INTERNATIONAL JOURNAL OF CLIMATOLOGY

Int. J. Climatol. 20: 881–897 (2000)

THE IMPACTS OF WEATHER AND POLLUTION ON HUMAN

MORTALITY IN BIRMINGHAM, ALABAMA AND PHILADELPHIA,
PENNSYLVANIA
KAREN E. SMOYERa,*, LAURENCE S. KALKSTEINb, J. SCOTT GREENEc and HENGCHUN YEd
a
Department of Earth and Atmospheric Sciences, Uni6ersity of Alberta, Edmonton, Alberta, Canada T6G 2E3
b
Department of Geography, Center for Climatic Research, Uni6ersity of Delaware, Newark, DE 19716, USA
c
En6ironmental Verification and Analysis Center, Uni6ersity of Oklahoma, Norman, OK 73069, USA
d
Department of Geography, Uni6ersity of Idaho, Moscow, ID 83844, USA

Recei6ed 1 September 1998

Re6ised 15 September 1999
Accepted 21 September 1999

ABSTRACT
Past studies have examined how both extreme weather and atmospheric pollutants influence human mortality.
However, the differential and/or synergistic impacts of weather and pollution on mortality are poorly understood.
This relationship is particularly notable in summer, when both extreme weather and high pollution episodes are
frequent. The goal of this study is to describe the relationship between atmospheric conditions (as characterized by
weather and air pollution) and mortality in the summer season for Birmingham, Alabama and Philadelphia,
Pennsylvania. To assess the health impacts of both weather and pollution (ozone and total suspended particulates, or
TSP), we used a synoptic, or air mass-based, approach to take into account the entire weather situation, rather than
individual weather elements. This method was used to identify ‘offensive’ air masses, which are associated with
elevated mortality, and then to investigate which individual or combination of atmospheric conditions poses the
greatest threat to human health in terms of acute (daily) mortality.
In both cities, offensive weather events have a greater impact on acute mortality than high concentrations of TSP
or ozone. The highest mortality levels occur when the hottest, but not the most polluted, air mass is present in each
city. In Philadelphia, neither TSP nor ozone appear to contribute an ‘add on’ effect to weather-related mortality.
Under non-offensi6e weather situations, pollution concentrations are associated with increased mortality in Philadel-
phia. Yet, regardless of pollution concentration, mortality levels are much lower for these air masses than for
offensive events. Pollution appears to be more important for mortality in Birmingham. Although Birmingham’s
high-mortality (offensive) air mass is not the most polluted, offensive air mass days with high pollution concentrations
nonetheless exhibit higher mean mortality than offensive air mass days with low pollution concentrations. Also
different from Philadelphia is a lack of a relationship in Birmingham between pollution levels and mortality on
non-offensive air mass days. The relationship between summer weather and mortality is strong in both cities, while
the role of pollution is less clear. This research underscores the imperative need for the development of a
weather/health watch-warning system to alert the public that an offensive synoptic situation is imminent. Copyright
© 2000 Royal Meteorological Society.
KEY WORDS: Philadelphia; Birmingham; synoptic classification; air pollution; human mortality

1. INTRODUCTION

Many studies have examined how natural stresses, such as extreme weather events, influence human
health while others have focused on the health impacts of anthropogenic factors such as atmospheric
pollutants. The evidence shows that both extreme weather and pollution adversely affect mortality. There
have been some efforts to evaluate the combined impacts of weather and air pollution on human health,
but the differential and/or synergistic impacts of the two are poorly understood. For example, it is

* Correspondence to: Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Alberta, Canada T6G 2E3.
Tel.: +1-780-492-3287; fax: + 1-780-492-7598; e-mail: karen.smoyer@ualberta.ca

