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The opportunity to assess short term impact of air pollution relies on thecausal interpretation of the exposure-outcome association, but up to now fewstudies explicitly faced this issue within a causal inference framework. Inthis paper, we reformulated the problem of assessing the short term impact ofair pollution on health using the potential outcome approach to causalinference. We focused on the impact of high daily levels of PM10 on mortalitywithin two days from the exposure in the metropolitan area of Milan (Italy),during the period 2003-2006. After defining the number of attributable deathsin terms of difference between potential outcomes, we used the estimatedpropensity score to match each high exposure-day with a day with similarbackground characteristics but lower PM10 level. Then, we estimated the impactby comparing mortality between matched days. We found that during the studyperiod daily exposures larger than 40 microgram per cubic meter wereresponsible of 1079 deaths (116; 2042). The impact was more evident among theelderly than in the younger classes of age. The propensity score matchingturned out to be an appealing method to assess historical impacts in thisfield.

Potential outcome approach to causal inference in assessing the short term impact of air pollution on mortality