 1.042 (3.6); 0-1 

All Year 

GAM model 

CO: 1.041 (7.2); 0-1 

CO, PM2.5, PM10-2.5, SO2, NO2, O3: 

1.032 (4.6); 0-1 

GAM Filtered Variables 

CO: 1.030 (4.3); 0-1 

CO, PM2.5, PM10-2.5, SO2, NO2, O3: 

1.022 (2.4); 0-1 

GLM 

CO: 1.023 (2.4); 0-1 

CO, PM2.5, PM10-2.5, SO2, NO2, O3: 

1.013 (1.1); 0-1 

Author: Conceicao et al. 

(2001, 016628) 

Period of Study:

1994-1997 

Location:

Sao Paulo, Brazil 

Health Outcome (ICD9):

Mortality: Respiratory diseases 

(460-519) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: <5 yr 

Pollutant: CO 

Averaging Time: Max 8-h ma 

Mean (SD) unit:

Total: 4.4 (2.2) ppm 

1994: 5.1 (2.4) ppm 

1995: 5.1 (2.4) ppm 

1996: 3.9 (2.0) ppm 

1997: 3.7 (1.6) ppm 

Range (Min, Max): NR 

Copollutant: 

PM10; SO2; O3

Increment: NR 

β (SE); lag:

CO: 0.0306 (0.0076); 2 

CO, SO2, PM10, O3: 0.0259 (0.0116); 2 

Model 1: Pollutant concentration: 

0.0827 (0.0077); 2 

Model 2: 1+loess(time): 

0.0285 (0.0074); 2 

Model 3: 2+loess(temperature)+humidity: 

0.0309 (0.0076); 2 

Model 4: 3+nonrespiratory counts: 

0.0306 (0.0076); 2 

Model 5: 4+autoregressive parameters: 

0.0292 (0.0118); 2 

Author: De Leon et al. 

(2003, 055688) 

Period of Study:

1/1985-12/1994 

Location:

New York, NY 

Health Outcome (ICD9):

Mortality: Circulatory (390-459); 

cancer (140-239) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM 

Age Groups Analyzed: 

All ages 

<75 yr 

>75 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 2.45 ppm 

IQR (25th, 75th): (1.80, 2.97) 

Copollutant: PM10; 

O3; 

SO2; 

NO2

The study did not present quantitative results for CO.

January 2010 C-74 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Dominici et al. 

(2003, 056116) 

Period of Study:

1987-1994 

Location:

90 U.S. cities (NMMAPS) 

Health Outcome (ICD9):

Mortality: All-cause 

(nonaccidental); 

cardiovascular; respiratory 

Study Design: Time series 

Statistical Analyses:

1. GAM with S-PLUS default 

convergence criteria 

2. GAM with more stringent 

convergence criteria 

3. Poisson GLM with natural 

cubic splines 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant:

O3; NO2; SO2; CO 

Increment: 1 ppm 

% Increase (Lower CI, Upper CI); Lag 

CO 

0.08% (-0.18 to 0.34); 0 

0.46% (0.18-0.73); 1 

0.16% (-0.12 to 0.45); 2 

Author: Fairley et al. (1999, 

000896) 

Period of Study:

1989-1996 

Location:

Santa Clara, CA 

Health Outcome (ICD9):

Mortality: Respiratory; 

cardiovascular 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 

24-h avg; Max 8-h avg 

Median (SD) unit:

24-h avg: 1.4 (1.0) ppm 

Max 8-h avg: 2.1 (1.6) ppm 

Range (Min, Max): 

24-h avg: (0.0, 7.6) 

Max 8-h avg: (0.2, 2.5) 

Copollutant: correlation 

PM10: r = 0.609; 

PM2.5: r = 0.435; 

PM10-2.5: r = 0.326; 

COH: r = 0.736; 

NO3: r = 0.270; 

SO4: r = 0.146; O3: r = -0.215 

Increment: 2.2 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

1980-1986 

CO: 1.04; 0; 

CO: 1.05; 1; 

CO, COH: 1.00; 1; 

CO, NO3: 1.03; 

CO, NO3, O3, COH: 1.00 

1989-1996 

CO: 1.02; 0; 

CO: 1.04; 1; 

CO, PM2.5: 0.98; 

CO, NO3: 1.01; 

CO, NO2, O3, NO3: 1.06 

Respiratory mortality: CO: 1.08; 1 

Cardiovascular mortality: CO: 1.04; 1 

Author: Fischer et al. (2003, 

043739) 

Period of Study:

1986-1994 

Location: The Netherlands 

Health Outcome (ICD9):

Mortality: Nonaccidental 

(<800); pneumonia 

(480-486); COPD (490-496); 

cardiovascular (390-448) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: 

<45 yr 

45-64 yr 

65-74 yr 

≥ 75 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Median (SD) unit: 406 μg/m3

Range (Min, Max): (174, 2620) 

Copollutant: 

PM10; BS; O3; NO2; SO2

Increment: 1,200 μg/m3

Relative Risk (Lower CI, Upper CI); lag: 

Cardiovascular 

Age Group: 

<45: 0.965 (0.750-1.240); 0-6 

45-64: 1.029 (0.941-1.125); 0-6 

65-74: 1.038 (0.972-1.108); 0-6 

≥ 75: 1.024 (0.984-1.065); 0-6 

COPD 

Age Group: 

<45: 1.710 (0.852-3.435); 0-6 

45-64: 1.181 (0.850-1.640); 0-6 

65-74: 1.377 (1.147-1.654); 0-6 

≥ 75: 1.072 (0.963-1.193); 0-6 

Pneumonia 

Age Group: 

<45: 0.927 (0.463-1.856); 0-6 

45-64: 2.691 (1.509-4.800); 0-6 

65-74: 1.118 (0.743-1.683); 0-6 

≥ 75: 1.230 (1.090-1.389); 0-6 

Author: Forastiere et al. 

(2005, 086323) 

Period of Study:

1998-2000 

Location: 

Rome, Italy 

Health Outcome (ICD9):

Mortality: IHD (410-414) 

Study Design: 

Time-stratified case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: >35 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 2.4 (1.0) mg/m3

IQR (25th, 75th): (1.7, 2.9) 

Copollutant correlation:

PNC: r = 0.89; PM10: r = 0.34; 

NO2: r = 0.54; SO2: r = 0.52; 

O3: r = 0.01 

Increment: 1.2 mg/m3 

% Increase (Lower CI, Upper CI); lag: 

6.5% (1.0-12.3); 0 

4.7% (-0.9 to 10.7); 1 

2.6% (-3.0 to 8.5); 2 

-0.1% (-5.5 to 5.5); 3 

7.0% (0.8-13.7); 0-1 

January 2010 C-75 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Forastiere et al. 

(2007, 090720) 

Period of Study:

1998-2001 

Location: Rome, Italy 

Health Outcome (ICD9):

Mortality: Malignant neoplasms 

(140-208); diabetes mellitus 

(250); hypertensive (401-405); 

previous AMI (410, 412); IHD 

(410-414); conduction 

disorders of the heart (426); 

dysrhythmia (427); heart failure 

(428); cerebrovascular (430-

438); peripherical artery 

disease (440-448); COPD 

(490-496) 

Study Design: Time-stratified 

case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: >35 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

IQR (25th, 75th): NR 

Copollutant: 

PM10; PM2.5; NOX; Benzene 

This study did not present quantitative results for 

CO. 

Author: Goldberg et al. 

(2001, 016548) 

Period of Study:

1984-1993 

Location: Montreal, 

Quebec, Canada 

Health Outcome (ICD9):

Mortality: Upper respiratory 

diseases (472-478); acute 

upper respiratory diseases 

(460-465); acute lower 

respiratory (466, 480-487, 512, 

513, 518, 519) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM; LOESS 

Age Groups Analyzed: 

<65 yr; ≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.8 (0.5) ppm 

Range (Min, Max): (0.1, 5.1) 

Copollutant: 

TSP; PM10; PM2.5; Sulfates; COH; 

SO2; NO2; NO; O3

The study did not present quantitative results for CO.

Author: Goldberg et al. 

(2003, 035202) 

Period of Study: 1984-1993 

Location: 

Montreal, Quebec, Canada 

Health Outcome (ICD9):

Mortality: CHF (428) 

Study Design: Time-series 

Statistical Analyses: Poisson 

GLM, natural splines 

Age Groups Analyzed: 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.8 (0.5) ppm 

Range (Min, Max): (0.1, 5.1) 

Copollutant: 

PM2.5; Sulfate; SO2; NO2; O3

Increment: 0.50 ppm 

% Increase (Lower CI, Upper CI); lag: 

Daily mortality from CHF 

-0.99% (-6.31 to 4.63); 0 

0.12% (-5.29 to 5.84); 1 

-1.38% (-8.81 to 6.66); 0-2 

Daily mortality among persons classified as having 

CHF before death 

2.10% (-0.24 to 4.49); 0 

2.28% (-0.09 to 4.72); 1 

2.86% (-0.46 to 6.29); 0-2 

Author: Goldberg et al. 

(2006, 088641) 

Period of Study:

1984-1993 

Location: 

Montreal, Quebec, Canada 

Health Outcome (ICD9):

Mortality: Diabetes (250) 

Study Design: Time series 

Statistical Analyses: Poisson, 

natural splines 

Age Groups Analyzed: ≥ 65 yr

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.8 (0.5) ppm 

Range (Min, Max): (0.1, 5.1) 

Copollutant: 

PM2.5; 

Sulfate; 

SO2; 

NO2; 

O3

Increment: 0.50 ppm 

% Increase (Lower CI, Upper CI); lag: 

Daily mortality from diabetes 

2.64% (-2.56 to 8.12); 0 

6.54% (1.31-12.03); 1 

8.08% (1.03-15.62); 0-2 

Daily mortality among persons classified as having 

diabetes before death 

1.15% (-1.69 to 4.07) ; 0 

1.30% (-1.58 to 4.27) ; 1 

2.63% (-1.42 to 6.85) ; 0-2 

Author: Gouveia et al. 

(2000, 012132) 

Period of Study:

1991-1993 

Location:

Sao Paulo, Brazil 

Health Outcome (ICD9):

Mortality: Respiratory; 

cardiovascular; all other causes

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

All ages 

>65 yr 

<5 yr 

Pollutant: CO 

Averaging Time:

Maximum 8-h moving avg 

Mean (SD) unit: 5.8 (2.1) ppm 

Range (Min, Max): (1.3, 16.2) 

Copollutant: 

PM10; SO2; NO2; O3

Increment: 5.1 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Age Group: All ages: 

All-causes 1.012 (0.994-1.031); 0 

Age Group: >65 

All-causes: 1.020 (0.996-1.046); 0 

Respiratory: 0.981 (0.927-1.037); 2 

CVD: 1.041 (1.007-1.076); 0 

Age Group: <5 

Respiratory: 1.086 (0.950-1.238); 0 

Pneumonia: 1.141 (0.962-1.321); 2 

January 2010 C-76 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Gwynn et al. (2000, 

074109) 

Period of Study:

5/1988-10/1990 

Location:

Buffalo, NY 

Health Outcome (ICD9):

Mortality: Respiratory (466, 

480-486); Circulatory (401-405, 

410-414, 415-417); All nonaccidental causes (<800) 

Study Design: Time-series 

Statistical Analyses:

Poisson GLM 

Age Groups Analyzed: All 

ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant correlation: 

H+: r =0.15; SO4

2-: r = 0.24; 

O3: r = -0.23; SO2: r = 0.11; 

NO2: r = 0.65 

Increment: NR 

β (SE); lag: 

Respiratory mortality: 0.032466 (0.053802); 0 

Circulatory mortality: 0.039216 (0.026544); 3 

Total mortality: 0.040214 (0.015205); 3 

Author: Hoek et al. (2001, 

016550) 

Period of Study:

1986-1994 

Location: The Netherlands 

Health Outcome (ICD9):

Mortality: Heart failure (428); 

arrhythmia (427); 

cerebrovascular (430-436); 

thrombocytic (433, 434, 444, 

452, 453); cardiovascular (390-

448) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

O3; BS; PM10; SO2; NO2

Increment: 120 μg/m3

Relative Risk (Lower CI, Upper CI); Lag 

Total CVD mortality: 1.026 (0.993-1.060); 0-6 

MI and other IHD mortality: 