Copyright © 2000 Royal Meteorological Society

882 K.E. SMOYER ET AL.

uncertain whether high pollution concentrations contribute an ‘add-on’ effect to the impact of hot and
humid weather on human mortality. An understanding of these relationships would be useful not only for
assessing present-day health risks, but also for supporting the development of policy to prepare for the
effects of a possible long-term climate change.
In this analysis of weather, pollution, and mortality, we used a synoptic approach that identifies
atmospheric conditions, rather than individual weather elements, associated with elevated mortality. The
synoptic method provides a more accurate depiction of atmospheric conditions than a one-variable
weather surrogate (e.g. temperature) because it represents natural climatic fluctuation using a number of
meteorological elements measured several times throughout each day. In the procedure, days with similar
meteorological characteristics are identified as a homogeneous group, or ‘synoptic type,’ which represents
an air mass that possesses a particular distinctive meteorological signature. Each air mass is then
examined to determine whether acute mortality is significantly higher during its occurrence. If an air mass
is associated with significantly heightened mean daily mortality, it is then evaluated separately to
determine which of its characteristics (including pollutant levels) might be responsible. When evaluating
the impact of an air mass upon human mortality, it is assumed that people respond to a set of
meteorological and pollution factors working in concert, forming an ‘umbrella of air,’ rather than to
individual weather elements such as temperature. The synoptic approach therefore allows for an
evaluation of potentially synergistic relationships among weather and pollution elements. It is based on
the assumption that the combined impact of several elements is greater than the sum of the individual
impacts of each element. Most importantly, the synoptic approach permits an impact analysis of real-time
weather situations as they truly exist at a given locale. Thus, the combination of atmospheric conditions
that comprise an air mass is accounted for with the synoptic approach.
The goal of this study is to use a synoptic approach to investigate the relationship between atmospheric
conditions (as characterized by weather, ozone, and total suspended particulates, or TSP) and human
mortality in Birmingham, Alabama and Philadelphia, Pennsylvania. Although mortality in other seasons
is also important, this study focuses on summer, a season subject to extreme weather and high pollution
episodes. Specifically, we aim to learn which individual or combination of summertime atmospheric
conditions poses the greatest threat to human health in terms of acute (daily) mortality.

2. LITERATURE REVIEW

Human mortality varies seasonally, as well as during extreme weather conditions. In North America,
average daily mortality typically is higher in winter than in summer, but the relationship between weather
and mortality is more pronounced and immediate in summer (Kalkstein and Davis, 1989). For example,
the number of deaths per day can increase more than 50% above baseline levels during hot and humid
conditions (Kilbourne, 1989; Centers for Disease Control, 1995). The summer weather/mortality relation-
ship is not linear, and a threshold temperature, above which mortality dramatically increases, has been
noted for several US and Canadian cities (Kalkstein and Davis, 1989; Kalkstein and Smoyer, 1993). Hot
and humid conditions cause physiological stress and can result in death through heatstroke as well as by
exacerbating many pre-existing health conditions. As a result, mortality from many causes increases
during heat wave conditions (Kilbourne, 1989).
Research has also demonstrated a statistically significant relationship between air pollution and acute,
or daily, human mortality (Shumway et al., 1988; Schwartz and Dockery, 1992a,b; Thurston, 1996). The
magnitude of this relationship is substantially smaller than for summer weather and mortality. Although
point estimates vary among studies, most findings concur that a 10 mg/m3 increase in coarse particulates
(PM10) results on average in a 0.64 – 1.49% increase in daily mortality (Ostro, 1993). While the
pollution/mortality relationship appears to be non-linear, no threshold has been observed (Ostro, 1984;
Schwartz and Marcus, 1990), as in the case of temperature and mortality. Unlike summer temperatures,
which typically are not associated with mortality below the threshold, mortality increases have been
detected at very low pollution levels (Schwartz and Dockery, 1992a,b; Pope et al., 1992; Schwartz, 1993;
Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
 WEATHER, POLLUTION AND HUMAN MORTALITY 883