1.050 (1.004-1.099); 0-6 

Arrhythmia: 1.062 (0.937-1.203); 0-6 

Heart failure mortality: 1.109 (1.012-1.216); 0-6 

Cerebrovascular mortality: 

1.066 (1.029-1.104); 0-6 

Embolism, thrombosis: 1.065 (0.926-1.224); 0-6 

Author: Hoek et al. (2000, 

010350) 

Period of Study:

1986-1994 

Location: The Netherlands 

Health Outcome (ICD9):

Mortality: Pneumonia 

(480-486); COPD (490-496); 

CVDs (CVD) (390-448) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM, LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Netherlands: 457 μg/m3 

Four Major Cities: 589 μg/m3

Range (Min, Max):

Netherlands: (174, 2620) 

Four Major Cities: (202, 4621) 

Copollutant correlation:

PM10: r = 0.64; BS: r = 0.89; 

O3: r = -0.48; NO2: r = 0.89; 

SO2: r = 0.65; SO4

2-: r = 0.55; 

NO3-: r = 0.58 

Increment: 

Single-day lag (1): 1,500 μg/m3

Weekly avg (0-6): 1200 μg/m3

Relative Risk (Lower CI, Upper CI); Lag 

CO 

Four Major Cities: 1.022 (0.995-1.050); 1 

Four Major Cities: 1.044 (1.008-1.082); 0-6 

Netherlands w/o Major Cities: 1.040 (1.020-1.060); 1

Netherlands w/o Major Cities: 

1.051 (1.026-1.076); 0-6 avg 

Entire Netherlands: 1.035 (1.018-1.052); 1 

Entire Netherlands: 1.046 (1.025-1.068); 0-6 

CVD: 1.044 (1.012-1.077); 0-6 

COPD: 1.194 (1.099-1.298); 0-6 

Pneumonia: 1.276 (1.143-1.426); 0-6 

Winter: 1.038 (1.013-1.063); 0-6 

Summer: 1.199 (1.108-1.296); 0-6 

Multi-pollutant model 

CO, PM10

Total mortality: 0.969 (0.914-1.028); 0-6 

CVD: 1.005 (0.918-1.101); 0-6 

BS, CO 

Total mortality: 0.980 (0.933-1.030); 0-6 

CVD: 0.927 (0.860-0.999); 0-6 

CO, SO4

2-

Total mortality: 0.990 (0.951-1.030); 0-6 

CVD: 0.999 (0.939-1.063); 0-6 

Author: Honda et al. (2003, 

193774) 

Period of Study:

1976-1990 

Location:

Tokyo, Japan 

Health Outcome (ICD9):

Mortality: 

Total (nonaccidental) (<800) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Median (SD) unit: 1.6 ppm 

Range (Min, Max): (0, 6.8) 

Copollutant correlation:

NO: r = 0.403; NO2: r = 0.415; 

Oxidant: r = 0.396; SO2: r = 0.675 

Increment: NR 

Rate Ratio (Lower CI, Upper CI); lag: 

CO concentration 

<1.1 ppm: 1.00 (reference category) 

1.1-1.6 ppm: 1.017 (1.009, 1.026) 

1.6-2.2 ppm: 1.031 (1.020, 1.041) 

>2.2 ppm: 1.051 (1.039, 1.063) 

January 2010 C-77 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Hong et al. (2002, 

035060) 

Period of Study:

1/1991-12/1997 

Location:

Seoul, Korea 

Health Outcome (ICD9):

Mortality: Hemorrhagic and 

ischemic stroke (431-434) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.44 (0.70) ppm 

Range (Min, Max): (0.430, 5.14) 

Copollutant: 

TSP; SO2; NO2; O3

Increment: 0.76 ppm 

Relative Risk (Lower CI, Upper CI); lag:

1.06 (1.02, 1.09); 1 

Multipollutant: 

CO, TSP: 1.07 (1.03, 1.11); 1 

CO, NO2: 1.06 (1.00, 1.11); 1 

CO, SO2: 1.05 (1.01, 1.10); 1 

CO, O3: 1.09 (1.05, 1.13); 1 

Author: Hong et al. (1999, 

011195) 

Period of Study:

1/1995-12/1995 

Location:

Inchon, Korea 

Health Outcome (ICD9):

Mortality: Cardiovascular (400-

440); respiratory 

(460-519); nonaccidental 

causes (<800) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM, LOESS 

Age Groups Analyzed:

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.7 (0.8) ppm 

Range (Min, Max): (0.3, 5.1) 

Copollutant: 

SO2; NO2; O3

Increment: 1 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Total mortality: 

0.993 (0.950, 1.037); 0-4 

Cardiovascular mortality: 

0.965 (0.892, 1.044); 0-4 

Author: Hong et al. (2002, 

024690) 

Period of Study:

1/1995-12/1998 

Location:

Seoul, Korea 

Health Outcome (ICD9):

Mortality: Stroke (160-169) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.2 (0.5) ppm 

Range (Min, Max): (0.4, 3.4) 

Copollutant: correlation

PM10: r = 0.22; NO2: r = 0.64; 

SO2: r = 0.90; O3: r = -0.35 

Increment: 0.3 ppm 

% Increase (Lower CI, Upper CI); lag: 

CO: 2.2% (0.4, 4.1); 2 

CO (stratified by PM10 concentration): 

<median concentration of PM10: 1.1; 2 

≥ median concentration of PM10: 3.6; 2 

Author: Hong et al. (1999, 

008087) 

Period of Study:

1/1995-8/1996 

Location:

Inchon, South Korea 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); respiratory; 

cardiovascular 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM; LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 15.2 (7.1) ppb 

Range (Min, Max): (2.9, 51.2) 

Copollutant: 

PM10; NO2; SO2; O3

Increment: 100 ppb 

β (SE); lag: 

Total Mortality 

CO 

0.0019 (0.0015); 1 

0.0024 (0.0041); 0-4 

CO, PM10, NO2, SO2, O3

-0.0009 (0.0019); 1 

-0.0018 (0.0043); 0-4 

Cardiovascular Mortality 

CO 

0.0019 (0.0073); 1 

-0.0008 (0.0028); 0-4 

CO, PM10, NO2, SO2, O3

-0.0053 (0.0078); 1 

-0.0037 (0.0033); 0-4 

Respiratory Mortality 

CO 

0.0148 (0.0065); 1 

0.0063 (0.0171); 0-4 

CO, PM10, NO2, SO2, O3

0.0121 (0.0079); 1 

-0.0034 (0.0183); 0-4 

Author: Keatinge et al. 

(2001, 017063) 

Period of Study:

1976-1995 

Location: 

London, England 

Health Outcome (ICD9):

Mortality: Nonaccidental 

causes (<800) 

Study Design: Time series 

Statistical Analyses: Singleand multiple-delay regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

SO2; PM10

The study did not present quantitative results for CO.

January 2010 C-78 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Kettunen et al. 

(2007, 091242) 

Period of Study: 1998-2004 

Location:

Helsinki, Finland 

Health Outcome (ICD10):

Mortality: Stroke (I60-I61, 

I63-I64) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM, penalized thinplate splines 

Age Groups Analyzed: 

≥ 65 yr 

Pollutant: CO 

Averaging Time: Max 8-h ma 

Median (SD) unit:

Cold Season: 0.5 mg/m3

Warm Season: 0.4 mg/m3

Range (Min, Max): 

Cold Season: (0.1, 2.4) 

Warm Season: (0.1, 1.1) 

Copollutant: correlation

Cold Season: 

PM2.5: r = 0.32; UFP: r = 0.47 

Warm Season: 

PM2.5: r = 0.24; UFP: r = 0.39 

Increment: 0.2 mg/m3

% Increase (Lower CI, Upper CI); lag: 

Cold Season 

0.47 (-3.29 to 4.39); 0; / -0.63 (-4.39 to 3.28); 1; 

-2.69 (-6.46 to 1.24); 2; / -0.19 (-3.93 to 3.69); 3 

Warm Season 

3.95 (-3.78 to 12.30); 0; / 8.33 (0.63 to 16.63); 1; 

6.97 (-0.59 to 15.11); 2; / 7.54 (-0.05 to 15.71); 3 

Author: Klemm et al. (2004, 

056585) 

Period of Study:

8/1998-7/2000 

Location:

Fulton County and DeKalb 

County, GA (ARIES) 

Health Outcome (ICD9):

Mortality: Nonaccidental 

(<800); cardiovascular 

(390-459); respiratory 

(460-519); cancer (140-239) 

Study Design: Time series 

Statistical Analyses:

Poisson GLM, natural cubic 

splines 

Age Groups Analyzed: 

<65 yr; ≥ 65 yr 

Pollutant: CO 

Averaging Time: 1-h max 

Median (SD) unit: 

1,310 (939.13) ppb 

Range (Min, Max): (303.58, 7400) 

Copollutant: 

PM2.5; PM10-2.5; O3; NO2; SO2; Acid; 

EC; OC; SO4; Oxygenated HCs; 

NMHCs; NO3

Increment: NR 

β (SE); lag: 

Quarterly Knots: 0.00002 (0.00001); 0-1 

Monthly Knots: 0.00002 (0.00001); 0-1 

Biweekly Knots: 0.00001 (0.00002); 0-1 

Author: Knox et al. (2008, 

193776) 

Period of Study: 1996-2004 

Location: 352 English local 

authorities 

Health Outcome: Mortality 

Study Design: Cross sectional

Statistical Analyses: Linear 

regression 

Age Groups Analyzed: NR 

Sample Description: Data 

from Oxford Cancer 

Intelligence Unit 

Averaging Time: NR 

Meuan (SD) nit: NR 

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: NR 

Significant (p<0.01) correlations (r) between CO and 

diseases: Lung cancer: 0.28, Stomach cancer: 0.20, 

Oesophagus cancer: -0.20, Prostate cancer: -0.25, 

Brain cancer: -0.24, Melanoma: -0.24, Hodgkin’s: -

0.19, Peripheral vascular disease: 0.15, Stroke: 

0.16, Rheumatic heart disease: 0.27, Peptic ulcer: 

0.28, Diabetes: 0.17, COPD: 0.25, Asthma: 0.14, 

Pneumonia: 0.44, Multiple sclerosis: -0.16, 

Motorneurone disease: -0.24, Parkinsons disease: -

0.15 

Significant (p<0.01) socially standardized 

correlations between diseases and exposures: Lung 

cancer: 0.25, Stomach cancer: 0.18, RHD: 0.19, 

Pneumonia: 0.37, COPD: 0.17, Peptic ulcer: 0.16 

Lags examined: NR 

January 2010 C-79 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Kwon et al. (2001, 

016699) 

Period of Study:

1994-1998 

Location:

Seoul, Korea 

Health Outcome (ICD9):

Mortality: CHF (428); 

cardiovascular (390-459) 

Study Design: 

1. Time-series 

2. Bi-directional case-crossover

Statistical Analyses:

1. Poisson GLM, LOESS 

2. Conditional logistic 

regression 

Age Groups Analyzed: <55 yr 

55-64 yr 

65-74 yr 

75-84 yr 

≥ 85 yr 

Pollutant: CO 

Averaging Time: 1-h avg 

Mean (SD) unit: 12.4 ppb 

Range (Min, Max): (4.1, 38.0) 

Copollutant correlation:

PM10: r = 0.713; NO2: r = 0.744; 

SO2: r = 0.843; O3: r = -0.367 

Increment: 0.59 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

From GAM approach 

CHF patients: 1.054 (0.991-1.121); 0; 0 

General Population: 1.022 (1.017- 1.029); 0 

From case-crossover design 

CHF patients: 1.033 (0.946-1.127); 0 

General Population: 1.007 (0.997- .016); 0 

Modifiers and CHF patients (case-crossover design)

Gender 

Male: 1.025 (0.890-1.180); 0 

Female: 1.035 (0.925-1.157); 0 

Age Group: 

<75: 0.948 (0.890-1.180); 0 

≥ 75: 1.116 (0.989-1.258); 0 

Time from admission to death 

4 or less wk: 1.088 (0.907-1.306); 0 

>4 wk: 1.017 (0.920-1.124); 0 

Total mortality: 1.033 (0.946-1.127); 0 

Cardiovascular mortality: 1.033 (0.920-1.160); 0 

Cardiac death: 1.052 (0.919-1.204); 0 

Two-pollutant model in CHF patients (casecrossover design) 

CO alone: 1.054 (0.991-1.121); 0 

CO, PM10: 1.096 (0.981-1.224); 0 

CO, NO2: 1.022 (0.932-1.122); 0 

CO, SO2: 1.014 (0.909-1.131); 0 

CO, O3: 1.056 (0.992-1.124); 0 

Author: Lee et al. (2007, 

093042) 

Period of Study:

1/2000-12/2004 

Location:

Seoul, Korea 

Health Outcome (ICD10):

Mortality: Nonaccidental (A00-

R99) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: Max 8-h ma 

Mean (SD) unit:

w/ Asian dust days: 0.92 (0.42) ppm 

w/o Asian dust days:0.92 (0.41) ppm

Asian dust days only: 1.00 

(0.47) ppm 

Range (Min, Max): NR 

Copollutant: PM10; NO2; SO2; O3

Increment: 0.54 ppm 

% Increase (Lower CI, Upper CI); lag: 

Model with Asian Dust Days: 3.3% (2.5-4.1); 1 

Model without Asian dust days: 3.3% (2.5-4.2); 1 

Author: Lipfert et al. (2000, 

004088) 

Period of Study:

5/1992-9/1995 

Location:

Philadelphia, PA, three 

nearby suburban 

Pennsylvania counties, and 

three nearby New Jersey 

counties 

Health Outcome (ICD9):

Mortality: Respiratory 

(460-519); cardiac (390-448); 

Cancer; other causes (<800) 

Study Design: Time series 

Statistical Analyses:

Step-wise regression 

Age Groups Analyzed:

<65 yr 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg; 1-h max 

Mean (SD) unit:

Camden: 

24-h avg: 0.75 (0.40) ppm 

Philadelphia: 

24-h avg: 0.63 (0.40) ppm 

1-h max: 1.44 (1.04) 

Range (Min, Max):

Camden: (0.10, 3.8) 

Philadelphia: 

24-h avg: (0.10, 3.3) 

1-h max: (0.0, 7.8) 

Copollutant: 

NO; NO2; O3; SO2; SO4

2-; 

PM10; PM2.5

Increment: NR 

Attributable Risk; lag: 

Peak CO 

All-cause 

Philadelphia: 0.0054; 0-1 

4 Pennsylvania Counties: 0.0081; 0-1 

Pennsylvania + NJ: 0.0085; 0-1 

CO 

All seven counties in Pennsylvania and New Jersey

All ages 

Respirator y: -0.0067; Cardiac: 0.0131; 

Other: 0.0078 

All-cause: 

<65: 0.0148; 0-1; ≥ 65: 0.0054; 0-1 

Joint model with CO 

Philadelphia: 0.0059; 0-1 

4 Pennsylvania Counties: 0.0089; 0-1 

Pennsylvania + NJ: 0.0096; 0-1 

Cardiac: 0.0135; 0-1; 

Other causes: 0.0084 

<65: 0.0154; 0-1; 

≥ 65: 0.0060; 0-1 

January 2010 C-80 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Lippmann et al. 

(2000, 011938) 

Period of Study:

1985-1990 

1992-1994 

Location:

Detroit, MI and Windsor, ON 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); circulatory (390-459); 

respiratory (460-519) 

Study Design: Time series 

Statistical Analyses:

Poisson GLM 

Age Groups Analyzed: 

≥ 65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

1985-1990: 0.9 ppm 

1992-1994: 0.72 ppm 

Range (5th, 95th):

1985-1990: (.46, 1.61) 

1992-1994: (0.36, 1.2) 

Copollutant correlation:

1985-1990 

PM10: r = 0.35; TSP: r = 0.28; 

TSP-PM10: r = 0.02; 

TSP-SO4

2-: r = 0.18; 

O3: r = -0.22; SO2: r = 0.36; 

NO2: r = 0.58 

1992-1994 

PM10: r = 0.38; PM2.5: r = 0.38; 

PM10-2.5: r = 0.24; 

H+: r = 0.16; SO4

2-:r = 0.32; 

O3: r = 0.16; SO2: r = 0.42; 

NO2: r = 0.68 

Increment: 

1985-1990: 11.5 ppm; 1992-1994: 8.4 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

1985-1990 

Total Mortality: 

0.9842 (0.9667-1.002); 0 

1.0103 (0.9926-1.0284); 1 

1.0075 (0.9898-1.0254); 2 

1.0145 (0.9967-1.0326); 3 

0.9968 (0.9789-1.0151); 0-1 

1.0105 (0.9925-1.0288); 1-2 

1.0134 (0.9954-1.0317); 2-3 

1.0003 (0.9823-1.0187); 0-2 

1.0152 (0.9971-1.0336); 1-3 

1.0053 (0.9873-1.0236); 0-3 

Circulatory Mortality: 

0.9818 (0.9574-1.0068); 0 

0.9991 (0.9745-1.0243); 1 

0.9980 (0.9735-1.0232); 2 

1.0088 (0.9841-1.0341); 3 

0.9888 (0.9640-1.0144); 0-1 

0.9981 (0.9732-1.0237); 1-2 

1.0042 (0.9792-1.0298); 2-3 

0.9900 (0.9650-1.0157); 0-2 

1.0029 (0.9777-1.0287); 1-3 

0.9944 (0.9692-1.0202); 0-3 

Respiratory Mortality; 

0.9644 (0.9042-1.0287); 0 

1.0142 (0.9518-1.0808); 1 

1.0483 (0.9845-1.1164); 2 

1.0468 (0.9828-1.1149); 3 

0.9868 (0.9248-1.053); 0-1 

1.0372 (0.9730-1.1056); 1-2 

1.0554 (0.9904-1.1246); 2-3 

1.0088 (0.9457-1.0762); 0-2 

1.0466 (0.9817-1.1158); 1-3 

1.0205 (0.9569-1.0884); 0-3 

Total minus respiratory and circulatory mortality: 

0.9939 (0.9668-1.0217); 0 

1.0278 (1.0001-1.0562); 1 

1.0178 (0.9902-1.0461); 2 

1.0227 (0.9948-1.0514); 3 

1.0127 (0.9860-1.0412); 0-1 

1.0269 (0.9989-1.0556); 1-2 

1.0249 (0.9968-1.0538); 2-3 

1.0172 (0.9893-1.0458); 0-2 

1.0322 (1.0041-1.0612); 1-3 

1.0229 (0.9950-1.0516); 0-3 

1992-1994 

Total Mortality 

0.9933 (0.9636-1.024); 0 

1.0162 (0.9860-1.0473); 1 

1.0116 (0.9816-1.0426); 2 

0.9947 (0.9648-1.0254); 3 

1.0056 (0.9756-1.0366); 0-1 

1.0165 (0.9864-1.0476); 1-2 

1.0038 (0.9739-1.0476); 2-3 

1.0098 (0.9796-1.0409); 0-2 

1.0104 (0.9862-1.0414); 1-3 

1.0064 (0.9755-1.0382); 0-3 

Circulatory Mortality 

1.0076 (0.9640-1.0531); 0 

1.0307 (0.9865-1.0768); 1 

1.0142 (0.9705-1.0598); 2 

0.9523 (0.9102-0.9964); 3 

1.0229 (0.9788-1.0688); 0-1 

1.0267 (0.9827-1.0727); 1-2 

0.9802 (0.9375-1.0248); 2-3 

1.0243 (0.9801-1.0726); 0-2 

0.9987 (0.9553-1.0441); 1-3 

1.0019 (0.9573-1.0487); 0-3 

January 2010 C-81 
Study Design Concentrations Effect Estimates (95% CI) 

Respiratory Mortality 

0.9894 (0.8912-1.0984); 0 

0.9474 (0.8521-1.0533); 1 

0.9652 (0.8682-1.0732); 2 

0.9931 (0.8934-1.1040); 3 

0.9626 (0.8668-1.0691); 0-1 

0.9485 (0.8535-1.0541); 1-2 

0.9752 (0.8775-1.0838); 2-3 

0.9555 (0.8802-1.0615); 0-2 

0.9567 (0.8607-1.0635); 1-3 

0.9584 (0.9604-1.0675); 0-3 

Total minus respiratory and circulatory mortality: 

0.9769 (0.9332-1.0227); 0 

1.0135 (0.9682-1.0609); 1 

1.0195 (0.9747-1.0664); 2 

1.0429 (0.9974-1.0905); 3 

0.9940 (0.9494-1.0406); 0-1 

1.0197 (0.9746-1.0670); 1-2 

1.0371 (0.9918-1.0845); 2-3 

1.0045 (0.9596-1.0515); 0-2 

1.0353 (0.9896-1.0831); 1-3 

1.0215 (0.9749-1.0702); 0-3 

Author: Maheswaran et al. 

(2005, 090769) 

Period of Study:

1994-1998 

Location:

Sheffield, United Kingdom 

Health Outcome (ICD9):

Mortality: CHD (410-414) 

Study Design: Ecological 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

≥ 45 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: 

NOX; 

PM10

Notes: Quintiles represent the 

following mean CO concentrations 

and category limits: 

5: 482 μg/m3

 (≥ 455) 

4: 443 μg/m3

 (≥ 433 to <455) 

3: 426 μg/m3

 (≥ 419 to <433) 

2: 405 μg/m3 (≥ 387 to <419) 

1: 360 μg/m3

 (<387) 

Increment: NR 

Rate Ratios (Lower CI, Upper CI): 

CO 

Adjusted for sex and age 

Quintile: 

5 (highest): 1.24 (1.14, 1.36) 

4: 1.30 (1.19, 1.41) 

3: 1.15 (1.05, 1.25) 

2: 1.08 (0.99, 1.17) 

1: (lowest): 1.00 

CO 

Adjusted for sex, age, deprivation, and smoking 

Quintile: 

5 (highest): 1.05 (0.95, 1.16); 

4: 1.16 (1.06, 1.28); 

3: 1.04 (0.95, 1.14); 

2: 1.03 (0.94, 1.13); 

1 (lowest): 1.00 

CO 

Adjusted for sex, age, deprivation, and smoking 

(spatially smoothed using a 1 km radius) 

Quintile: 

5 (highest): 1.07 (0.96, 1.18); 

4: 1.13 (1.03, 1.24); 

3: 1.04 (0.95, 1.14); 

2: 1.01 (0.92, 1.10); 

1 (lowest): 1.00 

January 2010 C-82 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Maheswaran et al. 

(2005, 088683) 

Period of Study:

1994-1998 

Location:

Sheffield, United Kingdom 

Health Outcome (ICD9):

Mortality: Stroke deaths 

(430-438) 

Study Design: Ecological 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

≥ 45 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Quintile: 

5: 482 μg/m3

; 

4: 443 μg/m3

; 

3: 426 μg/m3

; 

2: 405 μg/m3

; 

1: 360 μg/m3

Range (Min, Max): NR 

Copollutant correlation:

PM10: r = 0.88; NOX: r = 0.87 

Notes: Quintiles represent the 

following mean CO concentrations 

and category limits: 

5: 482 μg/m3

 (≥ 455) 

4: 443 μg/m3

 (≥ 433 to <455) 

3: 426 μg/m3

 (≥ 419 to <433) 

2: 405 μg/m3

 (≥ 387 to <419) 

1: 360 μg/m3

 (<387) 

Increment: NR 

Rate Ratios (Lower CI, Upper CI); lag: 

RR for mortality and CO modeled outdoor air 

pollution 

Adjusted for sex and age 

Quintile: 

5 (highest): 1.35 (1.19, 1.53); 

4: 1.40 (1.24, 1.58); 

3: 1.08 (0.95, 1.23); 

2: 1.10 (0.97, 1.24); 

1 (lowest): 1.00 

Adjusted for sex, age, deprivation, and smoking 

Quintile: 

5 (highest): 1.26 (1.10, 1.46); 

4: 1.32 (1.15, 1.50); 

3: 1.07 (0.93, 1.22); 

2: 1.12 (0.99, 1.28); 

1 (lowest): 1.00 

Not spatially smoothed CO outdoor air pollution 

Quintile: 

5 (highest): 1.26 (1.10, 1.46); 

4: 1.32 (1.15, 1.50); 

3: 1.07 (0.93, 1.22); 

2: 1.12 (0.99, 1.28); 

1 (lowest): 1.00 

Spatially smoothed using a 1-km radius 

Quintile: 

5 (highest): 1.16 (1.01, 1.34); 

4: 1.22 (1.07, 1.39); 

3: 0.95 (0.83, 1.09); 

2: 0.97 (0.85, 1.11); 

1 (lowest): 1.00 

Author: Mar et al. (2000, 

001760) 

Period of Study:

1995-1997 

Location:

Phoenix, AZ 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); cardiovascular (390-

449) 

Study Design: Time series 

Statistical Analyses: Poisson 

Age Groups Analyzed: 

>65 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.5 (0.8) ppm 

Range (Min, Max):

1995: (0.5, 4.0) ppm 

1996: (0.3, 4.0) ppm 

1997: (0.3, 3.7) ppm 

Copollutant correlation:

PM2.5: r = 0.85; 

PM10: r = 0.53; 

PM10-2.5: r = 0.34; 

NO2: r = 0.87; 

O3: r =-0.40; 

SO2: r =0.53 

Increment: 1.19 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Total Mortality (CO exposure): 

1.06 (1.02, 1.09); 0; 

1.05 (1.01, 1.09); 1 

Cardiovascular Mortality (CO exposure): 

1.05 (1.00, 1.11); 0; 

1.10 (1.04, 1.15); 1; 

1.07 (1.02, 1.12); 2; 

1.07 (1.02, 1.12); 3; 

1.08 (1.03, 1.13); 4 

January 2010 C-83 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Moolgavkar et al. 