Burnett et al., 1998a,b), well below the current United States National Ambient Air Quality Standard.
The causal mechanism between air pollution and morality is unclear. It has been hypothesized that
pollutants cause stress to the respiratory system and the ensuing physiological stress can exacerbate other
health conditions, leading to death in some cases (Lang, 1998).
An important issue in several of these studies is the relative importance of weather and air pollution in
human health, as well as the confounding effect of seasonality and weather on the pollution/mortality
relationship. Days with high air pollution levels, particularly in summer, frequently also have high
temperatures associated with high pressure systems and stagnant air. The link between hot and humid
conditions and mortality has been well demonstrated (Kalkstein and Davis, 1989; Kilbourne, 1989;
Semenza et al., 1996; Smoyer 1998), but less is known about how air pollution may affect the
weather/mortality relationship.
Several studies have noted statistically significant relationships between TSP and mortality that persist
after controlling for weather (Schwartz and Dockery, 1992a,b; Schwartz, 1993). But other researchers
have been unable to discern pollution from weather impacts. Wyzga (1978) found that high coefficients
of haze (COH) are associated with increased mortality in Philadelphia, but that heat wave conditions may
contribute to this relationship. Ramlow and Kuller (1990) found that during the 1988 heat wave daily
mortality in the Pittsburgh metropolitan area was most closely associated with the average temperature of
the previous day. High ozone concentrations did not contribute significantly to excess mortality. In
another study, Biersteker and Evendijk (1976) examined the effects of ozone concentrations on daily
mortality in Rotterdam, the Netherlands during the summers of 1974 and 1975. They concluded that
elevated ozone levels alone had no discernible effect on mortality in 1974, and if any effect existed in 1975,
it was not separable from the temperature effect. Styer et al. (1995) reported confounding in the summer
months between weather and PM10 and between weather and mortality in Cook County, and noted the
difficulty these associations pose in attempts to partial out the differential effects of pollution and weather
on mortality using standard regression procedures.
It is evident from the review above that considerable uncertainty exists among researchers regarding the
differential impact of weather and pollution on acute mortality. Although some studies have found that
pollution levels are a risk factor in acute mortality, it is unclear whether pollution concentrations
exacerbate weather effects (or weather conditions exacerbate pollution effects), or if the two variables
affect mortality independently. Undoubtedly the relationship between weather, pollution, and mortality is
complex, and past researchers have devised different methods to characterize this relationship. Previous
studies typically have represented weather in terms of mean daily temperature, dew point, or relative
humidity (e.g. Ostro, 1984; Pope et al., 1992; Schwartz, 1993), and/or through dummy variables to
account for hot and humid weather (e.g. Biersteker and Evendijk, 1976; Schwartz and Marcus, 1990; Pope
et al., 1992; Mackenbach et al., 1993; Schwartz, 1993). Often these studies have attempted to depict the
weather/pollution/mortality relationship through increasingly complex data filters and statistical models
(e.g. semi-parametric and autoregressive models with quadratic weather variable terms), but often with
inconsistent findings (Li and Roth, 1995; Lipfert and Wyzga, 1995).
Characterizing the weather with mean climatological data, such as daily temperature or relative
humidity, running means, or dummy variables based on these data provides only a limited description of
weather conditions. These methods may have underestimated the impact of meteorological extremes upon
human mortality. Although some studies have effectively evaluated maximum or minimum daily
temperature, virtually none have investigated how atmospheric situations (e.g. the temperature and
humidity of air masses in addition to their ‘contents’ in terms of pollutants, allergens, and dust, etc.)
contribute to heightened mortality.
We propose a different approach. Rather than modelling the pollution/weather/mortality relationship
with a limited number of individual weather variables, we use a synoptic, air mass-based approach to
characterize the atmospheric situation. Some studies have attempted to control for seasonal or meteoro-
logical variation in order to identify pollution/mortality relationships. We argue that ambient outdoor
pollution levels are a function of atmospheric processes and thus, to understand their health impacts,
should not be analysed independently of the current weather situation. A more appropriate line of inquiry

Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
884 K.E. SMOYER ET AL.

should address understanding the effects of offensive weather under high and low pollution concentra-
tions and the effects of high pollution episodes under different weather conditions.
New insight into the relationship between pollution, weather, and daily fluctuations in human mortality
can be gained through a synoptic climatological approach. This method was used to model daily weather
as holistic units in an evaluation of the impact of summer weather and pollution on mortality in St. Louis,
Missouri (Kalkstein, 1991). One particular air mass was disproportionately represented within the days
with the highest mortality. This air mass was associated with the hottest conditions found in St. Louis,
but did not possess particularly high mean pollution concentrations of the six pollutants examined.
Conversely, those air masses associated with anticyclonic surface flow and commonly possessing the
highest pollution concentrations were not associated with unusually high numbers of deaths. Nine
additional US cities were evaluated in this study to determine if the St. Louis finding was an aberration.
Results indicated that seven of ten cities evaluated (including St. Louis) possessed strong or moderate
summer weather/mortality signals as demonstrated by a particular air mass with an unusually high mean
daily mortality. None of the cities, however, experienced unusually high mean daily mortality when a
highly polluted air mass was present. The synoptic evaluation suggested that fluctuations in daily
mortality appear to be significantly more sensitive to stressful weather than to high levels of pollution
(Kalkstein, 1991). The role of pollution levels within the high mortality air masses, however, was not
investigated. One purpose of the current paper is to expand Kalkstein’s (1991) study to include an
investigation of the impact on mortality of pollution during extreme summer weather.