(2000, 012054) 

Period of Study:

1987-1995 

Location:

Cook County, IL 

Los Angeles County, CA 

Maricopa County, AZ 

Health Outcome (ICD9):

Mortality: 

Circulatory (390-448); 

cardiovascular (390-429); 

cerebrovascular (430-448); 

COPD (490-496); asthma (493)

Study Design: Time series 

Statistical Analyses: Poisson 

GAM, spline smoother 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Median unit:

Cook county: 993 ppb 

Los Angeles: 1347 ppb 

Maricopa: 1240 ppb 

Range (Min, Max):

Cook county: (224, 3912) 

Los Angeles: (237, 5955) 

Maricopa: (269, 4777) 

Copollutant correlation: 

PM10: 

Cook: r = 0.30; 

LA: r = 0.45; 

Maricopa: r = 0.20 

NO2: 

Cook: r = 0.63; 

LA: r = 0.80; 

Maricopa: r = 0.66 

SO2: 

Cook: r = 0.35; 

LA: r = 0.78; 

Maricopa: r = 0.53 

O3: 

Cook: r = -0.28; 

LA: r = -0.52; 

Maricopa: r = -0.61 

Increment: 1 ppm 

% Change (Lower CI, Upper CI); lag: 

CVD Mortality 

Cook County 

CO 

-1.07 (-2.67, 0.54); 0; / 1.25 (-0.36, 2.87); 1; 

1.49 (-0.09, 3.07); 2; / 1.90 (0.32, 3.48); 3; 

1.44 (-0.16, 3.03); 4; / 0.72 (-0.89, 2.32); 5 

Los Angeles County 

CO 

3.47 (2.94, 4.00); 0; / 3.93 (3.41, 4.46); 1; 

4.08 (3.56, 4.60); 2; / 3.76 (3.24, 4.28); 3; 

2.91 (2.37, 3.44); 4; / 2.63 (2.09, 3.17); 5 

CO, PM10

2.27 (0.88, 3.66); 0; / 4.33 (2.96, 5.69); 1; 

4.72 (3.38, 6.05); 2; / 4.26 (2.90, 5.63); 3; 

2.49 (1.10, 3.88); 4; / 5.93 (4.60, 7.27); 5 

CO and PM2.5

0.43 (-1.35, 2.20); 0; / 2.88 (1.16, 4.60); 1; 

4.65 (2.93, 6.37); 2; / 5.93 (4.20, 7.65); 3; 

3.88 (2.13, 5.63); 4; / 5.85 (4.12, 7.58); 5 

Maricopa County 

CO 

0.81 (-0.79, 2.39); 0; / 2.20 (0.61, 3.79); 1; 

3.05 (1.49, 4.61); 2; / 3.78 (2.27, 5.28); 3; 

3.73 (2.27, 5.19); 4; / 2.25 (0.76, 3.72); 5 

COPD Mortality 

Cook County 

CO 

-2.65 (-7.05, 1.75); 0; / 2.80 (-1.60, 7.19); 1; 

0.98 (-3.34, 5.31); 2; / 2.20 (-2.12, 6.53); 3; 

1.31 (-3.06, 5.68); 4; / 1.59 (-2.78, 5.97); 5 

Los Angeles County 

CO 

3.78 (2.31, 5.25); 0; / 5.23 (3.78, 6.69); 1; 

5.71 (4.26, 7.17); 2; / 5.42 (3.95, 6.89); 3; 

4.01 (2.51, 5.50); 4; / 3.82 (2.31, 5.33); 5 

Maricopa County 

CO 

1.29 (-2.19, 4.76); 0; / 4.63 (1.17, 8.09); 1; 

0.07 (-3.36, 3.50); 2; / 3.00 (-0.30, 6.30); 3; 

6.21 (3.02, 9.40); 4; / 3.27 (0.04, 6.50); 5 

Cerebrovascular Disease Mortality 

Cook County 

-0.41 (-3.30, 2.47); 0; / 3.13 (0.23, 6.02); 1; 

2.12 (-0.73, 4.97); 2; / 1.00 (-1.85, 3.86); 3; 

2.50 (-0.36, 5.37); 4; / 1.88 (-1.00, 4.76); 5 

Los Angeles County 

3.31 (2.32, 4.31); 0; / 3.88 (2.89, 4.87); 1; 

3.23 (2.25, 4.22); 2; / 2.65 (1.66, 3.65); 3; 

2.11 (1.11, 3.12); 4; / 2.04 (1.02, 3.06); 5 

Maricopa County 

0.26 (-2.65, 3.16); 0; / 3.50 (0.60, 6.41); 1; 

3.52 (0.66, 6.38); 2; / 4.61 (1.85, 7.37); 3; 

4.78 (2.10, 7.46); 4; / 5.15 (2.45, 7.84); 5 

Notes: Total Mortality effect estimates were not 

presented quantitatively. 

January 2010 C-84 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Moolgavkar et al. 

(2003, 051316) 

Period of Study: 1987-1995 

Location: 

Cook County, Illinois & Los 

Angeles County, California 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); circulatory (390-448) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 

All Ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Median unit:

Cook County: 993 ppb 

LA County: 1347 ppb 

Range (Min, Max): 

Cook County: (224, 3912) ppb 

LA County: (237, 5955) ppb 

Copollutant correlation: 

Cook County: 

NO2: r = 0.63; 

O3: r = -0.22; 

SO2: r = 0.35; 

PM10: r = 0.30 

LA County: 

NO2: r = 0.80; 

O3: r = -0.52; 

SO2: r = 0.78; 

PM10: r = 0.45; 

PM2.5: r = 0.58 

Increment: 1 ppm 

% Increase (t-statistic); lag 

Total Mortality Cook County 

CO: 

0.6% (1.2); 0; / 2.5% (5.4); 1; / 1.2% (2.6); 2; 

1.5% (3.2); 3; / 1.1% (2.5); 4; / 0.6% (1.3); 5 

CO, PM10: 

-0.5% (-1.0); 0; / 2.2% (4.3); 1; / 1.1% (2.2); 2; 

1.0% (1.9); 3; / 1.1% (2.1); 4; / 1.4% (2.7); 5 

Total Mortality Los Angeles County 

CO: 

1.3% (7.4); 0; / 1.9% (10.5); 1; / 1.6% (8.9); 2; 

1.4% (8.1); 3; / 1.0% (5.9); 4; / 0.7% (4.1); 5 

CO, PM10: 

0% (0); 0; / 2.2% (4.8); 1; / 1.4% (3.1); 2; 

0.8% (1.8); 3; / 0.7% (1.6); 4; / 1.3% (3.0); 5 

CO, PM2.5: 

-0.1% (-1.5); 0; / 1.5% (2.5); 1; / 2.4% (3.8); 2; 

0.3% (0.5); 3; / 1.6% (2.8); 4; / 1.5% (2.6); 5 

Total Mortality (Season-specific) Cook County 

Spring (CO): 

0.8% (0.9); 0; / 2.4% (2.9); 1; / 0% (0); 2; 

1.2% (1.5); 3; / 0.8% (1.0); 4; / -0.1% (-0.2); 5 

Summer (CO): 

1.2% (1.0); 0; / 3.6% (3.0); 1; / 4.2% (3.6); 2; 

-0.3% (-0.2); 3; / -1.1% (-1.0); 4; /-0.7% (-0.6); 5 

Fall (CO): 

1.2% (1.5); 0; / 2.1% (2.7); 1; / 0% (0); 2; 

0% (0); 3; /-0.5% (-0.6); 4; / -0.7% (-0.9); 5 

Winter (CO): 

-0.7% (-1.0); 0; / 1.8% (2.3); 1; / -0.2% (-0.3); 2; 

0.5% (0.6); 3; / 1.2% (1.5); 4; / 1.0% (1.3); 5 

Los Angeles County 

Total Mortality (Season-specific) 

Spring (CO): 

3.6% (6.3); 0; / 3.5% (6.2); 1; / 1.9% (3.4); 2; 

0.6% (1.0); 3; / -0.5% (-0.8); 4; / -0.7% (-1.2); 5 

Summer (CO): 

3.0% (3.0); 0; / 4.7% (4.6); 1; / 5.2% (5.1); 2; 

4.1% (3.8); 3; / 1.9% (1.8); 4; / 1.4% (1.3); 5 

Fall (CO): 

1.8% (4.6); 0; / 2.0% (5.1); 1; / 1.0% (2.6); 2; 

0.6% (1.5); 3; / 0.4% (1.2); 4; / 0.2% (0.6); 5 

Winter (CO): 

0% (0); 0; / 0.8% (2.5); 1; / 0.9% (3.1); 2; 

1.0% (3.4); 3; / 0.5% (1.7); 4; / 0.5% (1.6); 5 

CVD Mortality Cook County 

CO: 

-1.1% (-1.5); 0; / 1.8% (2.5); 1; / 1.5% (2.2); 2; 

1.6% (2.4); 3; / 1.4% (2.1); 4; / 0.7% (1.0); 5 

CO, PM10: 

-2.1% (-2.6); 0; / 1.5% (1.8); 1; / 1.4% (1.7); 2; 

0.1% (1.1); 3; / 1.4% (1.9); 4; / 1.6% (2.1); 5 

CVD Mortality Los Angeles County 

CO: 

1.6% (6.3); 0; / 1.9% (7.6); 1; / 1.6% (6.6); 2; 

1.9% (8.2); 3; / 1.6% (7.1); 4; / 1.4% (6.1); 5 

CO, PM10: 

-0.8% (-1.2); 0; / 1.9% (3.0); 1; / 2.7% (4.3); 2; 

1.3% (2.2); 3; / 0.5% (0.9); 4; / 2.8% (4.7); 5 

CO, PM2.5: 

-2.2% (-2.7); 0; / 1.5% (1.8); 1; / 1.9% (2.0); 2; 

1.9% (2.2); 3; / 2.1% (2.6); 4; / 3.7%(4.5); 5 

January 2010 C-85 
Study Design Concentrations Effect Estimates (95% CI) 

CVD Mortality (Season Specifid) Cook County 

Spring (CO): 

0.7% (0.5); 0; / 1.4% (1.1); 1; / 0.3% (0.3); 2; 

1.1% (0.9); 3; / 0.4% (3.1); 4; / 0.1% (0.6); 5 

Summer (CO): 

-2.6% (-1.4); 0; / 2.5% (1.4); 1; / 6.5% (3.7); 2; 

0.9% (0.5); 3; / -1.9% (-1.1); 4; / -1.0% (-0.6); 5 

Fall (CO): 

0% (0); 0; / 2.9% (2.5); / 1; 0% (0); 2; 

0% (0); 3; /-0.8% (-0.7); / 4; 0% (0); 5 

Winter (CO): 

-2.5% (-2.2); 0; / 0.7% (0.6); 1; / 0% (0); 2; 

1.3% (1.1); 3; / 0.8% (0.7); 4; / 0.4% (0.4); 5 

Los Angeles County 

CVD Mortality (Season-specific) 

Spring (CO): 

3.0% (3.7); 0; / 3.3% (4.1); 1; / 2.3% (2.9); 2; 

0.7% (0.9); 3; / -1.2% (-1.6); 4; / 0% (0); 5 

Summer (CO): 

4.0% (2.8); 0; / 5.2% (3.5); 1; / 6.3% (4.3); 2; 

5.0% (3.3); 3; / 3.1% (2.0); 4; / 3.6% (2.3); 5 

Fall (CO): 

2.3% (4.2); 0; / 2.1% (3.7); 1; / 1.1% (1.9); 2; 

1.2% (2.2); 3; / 1.5% (2.9); 4; / 1.0% (1.8); 5 

Winter (CO): 

0.3% (0.8); / 0; 0.7% (1.7); 1; / 0.8% (2.0); 2; 

1.4% (3.4); 3; / 1.0% (2.3); 4; / 1.1% (2.5); 5 

Author: Ostro et al. (1999, 

006610) 

Period of Study:

1989-1992 

Location:

Coachella Valley, California 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); respiratory (460-519); 

cardiovascular (393-440) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM; LOESS 

Age Groups Analyzed: >50 yr 

Pollutant: CO 

Averaging Time: 1-h max 

Mean (SD) unit: 1.35 ppm 

Range (Min, Max): (0, 6.0) 

Copollutant correlation:

PM10: r = -0.18; O3: r = -0.47; 

NO2: r = 0.65 

Increment: NR 

β (SE); lag: 

CO: 0.0371 (0.0157); 2 

CO, PM10: 0.0300 (0.0194); 2 

Author: Penttinen et al. 