3. METHODS

3.1. Data sources and treatment

The study period comprises 12 summers, from 1 June–31 August, for each year between 1975 and 1988
for Philadelphia and between 1974 and 1988 for Birmingham. Mortality data were not available, however,
for 1977 and 1979 and thus these years were omitted from the study. All counties comprising the
metropolitan statistical area (MSA) of each city were included. Philadelphia and Birmingham are cities
with large populations where many deaths occur each day. Daily mortality frequencies, therefore,
demonstrate a normal distribution. In addition, both cities have a relatively long and complete data
record for the pollutant (TSP and ozone) and weather variables.
Pollution data were obtained from the US Environmental Protection Agency’s (EPA) Aerometric
Information Retrieval System (AIRS). Measurements of daily TSP in mg/m3 and hourly ozone (O3) in
parts per million (ppm), in addition to several other pollutants, are available for multiple sites within
many US cities. This study is limited to TSP and ozone, which had substantially more complete data
records than the other measured pollutants. Nonetheless, because of incomplete or incompatible data
records for certain sites, in some cases we used TSP and ozone measures collected at different sites as well
as multiple monitors for TSP in order to supplement missing measurements.
To develop a more complete data record, TSP values were interpolated from nearby monitoring sites
with highly correlated measurements. Missing values for a primary site were calculated using a regression
algorithm derived from its relationship with the surrogate site. If missing values remained after use of this
procedure, it was repeated using the surrogate site with the next highest R 2. Subsequent repetitions were
performed until the data set was complete or the R 2 of the next surrogate station dropped below 0.85. In
both Philadelphia and Birmingham, TSP data were available from a downtown monitor. For Philadel-
phia, 7.6%, and for Birmingham, 21.1%, of these data were derived from the interpolation procedure.
Philadelphia ozone readings were obtained from an urban but less densely populated site in Northeast
Philadelphia, while Birmingham’s ozone data were collected from a suburban site approximately 10 km
southwest of the city centre. Since the hourly ozone record is more complete, interpolation was deemed
unnecessary. From the raw hourly ozone record, a daily data set was produced by selecting the maximum
daytime hourly observation (between 11 am and 7 pm Local Standard Time (LST)) for each day. This
Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
 WEATHER, POLLUTION AND HUMAN MORTALITY 885

time interval was chosen since ozone reaches a maximum during daylight hours. To avoid assigning a
maximum ozone reading from a time of day that typically does not possess the highest values, we omitted
from further analysis days missing all observations between 11 am and 3 pm LST. Due to missing
pollution data within the study period, the Philadelphia record is 86.3% complete for both ozone and
TSP. The Birmingham record is 89.9% complete for ozone. A large number of TSP readings equal zero,
which is well below the next lowest value, of 16 mg/m3, and thus these days were not included in the TSP
analysis. The resulting data record for Birmingham, therefore, is only 56.3% complete for TSP.
Weather data are from the National Climatic Data Center (NCDC) in Asheville, North Carolina and
consist of Surface Airways data sets containing hourly measurements of temperature, dew point, wind
speed, wind direction, surface pressure, and cloud cover (U.S. Department of Commerce, 1988). These
data generally are very complete, but short missing periods occasionally occur. Sequences with missing
values of less than 6 h were estimated using linear interpolation between adjacent hours for which data
existed. In a few cases, values were interpolated spatially from nearby locations where available. Several
days containing larger spans of missing values were eliminated from further analysis. Raw meteorological
data were utilized in all climatic modelling with the exception of wind speed and direction, which were
converted to north/south and east/west scalars (see Kalkstein et al., 1987).
The National Center for Health Statistics (NCHS) provided detailed daily mortality data for the
periods 1964–1966, 1973 – 1976, 1978, and 1980–1986; intervening years possessed data problems which
prevented their use in this research (National Center for Health Statistics, 1978). Additional mortality
data for 1987–1988 were provided by the U.S. Environmental Protection Agency. Daily total mortality
(from all causes and for all age groups) was tabulated for the Philadelphia and Birmingham MSAs for the
period of evaluation.
The data exhibit interannual mortality fluctuations as well as declining mortality rates over time. We
suspect these variations are the result of changes in several factors, including population age structure, the
availability of health care, and increased life expectancy. Thus, converting the mortality data to rates (i.e.
deaths per 100 000 people) would give disproportionate weight to relationships in the earlier part of the
study period. Instead, long-term trends in mortality, which were unlikely to be related to weather or air
pollution, were removed to prevent them from influencing the results. The mortality data were standard-
ized, and excess deaths calculated, by regressing mean daily mortality for each year during the period of
record against time (in years). When this relationship was statistically significant, as for Birmingham, the
predicted mean daily mortality for each year (as derived from the regression relationship) was deemed a
baseline value, and the difference between each day’s actual mortality and this baseline was calculated and
utilized for further analysis. This relationship, however, was not significant in Philadelphia. Thus, for
Philadelphia, the mean daily mortality for the whole period was used as the baseline value, and daily
differences were calculated from this baseline. Due to the different standardization procedures, the
standardized mortality presented in the results tables is not directly comparable for the two cities,
although each represent a measure of excess deaths above baseline levels.

3.2. Identification of pollution and weather e6ents conduci6e to high mortality

The ‘temporal synoptic index’ (TSI), which has been used successfully in other weather/mortality
research (Kalkstein, 1991; Kalkstein and Smoyer 1993) was employed in this study to identify air masses.
The TSI is particularly useful in biometeorology research because it describes conditions in the boundary
layer, where most human activity and exposures to atmospheric stressors occur. The TSI is automated,
which permits a relatively rapid determination of daily air mass type for a long time period at a given
locale. Software is available to identify air masses real-time, and even to predict air masses for the next
few days based on weather forecasts. This is a necessity if a climatic indexing procedure is to be employed
as part of a watch-warning system.
The TSI was run for all days with weather data, regardless of whether pollution and mortality data
were available. The procedure starts with six readily available meteorological elements, measured four
times daily: air temperature, dew point, total cloud cover, sea-level pressure, wind speed, and wind

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886 K.E. SMOYER ET AL.

direction. These variables, used as air mass indicators, include primary elements, which describe the heat
and moisture properties of the atmosphere, and secondary elements, which assist in the ultimate daily
separation of air masses (Crowe, 1971; Barry and Perry, 1973). The TSI uses principal components
analysis (PCA) to reduce these 24 variables (six variables × four observations) into a reduced set of
orthogonal components. An average linkage clustering procedure is then used to group those days with
similar component scores into meteorologically homogeneous categories, which represent the air mass
types used in this study. Once the categories have been determined, a daily air mass calendar is developed,
and average values are calculated for the 24 meteorological variables for all days within each particular
group. More detailed descriptions of the TSI are provided in Kalkstein and Corrigan (1986), Kalkstein et
al. (1987), and Kalkstein et al. (1990).
A two-tiered system of impact analysis has been employed to determine the differential effects of
weather and pollution on acute mortality. The first tier involves computing mean daily mortality for each
air mass to ascertain whether particular air masses have distinctively high mortality. Potential lag times
were determined by evaluating the daily air mass type on the day of the deaths, as well as 1, 2, and 3 days
before the day of the deaths. Next, air masses were identified for the 50 days with the highest daily
mortality at each locale. Mean mortality for each air mass, as well as the top 50 mortality days, was based
on all days for which both mortality and weather data were available, and thus pollution data were
missing for some of these days.
To determine whether any of the air mass categories were over-represented in the highest 50 mortality
days, a ratio of the category’s occurrence in the top 50 days to its occurrence in the whole record was
determined. Categories with ratios significantly greater than 1.0 are considered to be over-represented in
the top 50 mortality days, and therefore associated with high mortality. These air masses are considered
‘offensive’. Daily concentrations of TSP and ozone were also examined for each air mass to determine
whether the air masses associated with the highest mortality were also the most polluted.
The second tier of the impact analysis involves identifying which elements within the offensive air mass
contribute most to heightened mortality. Although each day assigned to an air mass category is most
similar meteorologically to all days within that category, there still exists within each air mass some
variance in meteorological conditions as well as pollution concentration. In addition, not all days within
an offensive air mass possess high mortality totals. It is apparent that day-to-day variation in meteorolog-
ical, pollution, or other variables within the offensive air mass leads to elevated mortality. A stepwise
multiple regression procedure was performed on all days within each offensive air mass to determine
which environmental factors contribute most to high mortality. A number of meteorological and pollution
factors were used as independent variables within the regression analysis (Table I).
Two additional variables, ‘time’ and ‘day in sequence’, were also evaluated. A heat wave or pollution
event in August might have less influence on mortality than a similar event in June, as the population
would be accustomed to the late season event. In addition, consecutive day runs of oppressive
atmospheric conditions appear be more stressful than individually occurring days (Kilbourne, 1989;

Table I. Independent variables used in regression analysis

Maximum temperature (MaxT)

Minimum temperature (MinT)
Maximum dewpoint (MaxDPT)
Minimum dewpoint (MinDPT)
3 pm LSTa cloud cover (CC1500)b
3 pm LSTa Windspeed (Wsp1500)b
Daily total TSP (TSP)
Maximum hourly ozone (Ozone)
Time of season (Time)
Consecutive day in sequence (Day)
a
LST, Local Standard Time.
b
Values represent cloud cover and windspeed measured at 15:00 h (3 pm LST).

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 WEATHER, POLLUTION AND HUMAN MORTALITY 887

Kalkstein, 1991; Kalkstein and Smoyer, 1993). The ‘time’ variable determines the intra-seasonal timing of
a particular mortality event number (i.e. June 1= 1, August 31= 92), while the variable ‘day in sequence’
notes how a particular air mass day is positioned within a consecutive day sequence.
As another test to investigate whether TSP and ozone contribute to heightened mortality during
oppressive weather situations in Philadelphia and Birmingham, offensive air mass days were divided into
five (or in one case, four) categories based on ozone and TSP concentrations. We used a combination of
equal intervals and natural breaks in pollution levels to create quintiles (or quartiles) containing
approximately the same number of days. Mean daily mortality was calculated for each quintile to assess
whether a dose–response relationship between pollution and mortality was evident for offensive days.
Both the regression models and the pollution quintile analysis were designed to elucidate whether
pollution levels contribute an add-on effect to mortality on offensive air mass days.