(2004, 087432) 

Period of Study:

1988-1996 

Location:

Helsinki, Finland 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); respiratory (460-519); 

cardiovascular (393-440) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM, LOESS 

Age Groups Analyzed: 

All ages 

15-64 yr 

65-74 yr 

≥ 75 

Pollutant: CO 

Averaging Time: Max 8-h avg 

Median unit: 1.2 mg/m3

Range (Min, Max): (0, 12.4) 

Copollutant correlation:

O3: r = -0.46; NO2: r = 0.59; 

SO2: r = 0.55; PM10: r = 0.45; 

TSP: r = 0.26; 

TSP Blackness: r = 0.26 

Increment: 1 mg/m3

% Increase (Lower CI, Upper CI); lag: 

Total Mortality 

-1.50% (-2.78, -0.22); 0 

0.15% (-1.09, 1.39); 1 

-1.00% (-2.80, 0.81); 0-3 

Cardiovascular Mortality 

-2.48% (-4.30, -0.66); 0 

-0.84% (-2.61, 0.93); 1 

-1.87% (-4.43, 0.69); 0- 

Respiratory Mortality 

-0.48% (-4.84, 3.87); 0 

-0.14% (-4.43, 4.15); 1 

-1.49% (-7.73, 4.74); 0-3 

Author: Peters et al. (2000, 

001756) 

Period of Study:

1982-1994 

Location:

Northern Bavaria (Rural 

Germany) and the Coal 

Basin of the Czech Republic 

Health Outcome (ICD9):

Mortality: Total (non-accidental) 

(<800); Cardiovascular (390-

459); Respiratory (460-519); 

Cancer (140-239) 

Study Design: Time-series 

Statistical Analyses:

(1) Poisson Regression Models 

by logistic regression analyses 

with a cubic function; 

(2) Poisson GAM, natural 

splines 

Age Groups Analyzed: 

All Ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

Coal Basin: 0.58 (0.39) mg/m3

Northeast Bavaria: 

0.88 (0.69) mg/m3

Range (Min, Max): 

Coal Basin: (-0.1, 2.88) 

Northeast Bavaria: (0.1, 6.2) 

Copollutant correlation:

SO2: r = 0.37; TSP: r = 0.37; NO2: r = 

0.32; O3: r = -0.57; PM10: r = 0.44; 

PM2.5: r = 0.42 

Increment: 1 mg/m3

Relative Risk (Lower CI, Upper CI); lag: 

Coal Basin of the Czech Republic 

Total Mortality: 

1.016 (0.998, 1.035); 0; / 1.016 (0.998, 1.034); 1; 

1.013 (0.996, 1.030); 2; / 1.012 (0.995, 1.028); 3 

Northeast Bavaria 

Total Mortality: 

1.014 (0.994, 1.034); 0; / 1.023 (1.005, 1.041); 1; 

1.013 (0.995, 1.031); 2; / 1.003 (0.985, 1.021); 3 

CVD Mortality: 

1.018 (0.994, 1.044); 0; / 1.012 (0.987, 1.038); 1; 

1.016 (0.991, 1.041); 2; / 1.004 (0.980, 1.029); 3 

January 2010 C-86 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Rainham et al. 

(2003, 053202) 

Period of Study:

1980-1996 

Location:

Toronto, ON, Canada 

Health Outcome (ICD9):

Mortality: Cardiac (390-459); 

Respiratory (480-519); Total 

(non-accidental) (<800) 

Study Design: Time-series 

Statistical Analyses:Poisson 

GAM, natural cubic splines 

Age Groups Analyzed: 

<65 

≥ 65 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.0 (0.4) ppm 

Range (Min, Max): (0.0, 4.0) 

Copollutant: O3; NO2; SO2

The study did not present quantitative results for CO. 

Author: Roemer et al. 

(2001, 019391) 

Period of Study:

1/1987-11/1998 

Location: Amsterdam 

Health Outcome (ICD9):

Mortality: Total (non-accidental) 

(<800) 

Study Design: Time-series 

Statistical Analyses:

Poisson GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Air pollution background: 

836 μg/m3

Air pollution traffic: 1805 μg/m3

Range (10th, 90th):

Air pollution background: 

(448, 1315) μg/m3

Air pollution traffic: 

(727, 3192) μg/m3

Copollutant: 

BS; PM10; SO2; NO2; NO; O3

Increment: 

Lag 1 and 2: 100 μg/m3

Lag 0-6: 50 μg/m3

Relative Risk (Lower CI, Upper CI); lag: 

Total Population using Background sites 

1.002 (1.000-1.004); 1; 

1.001 (0.999-1.003); 2; 

1.001 (1.000-1.003); 0-6 

Traffic Population using Background Sites 

1.003 (0.997-1.008); 1; 

1.008 (1.003-1.013); 2; 

1.003 (0.999-1.007); 0-6 

Total population using Traffic Sites 

1.000 (1.000-1.001); 1; 

1.000 (0.999-1.001); 2; 

1.000 (1.000-1.001); 0-6 

January 2010 C-87 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Samet et al. (2000, 

013132) 

Period of Study:

1987-1994 

Location:

20 U.S. Cities: Los Angeles, 

CA; New York, NY; Chicago, 

IL; Dallas, TX; Houston, TX; 

San Diego, CA; Anaheim, 

CA; Phoenix, AZ; Detroit, MI; 

Miami, FL; Philadelphia, PA; 

Minneapolis, MN; Seattle, 

WA; San Jose, CA; 

Cleveland, OH; 

San Bernardino, CA; 

Pittsburgh, PA; Oakland, 

CA; Atlanta, GA; 

San Antonio, TX 

Health Outcome (ICD9):

Mortality: Cardiovascular (390-

459); Respiratory 

(460-519); Other (nonaccidental) (<800) 

Study Design: Time-series 

Statistical Analyses:

Two-stage log linear regression 

model 

Age Groups Analyzed: 

<65 

65-74 

≥ 75 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Los Angeles: 15.1 ppm 

New York: 20.4 ppm 

Chicago: 7.9 ppm 

Dallas: 7.4 ppm 

Houston: 8.9 ppm 

San Diego: 11.0 ppm 

Anaheim: 12.3 ppm 

Phoenix: 12.6 ppm 

Detroit: 6.6 ppm 

Miami: 10.6 ppm 

Philadelphia: 11.8 ppm 

Minneapolis: 11.8 ppm 

Seattle: 17.8 ppm 

San Jose: 9.4 ppm 

Cleveland: 8.5 ppm 

San Bernardino: 10.3 ppm 

Pittsburgh: 12.2 ppm 

Oakland: 9.1 ppm 

Atlanta: 8.0 ppm 

San Antonio: 10.1 ppm 

Range (10th, 90th): 

Los Angeles: (5.9, 28.3) 

New York: (14.8, 27.6) 

Chicago: (4.5, 11.9) 

Dallas: (3.6, 12.0) 

Houston: (4.0, 14.2) 

San Diego: (4.5, 20.5) 

Anaheim: (3.7, 25.2) 

Phoenix: (5.4, 22.6) 

Detroit: (3.2, 11.1) 

Miami: (6.5, 15.9) 

Philadelphia: (7.0, 17.2) 

Minneapolis: (7.0, 17.0) 

Seattle: (10.5, 26.4) 

San Jose: (1.7, 21.3) 

Cleveland: (3.7, 13.8) 

San Bernardino: (4.0, 17.5) 

Pittsburgh: (6.1, 19.8) 

Oakland: (2.9, 17.0) 

Atlanta: (3.2, 14.3) 

San Antonio: (4.1, 17.3) 

Copollutant correlation:

PM10: r = 0.45; O3: r = -0.19; 

NO2: r = 0.64; SO2: r = 0.41 

This study did not provide quantitative results for 

CO. 

Author: Samoli et al. (2007, 

098420) 

Period of Study:

1990-1997 

Location:

19 European Cities 

(APHEA2) 

Health Outcome (ICD9):

Mortality: Total (non-accidental) 

(<800); Cardiovascular (390-

459) 

Study Design: Time-series 

Statistical Analyses:

Poisson and two-stage 

hierarchical model 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean Range (unit–mg/m3):

Athens: 6.1; Barcelona: 0.9; Basel: 

0.6; Birmingham: 1.0; Budapest: 5.1; 

Geneva: 1.5; Helsinki: 1.2; Ljubljana: 

1.6; London: 1.4; Lyon: 3.8; 

Milano: 5.4; Netherlands: 0.6; 

Prague: 0.9; Rome: 4.1; Stockholm: 

0.8; Teplice: 0.7; Torino: 5.5; 

Valencia: 4.1; Zurich: 1.2 

Range (10th, 90th):

Athens: (3.5, 9.2) 

Barcelona: (0.4, 1.7) 

Basel: (0.4, 1.1) 

Birmingham: (0.5, 1.6) 

Budapest: (3.3, 7.4) 

Geneva: (0.8, 2.6) 

Helsinki: (0.7, 1.9) 

Ljubljana: (0.6, 3.0) 

London: (0.7, 2.2) 

Lyon: (2.0, 6.0) 

Milano: (2.9, 8.7) 

Netherlands: (0.4, 1.2) 

Prague: (0.5, 1.5) 

Increment: 1 mg/m3

% Increase (Lower CI, Upper CI); lag:

Non-accidental mortality 

8 Degrees of Freedom per yr 

Fixed Effects: 

CO: 0.59% (0.41-0.78); 0-1 

CO, BS: 0.35% (-0.03 to 0.72); 0-1 

CO, PM10: 0.48% (0.24-0.72); 0-1 

CO, SO2: 0.44% (0.21-0.67); 0-1 

CO, O3: 0.66% (0.46-0.86); 0-1 

CO, NO2: 0.27% (0.03-0.51); 0-1 

Random Effects: 

CO: 0.66% (0.27-1.05); 0-1 

CO, BS: 0.45% (-0.01 to 0.92); 0-1 

CO, PM10: 0.58% (0.12-1.04); 0-1 

CO, SO2: 0.46% (0.07-0.85); 0-1 

CO, O3: 0.76% (0.45-1.06); 0-1 

CO, NO2: 0.30% (-0.11 to 0.71); 0-1 

PACF: (Partial Autocorrelation Function) Plot Fixed 

Effects: 

CO: 1.00% (0.83-1.18); 0-1 

CO, BS: 0.67% (0.30-1.04); 0-1 

CO, PM10: 0.78% (0.55-1.00); 0-1 

CO, SO2: 0.68% (0.47-0.90); 0-1 

CO, O3: 1.12% (0.93-1.31); 0-1 

CO, NO2: 0.72% (0.50-0.95); 0-1 

January 2010 C-88 
Study Design Concentrations Effect Estimates (95% CI) 