4. RESULTS AND DISCUSSION

Air masses were determined for each city, and mean meteorological characteristics were computed. These
include air masses with maritime tropical and continental polar characteristics, in addition to transitional
categories representing a shift from one air mass type to another throughout the course of the day. The
ten most frequent air masses are shown here, comprising 85.7% of Philadelphia’s climate record and
81.6% of Birmingham’s (Table II). Air mass categories occurring less than 4% of the study period were
omitted from the analysis to ensure statistical robustness. Each city exhibits a hot, oppressive air mass; for
example, Birmingham’s hottest air mass is number 6 with a mean 3 pm LST air temperature of 34.4oC
(Table II). In general, this air mass also exhibits a relatively high dew point, which is characteristic of
maritime tropical air intruding into the area. It is also important to note that the hottest air mass is cooler
in Philadelphia than in Birmingham. Past research indicates that human response to weather is relative
rather than absolute, and people respond to a relatively rare hot event based on its frequency rather than
its intensity (Kalkstein and Valimont, 1986). Thus, it is possible that the population in Philadelphia will
respond more negatively to the hottest air mass than the population in Birmingham, even though the
temperature of this air mass is higher in Birmingham.
Mean pollution concentrations within the air masses for each city indicate that the hottest air mass does
not possess the highest ozone and TSP concentrations on average (Table II). For example, three air
masses exhibit higher mean TSP concentrations than Birmingham’s hottest air mass. It is notable,
however, that the hottest air masses do in fact exhibit concentrations above the overall mean
The synoptic/mortality evaluation confirmed findings in previous research (Kalkstein, 1991; Kalkstein
and Smoyer, 1993). For both cities the hottest air mass is associated with the highest mean total mortality
(Table III). The response time is short, with the strongest weather/mortality relationship occurring with
a zero-day lag for each city. These results are especially pronounced for Philadelphia, where the mean
mortality for category 2 (the hottest air mass) is nearly 11 times higher per day than for the other air
masses combined (7.43 versus − 0.75 standardized deaths). Perhaps most striking are the relative
frequencies of the hottest ‘offensive’ air masses among the 50 top mortality days in each city (Table III).
In Philadelphia, for example, category 2 occurs less than 12% of the time during the summer, yet it is
present on 23 of the top 50 mortality days (46%), almost four times what might be expected. Similar, but
less dramatic results were detected in Birmingham, where category 6 is present nearly three times more
often in the top 50 mortality days than expected.
However, the offensive air masses in each city possess generally high standard deviations (S.D.s) in
daily mortality (Table III), implying that a number of days within these categories do not exhibit above
average mortality. A major facet of this research is to identify those conditions that render certain days
so offensive in terms of heightened mortality. The within-category regressions proved very useful in this
regard, but the pollution quintile analysis provided additional information not apparent from the
regression analysis.

Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
 888

Table II. Ten most frequent summer synoptic categories for Birmingham and Philadelphia

Category Percent Mean 3 pm LST Mean 3 am LST Mean 3 pm LST Mean 3 pm LST Mean TSP Mean ozone
number occurrence temperature temperature dewpoint cloud cover
(°C) (°C) (°C) (tenths) (mg/m3) (ppm)

Birmingham
1 15.2 30.4 22.3 21.4 7.5 87.1 0.063

Copyright © 2000 Royal Meteorological Society

2 12.8 30.3 17.8 15.5 3.9 92.5 0.074
3 9.8 33.3 21.9 20.4 4.9 92.9 0.069
4 9.4 29.4 20.8 18.8 6.3 87.0 0.063
5 7.1 27.2 21.8 21.3 8.7 69.3 0.057
6a 7.0 34.4 23.3 20.3 5.0 90.9 0.070
7 6.8 30.1 22.9 20.9 7.4 81.6 0.065
8 6.6 28.7 21.9 21.4 8.1 93.4 0.083
9 5.3 31.7 21.3 19.7 5.1 70.9 0.055
10 4.6 32.5 23.0 20.7 5.4 56.8 0.046
Philadelphia
K.E. SMOYER ET AL.

1 13.1 25.0 17.2 10.4 3.2 59.6 0.081

2a 11.6 31.7 24.0 21.0 3.7 92.1 0.099
3 11.2 28.0 22.8 21.1 8.4 79.9 0.081
4 9.7 26.1 19.4 15.9 7.1 72.1 0.080
5 8.8 28.1 23.0 21.2 8.1 76.2 0.076
6 7.1 29.5 23.5 19.1 5.7 76.4 0.079
7 6.9 27.0 20.2 16.5 6.9 75.3 0.090
8 6.3 29.7 20.8 17.5 3.3 92.4 0.106
9 6.3 23.7 18.4 11.1 5.0 56.8 0.067
10 4.8 28.7 22.5 15.4 2.5 65.8 0.078
a
Designates ‘offensive category’ for each city.

Int. J. Climatol. 20: 881 – 897 (2000)

 Table III. Mortality for most frequent synoptic categories

Birmingham Philadelphia

Category Mean S.D. % of top 50: % top 50: % Category Mean S.D. % of top 50: % top 50: %

Copyright © 2000 Royal Meteorological Society

number mortalityb mortalityc frequencyd number mortality mortality frequency

1 0.49 4.78 11.76 0.76 1 −4.11 12.87 2.00 0.14

2 0.05 4.72 19.61 1.57 2a 7.43 14.59 46.00 3.77
3 0.18 4.33 5.88 0.58 3 1.63 12.82 14.00 1.27
4 0.88 4.56 19.61 1.57 4 −4.43 10.19 0.00 0.00
5 −0.37 4.72 1.96 0.39 5 −2.57 11.14 4.00 0.45
6a 1.27 5.81 19.61 2.95 6 3.92 16.83 14.00 1.99
7 −0.33 4.59 1.96 0.28 7 0.70 11.82 2.00 0.14
8 0.13 4.66 5.88 1.17 8 2.47 12.49 8.00 1.08
9 −0.37 4.72 1.96 0.39 9 −4.49 12.53 0.00 0.00
10 0.93 4.27 1.96 0.48 10 0.13 11.80 6.00 1.07
a
Offensive air mass category.
b
Values are standardized using procedures described in text.
c
Represents the percentage of the top 50 mortality days within a particular synoptic category. Number of days may exceed 50 slightly if the 50th day’s mortality equals the
following day’s mortality.
d
WEATHER, POLLUTION AND HUMAN MORTALITY

Ratio of percentage of the top 50 days within category to seasonal frequency of category. Values greater than one indicate over-representation of the synoptic category among
the top 50 mortality days.

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890 K.E. SMOYER ET AL.

Birmingham’s within-category regression was surprisingly strong, and the coefficient of determination
(R 2) for the final model of statistically significant variables exceeded 0.50 (Table IV). The Philadelphia
model explained less than half the variation in daily mortality as the Birmingham model, with an R 2 just
above 0.20 (Table IV). In the models for both cities, maximum temperature was directly associated with
mortality during offensive category days, although the variable accounted for a larger percentage of the
variation in mortality in Birmingham than in Philadelphia. The significance of this variable highlights the
importance of high temperatures in human mortality in both cities. ‘Day in sequence’ was significant in
Philadelphia’s offensive air mass model, with a positive coefficient (Table IV). The direct relationship
suggests that long consecutive-day runs of the offensive air mass are detrimental to human mortality. This
corroborates our earlier findings in St. Louis and some eastern cities where long consecutive day periods
of offensive air masses exacerbated mortality (Kalkstein, 1991; Kalkstein and Smoyer, 1993). It is unclear
why ‘day in sequence’ was not statistically significant in Birmingham. The subtropical climate in
Birmingham may be a factor, and its residents may be more accustomed to long runs of oppressive
summer weather and thus less susceptible to these conditions than Philadelphia’s population.
The ‘time’ variable, which was found to be significant in earlier research (Kalkstein and Davis, 1989;
Kalkstein and Smoyer, 1993), also demonstrates a statistically significant inverse relationship within the
regression analyses for the offensive categories in Birmingham and Philadelphia (Table IV). Thus, an
occurrence of the offensive air mass early in the summer season (e.g. June) appears to have a much greater
impact than occurrence late in the season (e.g. August). Previously it was thought that this effect could
be attributed to increased adaptation to offensive weather as the summer progresses rather than a removal
of the pool of heat-susceptible individuals early in the season (Kalkstein and Davis, 1989). However, more
recent findings indicate that at least a portion of these deaths is attributed to ‘mortality displacement’ or
‘harvesting’. Thus, some of the people who died early in the season during the presence of an offensive
air mass would have died shortly afterward (within the next few days or months) regardless of the weather
(Kalkstein, 1993). The displacement phenomenon also has been noted in a study that evaluates
heat-related mortality in the Netherlands (Kunst et al., 1993).
Based on the assumption that if a large proportion of heat-related deaths are attributed to mortality
displacement, mortality totals shortly after a severe heat episode will be significantly below the long-term
mean, Kalkstein (1993) estimated that mortality displacement accounted for approximately 40% of extra
deaths during heat waves in New York and 19% in St. Louis. These estimates are probably high, as the
procedure assumes that all mortality below the mean after the heat wave is attributed to displacement.
The reason for the spatial differential between New York and St. Louis has not yet been assessed. Thus,
although the offensive air masses are responsible for a majority of deaths which would not have occurred
shortly afterward, there remains a sizeable minority of deaths which appear to have been ‘displaced’, and
this may contribute to the inverse ‘time’ relationship found in the regression models.
Table IV. Within-category regressions for offensive air mass categories