Rome: (2.5, 5.9) 

Stockholm: (0.5, 1.2) 

Teplice: (0.3, 1.2) 

Torino: (2.8, 9.1) 

Valencia: (2.4, 5.9) 

Zurich: (0.7, 2.0) 

Copollutant correlation:

PM10: r = 0.16 to 0.70 

BS: r = 0.67 to 0.82 

SO

2: r = 0.35 to 0.82 

NO

2: r = 0.03 to 0.68 

O

3: r = -0.25 to -0.65 

Random Effects: 

CO: 1.20% (0.63-1.77); 0-1 

CO, BS: 0.77% (0.28-1.26); 0-1 

CO, PM10: 1.09% (0.36-1.83); 0-1 

CO, SO

2: 0.75% (0.26-1.26); 0-1 

CO, O

3: 1.37% (0.81-1.95); 0-1 

CO, NO

2: 0.88% (0.22-1.55); 0-1 

Cardiovascular Mortality 

8 Degrees of Freedom per Year 

Fixed Effects: 

CO: 0.80% (0.53-1.07); 0-1 

CO, BS: 0.49% (-0.04 to 1.02); 0-1 

CO, PM10: 0.73% (0.39-1.07); 0-1 

CO, SO

2: 0.72% (0.39-1.04); 0-1 

CO, O

3: 0.91% (0.62-1.20); 0-1 

CO, NO

2: 0.44% (0.10-0.79); 0-1 

Random Effects: 

CO: 0.81% (0.36-1.26); 0-1 

CO, BS: 0.49% (-0.04 to 1.02); 0-1 

CO, PM10: 0.73% (0.39-1.07); 0-1 

CO, SO

2: 0.68% (-0.03 to 1.40); 0-1 

CO, O

3: 1.02% (0.58-1.46); 0-1 

CO, NO

2: 0.43% (-0.06 to 0.93); 0-1 

PACF (Partial Autocorrelation Function) Fixed 

Effects: 

CO: 1.06% (0.80-1.32); 0-1 

CO, BS: 0.83% (0.31-1.35); 0-1 

CO, PM10: 0.95% (0.62-1.27); 0-1 

CO, SO

2: 0.91% (0.59-1.22); 0-1 

CO, O

3: 1.28% (1.01-1.56); 0-1 

CO, NO

2: 0.68% (0.35-1.00); 0-1 

Random Effects: 

CO: 1.25% (0.30-2.21); 0-1 

CO, BS: 0.83% (0.31-1.35); 0-1 

CO, PM10: 1.13% (0.60-1.67); 0-1 

CO, SO

2: 0.86% (0.06-1.66); 0-1 

CO, O

3: 1.62% (0.72-2.52); 0-1 

CO, NO

2: 0.84% (-0.03 to 1.71); 0-1 

Effect Modifiers 

Non-accidental Mortality 

8 Degrees of Freedom per Year 

Number of CO monitors: 

25th Percentile: 0.71% (0.48-0.94); 0-1 

75th Percentile: 0.54% (0.34-0.74); 0-1 

Mean PM10 Levels: 

25th Percentile: 0.37% (0.08-0.66); 0-1 

75th Percentile: 0.49% (0.28-0.69); 0-1 

Standardized Mortality Rate: 

25th Percentile: 0.79% (0.55-1.03); 0-1 

75th Percentile: 0.44% (0.22-0.66); 0-1 

Western cities: 0.75% (0.47-1.03); 0-1 

Southern cities: 0.61% (0.32-0.91); 0-1 

Eastern cities: 0.03% (-0.47 to 0.53); 0-1 

PACF (Partial Autocorrelation Function) 

Number of CO monitors: 

25th Percentile: 1.18% (0.96-1.39); 0-1 

75th Percentile: 0.92% (0.73-1.11); 0-1 

Mean PM10 Levels: 

25th Percentile: 0.74% (0.46-1.02); 0-1 

75th Percentile: 1.07% (0.87-1.27); 0-1 

Standardized Mortality Rate: 

25th Percentile: 1.29% (1.06-1.52); 0-1 

75th Percentile: 0.77% (0.56-0.98); 0-1 

Western cities: 1.15% (0.90-1.40); 0-1 

Southern cities: 1.08% (0.79-1.38); 0-1 

Eastern cities: 0.27% (-0.20 to 0.74); 0-1 

Cardiovascular Mortality 

8 Degrees of Freedom per Year 

Mean O

3: 

25th Percentile: 1.04% (0.67-1.41); 0-1 

75th Percentile: 0.82% (0.55-1.10); 0-1 

Standardized Mortality Rate: 

25th Percentile: 1.06% (0.71-1.42); 0-1 

75th Percentile: 0.61% (0.30-0.93); 0-1 

January 2010 C-89 
Study Design Concentrations Effect Estimates (95% CI) 

Population >75 yr of age (%): 

25th Percentile: 0.58% (0.25-0.92); 0-1 

75th Percentile: 0.94% (0.64-1.24); 0-1 

Western cities: 1.06% (0.67-1.46); 0-1 

Southern cities: 0.70% (0.26-1.14); 0-1 

Eastern cities: 0.21% (-0.48 to 0.90); 0-1 

PACF (Partial Autocorrelation Function) 

Mean O3: 

25th Percentile: 1.32% (0.96-1.68); 0-1 

75th Percentile: 1.09% (0.83-1.14); 0-1 

Standardized Mortality Rate: 

25th Percentile: 1.40% (1.06-1.75); 0-1 

75th Percentile: 0.85% (0.55-1.14); 0-1 

Population >75 yr of age (%): 

25th Percentile: 0.74% (0.41-1.06); 0-1 

75th Percentile: 1.25% (0.96-1.54); 0-1 

Western cities: 1.38% (1.00-1.76); 0-1 

Southern cities: 0.90% (0.47-1.33); 0-1 

Eastern cities: 0.48% (-0.14 to 1.11); 0-1 

Author: Schwartz et al. 

(1999, 017915) 

Period of Study:

1989-1995 

Location:

Spokane, WA 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 1-h avg 

Mean (SD) unit:

Dust Storm Days: 

09/08/1990: 6.37 ppm 

09/12/1990: 3.40 ppm 

10/04/1990: 3.15 ppm 

11/09/1990: 2.45 ppm 

11/23/1990: 2.50 ppm 

09/13/1991: 4.60 ppm 

10/16/1991: 2.10 ppm 

10/21/1991: 2.20 ppm 

09/04/1992: 3.43 ppm 

09/12/1992: 1.80 ppm 

09/13/1992: 1.65 ppm 

09/25/1992: 2.95 ppm 

09/26/1992: 4.30 ppm 

10/08/1992: 3.85 ppm 

09/11/1993: 1.88 ppm 

11/3/1993: 5.33 ppm 

07/24/1994: 2.10 ppm 

08/30/1996: 2.85 ppm 

Range (Min, Max): NR 

Copollutant: PM10

The study did not present quantitative results for CO. 

Author: Sharovsky et al. 

(2004, 156976) 

Period of Study:

1996-1998 

Location:

Sao Paulo, Brazil 

Health Outcome (ICD10):

Mortality: MI (I.21) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM, LOESS 

Age Groups Analyzed:

35-109 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 3.7 (1.6) ppm 

Range (Min, Max): (1.0, 11.8) 

Copollutant: correlation

SO2: r = 0.73; PM10: r = 0.51 

Increment: NR 

β x 100 (SE); lag: 

CO: 1.42 (1.01) 

CO, SO2, PM10: 0.97 (1.27) 

Notes: The study did not present the lag used for 

CO. 

Author: Slaughter et al. 

(2005, 073854) 

Period of Study:

1/1995-6/2001 

Location:

Spokane, WA 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); respiratory (460-519); 

asthma (493); COPD (491, 

492, 494, 496); pneumonia 

(480-487); acute upper 

respirator y tract infections 

(464-466, 490); cardiac 

outcomes (390-459) 

Study Design: Time series 

Statistical Analyses:

Log-linear Poisson GLM, 

natural splines for calendar 

time 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit:

Areas in Spokane 

Hamilton St: 1.73 (0.46) ppm 

Backdoor Tavern: 

1.29 (0.23) ppm 

Spokane Club: 1.41 (0.32) ppm 

Third and Washington: 

1.82 (0.33) ppm 

Rockwood: 0.42 (0.15) ppm 

Range (Min, Max): NR 

Copollutant correlation:

PM1: r = 0.63; PM2.5: r = 0.62; 

PM10: r = 0.32; 

PM10-2.5: r = 0.32 

The study did not present quantitative results for CO.

January 2010 C-90 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Stieb et al. (2003, 

056908) 

Period of Study: 

1985-2000 

Location: All locations 

Health Outcome (ICD9):

Mortality: Nonaccidental 

Study Design: Meta-analysis 

Statistical Analyses: NR 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: NR 

IQR (25th, 75th): NR 

Copollutant: NR 

Increment: 1.1 ppm 

% Excess Mortality (Lower CI, Upper CI); lag: 

Non-GAM: 

Single-pollutant model (4 studies): 4.7% (1.1-8.4) 

Multi-pollutant model (1 study): 0.0% (-3.8 to 3.8) 

GAM: 

Single-pollutant model (18 studies): 1.6% (1.1-2.1) 

Multi-pollutant model (11 studies): 0.7% (-0.1 to 1.5) 

Author: Stölzel et al. (2007, 

091374) 

Period of Study:

9/1995-8/2001 

Location:

Erfurt, Germany 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); cardio-respiratory (390-

459, 460-519, 785, 786) 

Study Design: Time series 

Statistical Analyses: Poisson 

GAM 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.47 (0.39) mg/m3

IQR (25th, 75th): (0.23, 0.57) 

Copollutant correlation:

MC0.1-0.5: r = 0.58; 

MC0.01-2.5: r = 0.57; 

PM10: r = 0.50; NO: r = 0.70; 

NO2: r = 0.71 

Increment: 0.34 mg/m3

Relative Risk (Lower CI, Upper CI); lag: 

Total (non-accidental) 

1.000 (0.977-1.023); 0; 

1.002 (0.980-1.024); 1; 

1.013 (0.991-1.035); 2; 

1.007 (0.986-1.029); 3; 

1.012 (0.990-1.034); 4; 

0.995 (0.974-1.017); 5 

Author: Sunyer et al. (2001, 

019367) 

Period of Study:

1990-1995 

Location:

Barcelona, Spain 

Health Outcome (ICD9):

Mortality: COPD (491, 492, 

494, 496) 

Study Design: 

Bidirectional case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: >35 yr

Pollutant: CO 

Averaging Time: 8-h avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: PM10; NO2; O3

Increment: 4.5 μg/m3

Odds Ratio (Lower CI, Upper CI); lag: 

CO: 1.052 (0.990-1.117); 0-2 

CO, PM10: 1.017 (0.947-1.091); 0-2 

Author: Sunyer et al. (2002, 

034835) 

Period of Study:

1985-1995 

Location:

Barcelona, Spain 

Health Outcome (ICD9):

Mortality: Respiratory mortality 

Study Design: Case crossover

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: >14 yr

Study population:

Asthmatic individuals: 5,610 

Pollutant: CO 

Averaging Time: 24-h avg 

Median (SD) unit: 7.7 μg/m3

Range (Min, Max): (0.6, 66.0) 

Copollutant: 

PM10; BS; NO2; O3; SO2

Increment: 7.2 μg/m3

Odds Ratio (Lower CI, Upper CI); lag: 

Asthmatic individuals with 1 ED visit 

1.127 (0.895-1.418); 0-2 

Asthmatic individuals with >1 ED visit 

1.125 (0.773-1.638); 0-2 

Asthma/COPD individuals with >1 ED visit 

0.815 (0.614-1.082); 0-2 

Author: Tsai et al. (2003, 

050480) 

Period of Study:

1994-2000 

Location:

Kaohsiung, Taiwan 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); respiratory (460-519); 

circulatory (390-459) 

Study Design: 

Bidirectional case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.827 ppm 

Range (Min, Max): (0.226, 1.770) 

Copollutant: 

PM10; SO2; NO2; O3

Increment: 0.313 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Total (nonaccidental): 1.003 (0.968-1.039); 0-2 

Respiratory: 1.011 (0.883-1.159); 0-2 

Circulatory: 0.986 (0.914-1.063); 0-2 

Author: Tsai et al. (2006, 

090709) 

Period of Study:

1994-2000 

Location:

Kaohsiung, Taiwan 

Health Outcome (ICD9): 

Mortality: Total (nonaccidental) 

(<800) 

Study Design: Case crossover

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

27 days old to <1 yr of age 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 8.27 ppm 

Range (Min, Max): (2.26, 17.70) 

Copollutant: 

PM10; SO2; O3; NO2

Increment: 0.31 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Postneonatal Mortality 

1.051 (0.304-3.630); 0-2 

January 2010 C-91 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Vedal et al. (2003, 

039044) 

Period of Study:

1/1994-12/1996 

Location:

Vancouver, BC, Canada 

Health Outcome (ICD9):

Mortality: Total (nonaccidental) 

(<800); respiratory (460-519); 

cardiovascular (390-459) 

Study Design: Time series 

Statistical Analyses: 

Poisson GAM, LOESS 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.6 (0.2) ppm 

Range (Min, Max): (0.3, 1.9) 

Copollutant correlation:

Summer: 

PM10:r = 0.71; O3: r = 0.12; 

NO2: r = 0.81; SO2: r = 0.67 

Winter: 

PM10: r = 0.76; O3: r = -0.65; 

NO2: r = 0.78; SO2: r = 0.83 

The study did not present quantitative results for CO.

Author: Villeneuve et al. 

(2003, 055051) 

Period of Study:

1986-1999 

Location:

Vancouver, BC, Canada 

Health Outcome (ICD9): 

Mortality: Nonaccidental 

(<800); cardiovascular 

(401-440); respiratory 

(460-519); cancer (140-239) 

Study Design: Time series 

Statistical Analyses:

Poisson, natural splines 

Age Groups Analyzed: ≥ 65 yr

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.0 ppm 

Range (Min, Max): (0.2, 4.9) 

Copollutant: 

PM2.5; PM10; PM10-2.5; TSP; 

SO4; CO; COH; O3; NO2; SO2

Increment: 1.1 ppb 

% Increase (Lower CI, Upper CI); lag: 

Non-accidental 

0.5% (-1.9 to 2.9); 0-2; / -0.3% (-2.2 to 1.7); 0; 

0.6% (-1.3 to 2.6); 1; / 0.5% (-1.4 to 2.5); 2 

Cardiovascular 

2.3% (-1.6 to 6.3); 0-2; / 1.6% (-1.5 to 4.7); 0; 

1.2% (-2.0 to 4.5); 1; / 1.5% (-1.5 to 4.4); 2 

Respiratory 

-1.0% (-7.3 to 5.8); 0-2; / 1.3% (-4.4 to 7.3); 0; 

-0.1% (-5.3 to 5.4); 1; -/ 2.8% (-7.8 to 2.6); 2 

Cancer 

-2.8% (-7.6 to 2.4); 0-2; / -3.0% (-6.9 to 1.1); 0; 

-1.6% (-5.6 to 2.4); 1; / -0.5% (-4.7 to 3.8); 2 

Author: Wang et al. (2008, 

179974) 

Period of Study: Daily CO 

content: 2000-2005 (data 

from Beijing Environment 

Protection Bureau), Death 

rate: 2000-2003 

Location: Beijing, China 

Health Outcome: Mortality 

Study Design: Time series, 

Granger causality, Back 

propagation neural network 

model, MIV 

Statistical Analyses: Eviews 

3.1, SAS 9.0, Matlab 7.0 

Age Groups Analyzed: NR 

Sample Description: Death 

rate of respiratory diseases in 

Beijing from China Centers for 

Disease Control and 

Prevention 

Averaging Time: NR 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutant: NR 

 

Increment: NR 

Granger causality: Acute respiratory diseases 

probability: 0.03122 

COPD probability: 0.00047 

Change of death rate of acute respiratory diseases: 

Increasing 10%: +0.437, Decreasing 10%: -0.386 

Change of death rate of COPD: Increasing 10%: 

+0.181, Decreasing 10%: -0.316 

Lags examined: 10 

January 2010 C-92 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Wichmann et al. 

(2000, 013912) 

Period of Study:

9/1995-12/1998 

Location:

Erfurt, Germany 

Health Outcome (ICD9):

Mortality: Nonaccidental 

(<800); cardiovascular 

(401-440); respiratory 

(460-519) 

Study Design: Time series 

Statistical Analyses:

Poisson GAM, LOESS 

Age Groups Analyzed: 

<70 

70-79 

≥ 80 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 0.6 (0.5) mg/m3

Range (Min, Max): (0.10, 2.50) 

Copollutant: correlation 

PM2.5: r = 0.62; PM10: r = 0.58; 

TSP: r = 0.57; SO2: r = 0.59; 

NO2: r = 0.71 

Increment: 0.5 ppm 

Relative Risk (Lower CI, Upper CI); lag: 

Single-Day Lag 

CO: 1.055 (1.003-1.110); 4 

Polynomial Distributed Lag 

Multi-pollutant model: 1.076 (1.017-1.138); 4 

Total Mortality 

CO: 1.012 (0.977-1.049); 0 

Log-transformed: 1.016 (0.962-1.073); 0 

1.004 (0.969-1.040); 1 

Log-transformed: 1.027 (0.973-1.083); 1 

1.020 (0.984-1.057); 2 

Log-transformed: 1.024 (0.970-1.081); 2 

1.019 (0.984-1.055); 3 

Log-transformed: 1.037 (0.984-1.093); 3 

1.029 (0.995-1.063); 4 

Log-transformed: 1.055 (1.003-1.110); 4 

0.997 (0.965-1.031); 5 

Log-transformed: 1.014 (0.966-1.065); 5 

Total Mortality (Season-specific): 

Log-transformed 

Winter: 1.002 (0.922-1.088); 4 

Spring: 1.019 (0.942-1.102); 4 

Summer: 1.085 (1.018-1.156); 4 

Fall: 1.111 (1.039-1.188); 4 

Winter-specific: Log-transformed 

10/95-3/96: 1.046 (0.949-1.153); 4 

10/96-3/97: 1.091 (0.998-1.193); 4 

10/97-3/98: 1.028 (0.966-1.095); 4 

One-pollutant Model: Log-transformed 

CO: 1.055 (1.003-1.110); 4 

Author: Yang et al. (2004, 

055603) 

Period of Study:

1994-1998 

Location:

Taipei, Taiwan 

Health Outcome (ICD9):

Mortality: Nonaccidental 

(<800); circulatory (390-459); 

respiratory (460-519) 

Study Design: 

Bidirectional case crossover 

Statistical Analyses:

Conditional logistic regression 

Age Groups Analyzed: 

All ages 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 1.16 ppm 

Range (Min, Max): (0.24, 4.42) 

Copollutant: 

PM10; SO2; NO2; O3

Increment: 0.52 ppm 

Odds Ratio (Lower CI, Upper CI); lag: 

Non-accidental: 1.005 (0.980-1.031); 0-2 

Respiratory: 1.014 (0.925-1.110); 0-2 

Circulatory: 0.996 (0.948-1.046); 0-2 

January 2010 C-93 
Table C-8. Studies of long-term CO exposure and mortality. 

Study Design Concentrations Effect Estimates (95% CI) 

Author: Krewski et al. 

(2009, 191193) 

Period of Study: 

1983-2000 

Location:

United States 

Health Outcome: Mortality 

Study Design: Cohort 

Statistical Analyses: Random 

effects Cox model 

Age Groups Analyzed: 30+ yrs 

Sample Description:

508,538 adults living in large US 

cities 

Averaging Time: 1980 annual avg 

Mean (SD) unit: 1.68 (0.66) ppm 

Range (min, max):

0.19, 3.95 

Copollutant: 

PM15, PM2.5, SO2, SO4, TSP, O3, NO2

Increment: 1ppm 

HR Estimate [Lower CI, Upper CI]: 

Lags examined: NR 

All Causes: 1.00 (0.99, 1.01) 

Cardiopulmonary: 1.00 (0.99, 1.01) 

IHD: 1.01 (0.99, 1.03) 

Lung Cancer: 0.99 (0.97, 1.03) 

All Other Causes: 0.99 (0.98, 1.01) 

Author: Lipfert et al. 

(2000, 004087) 

Period of Study:

1975-1996 

Location:

32 Veterans Hospitals, 

USA 

Mortality 

Health Outcome (ICD9):

Nonaccidental 

Study Design: Cohort 

Study Population: 

~90,000 hypertensive male U.S. 

veterans 

Statistical Analyses:

Staged regression 

Age Groups Analyzed: NR 

Pollutant: CO 

Averaging Time: 

95th Percentile Annual avg 

Mean (SD) unit:

1960-1974: 10.82 (5.15) ppm 

1975-1981: 7.64 (2.94) ppm 

1982-1988: 3.42 (0.95) ppm 

1989-1996: 2.36 (0.67) ppm 

Range (Min, Max):

1960-1974: (0.94, 35.30) 

1975-1981: (0.43, 22.38) 

1982-1988: (0.30, 15.20) 

1989-1996: (0.30, 7.10) 

Copollutants; correlation: 

1960-1974: 

O3: r = 0.004; 

NO2: r = 0.690; 

SO4

2-: r = 0.469 

1975-1981: 

O3: r = 0.109; 

NO2: r = 0.249; 

SO4

2-: r = -0.155; 

IP SO4

2-: r = 0.356; 

PM2.5: r = 0.634; 

PM10-2.5: r = 0.498; 

PM15: r = 0.626 

1982-1988 

O3: r = 0.158; NO2: r = 0.413; 

SO4

2-: r = -0.518; 

IP SO4

2-: r = 0.075; 

PM2.5: r = 0.296; 

PM10-2.5: r = 0.135 

PM15: r = 0.284 

1989-1996 

O3: r = 0.397; 

NO2: r = 0.492; 

SO4

2-: r = -0.551 

Increment: NR 

Coefficient: 

Baseline Model 

Exposure Period: up to 1975 

Single Period: -0.000 

Deaths, 1976-81: 0.0043 

Deaths, 1982-88: -0.0002 

Deaths after 1988: -0.0041 

Exposure Period: 1975-81 

Single Period: -0.013 

Deaths, 1976-81: -0.0170 

Deaths, 1982-88: -0.0217 

Deaths after 1988: -0.0240 

Exposure Period: 1982-88 

Single Period: -0.028 

Deaths, 1976-81: -0.0294 

Deaths, 1982-88: -0.0484 

Deaths after 1988: -0.0424 

Exposure Period: 1989-96 

Single Period: -0.046 

Deaths, 1976-81: -0.0590 

Deaths, 1982-88: -0.0581 

Deaths after 1988: -0.0536 

Final Model w/ Ecological Variables 

Exposure Period: up to 1975 

Single Period: -0.001 

Deaths, 1976-81: 0.0013 

Deaths, 1982-88: -0.0022 

Deaths after 1988: -0.0061 

Exposure Period: 1975-81 

Single Period: -0.008 

Deaths, 1976-81: -0.0128 

Deaths, 1982-88: -0.0186 

Deaths after 1988: -0.0203 

Exposure Period: 1982-88 

Single Period: -0.009 

Deaths, 1976-81: -0.0007 

Deaths, 1982-88: -0.0246 

Deaths after 1988: -0.0216 

Exposure Period: 1989-96 

Single Period: -0.009 

Deaths, 1976-81: -0.0106 

Deaths, 1982-88: -0.0136 

Deaths after 1988: -0.0078 

Notes: Mortality risks based on mean 

concentrations of pollutants less estimated 

background weighted by the number of subjects in 

each county, but The study did not present this 

value for each pollutant. 

January 2010 C-94 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Lipfert and 

Morris (2002, 019217) 

Period of Study:

1960-1997 

Location:

U.S. counties 

Mortality 

Health Outcome (ICD9): 

Nonaccidental 

Study Design: 

Ecological/ cross sectional 

Statistical Analyses:

Staged regression 

Age Groups Analyzed: 

15-44 yr 

45-64 yr 

65-74 yr 

75-84 yr 

≥ 85 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit:

1960-1969: 13.81 (8.47) ppm 

1970-1974:9.64 (5.63) ppm 

1979-1981:5.90 (3.54) ppm 

1989-1991:2.69 (1.22) ppm 

1995-1997:1.72 (0.76) ppm 

Range (Min, Max): NR 

Copollutant: 

TSP 

SO4

2-

SO2

NO2

O3

Increment: NR 

Attributable risk (SE): 

Attributable Risks of mortality (1960-4) 

Peak CO 1960-1964, All locations 

Ages 15-44: 0.1299 (0.0341) 

Ages 45-64: 0.0340 (0.0280) 

Ages 65-74: -0.0058 (0.0220) 

Ages 75-84: 0.0121 (0.0188) 

Ages ≥ 85: 0.0374 (0.0225) 

Log Mean: 0.0365 (0.0149) 

Attributable Risks of mortality (1970-4) 

Peak CO 1970-1974, All locations 

Ages 15-44: 0.0553 (0.0240) 

Ages 45-64: 0.0181 (0.0148) 

Ages 65-74: -0.0146 (0.0134) 

Ages 75-84: -0.0128 (0.0098) 

Ages ≥ 85: -0.0151 (0.0093) 

Log Mean: 0.0038 (0.0086) 

Attributable Risks of mortality (1979-81) 

Peak CO 1979-1981, All locations 

Ages 15-44: 0.0054 (0.0174) 

Ages 45-64: -0.0060 (0.0141) 

Ages 65-74: -0.0251 (0.0105) 

Ages 75-84: -0.0331 (0.0086) 

Ages ≥ 85: -0.0123 (0.0079) 

Log Mean: -0.0183 (0.0077) 

Peak CO 1970-1974, All locations 

Ages 15-44: 0.0218 (0.0200) 

Ages 45-64: 0.0327 (0.0161) 

Ages 65-74: -0.0136 (0.0119) 

Ages 75-84: -0.0250 (0.0105) 

Ages ≥ 85: -0.0202 (0.0085) 

Log Mean: -0.0048 (0.0077) 

Peak CO 1960-1969, All locations 

Ages 15-44: 0.0506 (0.0478) 

Ages 45-64: 0.0704 (0.0337) 

Ages 65-74: 0.0100 (0.0211) 

Ages 75-84: -0.0124 (0.0143) 

Ages ≥ 85: 0.0187 (0.0135) 

Log Mean: 0.0084 (0.0149) 

Peak CO 1979-1981, CO 1970-1974 

Ages 15-44: 0.0244 (0.0209) 

Ages 45-64: 0.0016 (0.0181) 

Ages 65-74: -0.0183 (0.0128) 

Ages 75-84: -0.0382 (0.0108) 

Ages ≥ 85: -0.0201 (0.0089) 

Log Mean: -0.0165 (0.0089) 

Peak CO 1979-1981, CO 1960-1969 

Ages 15-44: 0.0748 (0.0679) 

Ages 45-64: 0.0844 (0.0496) 

Ages 65-74: 0.0144 (0.0259) 

Ages 75-84: -0.0158 (0.0168) 

Ages ≥ 85: -0.0073 (0.0170) 

Log Mean: 0.0109 (0.0218) 

Peak CO 1979-1981, CO 1960-1969 

Ages 15-44: 0.1191 (0.0709) 

Ages 45-64: 0.1163 (0.0491) 

Ages 65-74: 0.0177 (0.0310) 

Ages 75-84: -0.0120 (0.0212) 

Ages ≥ 85: -0.0040 (0.0202) 

Log Mean: 0.0211 (0.0231) 

Attributable Risks of mortality (1989-91) 

Peak CO 1989-1991, All locations 

Ages 15-44: 0.0404 (0.0322) 

Ages 45-64: -0.0262 (0.0162) 

Ages 65-74: -0.0397 (0.0115) 

Ages 75-84: -0.0464 (0.0097) 

Ages ≥ 85: -0.0209 (0.0073) 

Log Mean: -0.0178 (0.0098) 

Peak CO 1979-1981, All locations 

January 2010 C-95 
Study Design Concentrations Effect Estimates (95% CI) 

Ages 15-44: 0.0522 (0.0227) 

Ages 45-64: -0.0047 (0.0121) 

Ages 65-74: -0.0165 (0.0078) 

Ages 75-84: -0.0268 (0.0068) 

Ages ≥ 85: -0.0027 (0.0055) 

Log Mean: -0.0020 (0.0065) 

Peak CO 1970-1974, All locations 

Ages 15-44: 0.0685 (0.0274) 

Ages 45-64: 0.0022 (0.0148) 

Ages 65-74: -0.0051 (0.0091) 

Ages 75-84: -0.0158 (0.0079) 

Ages ≥ 85: -0.0069 (0.0060) 

Log Mean: 0.0038 (0.0077) 

Peak CO 1960-1969, All locations 

Ages 15-44: 0.0578 (0.0713) 

Ages 45-64: 0.0583 (0.0347) 

Ages 65-74: 0.0007 (0.0174) 

Ages 75-84: -0.0245 (0.0130) 

Ages ≥ 85: -0.0138 (0.0113) 

Log Mean: 0.0041 (0.0176) 

Attributable Risks of mortality (1995-97) 

Peak CO 1995-1997, All locations 

Ages 15-44: 0.0344 (0.0256) 

Ages 45-64: -0.0203 (0.0198) 

Ages 65-74: -0.0346 (0.0146) 

Ages 75-84: -0.0378 (0.0161) 

Ages ≥ 85: -0.0283 (0.0119) 

Log Mean: -0.0188 (0.0103) 

Peak CO 1989-1991, All locations 

Ages 15-44: 0.0289 (0.0248) 

Ages 45-64: -0.0192 (0.0192) 

Ages 65-74: -0.0466 (0.0140) 

Ages 75-84: -0.0497 (0.0147) 

Ages ≥ 85: -0.0301 (0.0108) 

Log Mean: -0.0240 (0.0096) 

Peak CO 1979-1981, All locations 

Ages 15-44: 0.0336 (0.0176) 

Ages 45-64: -0.0037 (0.0135) 

Ages 65-74: -0.0298 (0.0096) 

Ages 75-84: -0.0301 (0.0105) 

Ages ≥ 85: -0.0087 (0.0078) 

Log Mean: -0.0094 (0.0071) 

Peak CO 1970-1974, All locations 

Ages 15-44: 0.0464 (0.0202) 

Ages 45-64: 0.0202 (0.0155) 

Ages 65-74: -0.0032 (0.0112) 

Ages 75-84: -0.0157 (0.0122) 

Ages ≥ 85: -0.0142 (0.0084) 

Log Mean: 0.0007 (0.0077) 

Peak CO 1960-1969, All locations 

Ages 15-44: 0.0679 (0.0441) 

Ages 45-64: 0.0772 (0.0405) 

Ages 65-74: 0.0059 (0.0173) 

Ages 75-84: -0.0085 (0.0213) 

Ages ≥ 85: -0.0158 (0.0162) 

Log Mean: 0.0162 (0.0149) 

January 2010 C-96 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Lipfert et al. 

(2006, 088218) 

Period of Study:

1976-2001 

Location:

32 Veterans Hospitals, 

USA 

Mortality 

Health Outcome (ICD9):

Nonaccidental 

Study Design: Cohort 

Study Population:

 ~70,000 hypertensive male U.S. 

veterans 

Statistical Analyses:

Cox proportional-hazards model 

Age Groups Analyzed: NR 

Pollutant: CO 

Averaging Time: 

95th Percentile Annual avg 

Mean (SD) unit:

1976-1981: 7.6 (2.9) ppm 

1982-1988: 3.4 (9.5) ppm 

1989-1996: 2.4 (0.67) ppm 

1997-2001: 1.6 (5.6) ppm 

Range (Min, Max): NR 

Copollutants correlation: 

ln(VKTA): r = -0.06 

Avg NO2: r = 0.43 

Peak O3: r = 0.08 

Peak SO2: r = -0.05 

PM2.5: r = 0.08 

SO4

2-: r = -0.16 

Note: VKTA = annual vehicle-km 

traveled/km2

Increment: 2 ppm 

Relative risk (Lower CI, Upper CI): 

CO: 1.032 (0.954-1.117) 

CO, lnVKTA: 0.999 (0.923-1.081) 

CO, lnVKTA, NO2: 1.012 (0.923-1.110) 

CO, lnVKTA, NO2+O3: 1.023 (0.939-1.115) 

Author: Lipfert et al. 

(2006, 088756) 

Period of Study:

1997-2002 

Location:

32 Veterans Hospitals, 

USA 

Mortality 

Health Outcome (ICD9):

Nonaccidental 

Study Design: Cohort 

Study Population:

 ~18,000 hypertensive male U.S. 

veterans 

Statistical Analyses:

Cox proportional-hazards model 

Age Groups Analyzed: NR 

Pollutant: CO 

Averaging Time: 

95th Percentile Annual avg 

Mean (SD) unit:

1999-2001: 1.63 (0.84) ppm 

1999-2001 (STN sites only): 

1.73 (0.77) 

Range (Min, Max): 

1999-2001: (0.40, 6.7) 

1999-2001 (STN sites only): 

(0.47, 4.2) 

Copollutants correlation: 

ln(traffic density): r = -0.199 

PM2.5: r = 0.040; As: r = 0.148 

Cr: r = 0.448; Cu: r = 0.177 

Fe: r = -0.138; Pb: r = 0.420 

Mn: r = 0.357; Ni: r = 0.090 

Se: r = -0.110; V: r = 0.230 

Zn: r = 0.472; OC: r = 0.470 

EC: r = 0.234; SO4

2-: r = -0.123 

NO3-: r = -0.088 

PM2.5 comp.: r = 0.133 

NO2: r = 0.418 

Peak O3: r = 0.172 

Peak SO2: r = 0.405 

Increment: NR 

β coefficient (SE); t-statistic: 

-0.00000536 (0.0000324); -0.165 

Author: Jerrett et al. 

(2003, 087380) 

Period of Study:

1982-1989 

Location:

107 U.S. cities 

Mortality 

Health Outcome (ICD9):

Cardiovascular; CHD; 

Cerebrovascular disease 

Study Design: Cohort 

Study Population: 

65,893 postmenopausal women 

without previous CVD 

Statistical Analyses:

Cox proportional-hazards model 

Age Groups Analyzed: ≥ 30 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: 1.56 ppm 

Range (Min, Max): (0.19, 3.95) 

Copollutants correlation: 

Sulfates: r = -0.07 

NO2

O3

SO2

Increment: 1 ppm 

Relative risk (Lower CI, Upper CI): 

CO: 0.98 (0.92-1.03) 

CO, Sulfates: 0.97 (0.92-1.03) 

January 2010 C-97 
Study Design Concentrations Effect Estimates (95% CI) 

Author: Miller et al. 

(2007, 090130) 

Period of Study:

1994-1998 

Location:

36 U.S. cities 

Mortality 

Health Outcome (ICD9):

Cardiovascular; CHD; 

Cerebrovascular disease 

Study Design: Cohort 

Study Population: 

65,893 postmenopausal women 

without previous CVD 

Statistical Analyses:

Cox proportional-hazards model 

Age Groups Analyzed: 50-79 yr 

Pollutant: CO 

Averaging Time: Annual avg 

Mean (SD) unit: NR 

Range (Min, Max): NR 

Copollutants: 

PM2.5

PM10-2.5

SO2

NO2

O3

Increment: 1 ppm 

Hazard ratio (Lower CI, Upper CI): 

All subjects 

CO: 1.0 (0.81-1.22) 

Only subjects with non-missing exposure data 

CO: 0.92 (0.71-1.21) 

CO, PM2.5, PM10-2.5, SO2, NO2, O3: 0.93 (0.67, 1.30) 

Author: Pope et al. 

(2002, 024689) 

Period of Study:

1980-1998 

Location:

All 50 States, Washington 

DC, and Puerto Rico 

(ACS-CPS-II) 

Mortality 

Health Outcome (ICD9): 

Total (nonaccidental) (<800); lung 

cancer (162); cardiopulmonary 

(401-440, 460-519) 

Study Design: Prospective cohort 

Statistical Analyses:

Cox proportional hazards model 

Age Groups Analyzed: ≥ 30 yr 

Pollutant: CO 

Averaging Time: 24-h avg 

Mean (SD) unit: 

1980: 1.7 (0.7) ppm 

1982-1998: 1.1 (0.4) ppm 

Range (Min, Max): NR 

Copollutant: 

PM2.5; PM10; TSP; SO2; NO2; O3

The study presents results for CO graphically. 

January 2010 C-98 
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