Step Variable Coefficient Partial R 2 (%) Model R 2 (%) S.E. F Probability\F

Birmingham, category 6
Lag time= 0 day
Intercept −88.264096 13.28 44.19 0.0001
1 MaxT 0.9155280 39.23 39.23 0.14 45.02 0.0001
2 CC1500 1.2038526 13.45 52.68 0.30 15.85 0.0003
3 Time −0.0654691 4.48 57.16 0.32 4.19 0.0473
Philadelphia, category 2
Lag time= 0 day
Intercept −77.373326 38.76 3.98 0.0485
1 Day 3.2577499 8.87 8.87 1.24 6.85 0.0102
2 Time −0.1858866 7.72 16.58 0.06 9.70 0.0024
3 MaxT 0.9956009 3.94 20.52 0.44 5.16 0.0252

Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
 WEATHER, POLLUTION AND HUMAN MORTALITY 891

Afternoon cloud cover was associated with increased mortality in Birmingham. The positive coefficient
suggests that mortality was greater on cloudier days. The direct rather than inverse relationship is
surprising given that maximum temperature was the strongest variable in the model and that the hottest
days typically occur under clear skies. It is noteworthy that no pollution variables emerge as statistically
significant for either city. Thus, within those air masses with the highest mortality, the most offensive days
with the greatest mortality totals are those days with the most extreme weather conditions, irrespective of
TSP or ozone levels. The regression models suggest that neither ozone nor TSP contribute to mortality
during offensive air mass days.
The results of the quintile evaluation suggest a potentially different relationship for Birmingham than
that indicated by the regression models. When offensive category 6 is present in Birmingham, mean
mortality increases between the lowest and highest pollution categories for both ozone and TSP, although
this increase is not entirely systematic for ozone (Table V). This trend is also apparent in the increasing
number of maximum, but not minimum, daily standardized deaths for TSP categories. The difference
between mean mortality for the lowest and highest TSP levels is significant at the 0.10 level (p= 0.081),
while the difference in mortality between the highest and lowest ozone levels narrowly exceeds the 0.10
significance level (p = 0.109). Despite the fact that neither ozone nor TSP is significant in the offensive
category regression models, the quintiles suggest that pollution does contribute in some way to elevated
mortality in Birmingham during offensive air mass category days. The nature of the pollution/mortality
relationship, however, is unclear. The lack of statistical significance for either pollution variable in the
offensive air mass regression models and the wide range of mortality values within each pollution quintile
(quartile for TSP) suggest that the relationship between pollution and mortality is neither linear nor
consistent.

Table V. Mortality by ozone and TSP quintiles for offensive category days

Pollution Mortality

Concentration N Mean S.D. Minimum Maximum

Birmingham ozone, category 6

0.023–0.049 16 0.60 3.80 −4.93 8.63
0.050–0.067 16 −0.23 4.20 −7.84 7.16
0.068–0.077 16 1.29 6.39 −6.65 16.35
0.078–0.090 16 1.13 4.85 −6.65 10.69
0.091–0.157 15 3.70 8.68 −8.21 20.35
Birmingham TSPa, category 6
38–60 11 −0.84 5.17 −8.21 7.16
61–77 11 0.91 4.69 −5.21 10.69
78–102 11 2.52 6.41 −6.65 16.35
103–161 11 3.16 7.48 −5.75 20.35
Philadelphia ozone, category 2
0.03–0.08 21 7.33 13.84 −13 44
0.09–0.10 23 7.26 16.22 −18 62
0.11–0.11 28 7.21 11.16 −10 38
0.12–0.13 18 10.33 15.73 −15 43
0.14–0.20 18 5.17 17.76 −21 40
Philadelphia TSP, category 2
43–72 20 9.15 14.56 −14 44
73–83 23 7.00 10.16 −7 38
84–95 21 6.19 9.46 −6 27
96–109 22 9.59 21.52 −21 62
110–189 22 5.32 14.92 −19 33
a
Due to the smaller TSP dataset, quartiles were used instead of quintiles.

Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
892 K.E. SMOYER ET AL.

Interestingly, the quintile evaluation confirms that in Philadelphia, ozone and TSP have little impact on
mortality if the weather is stressful (Table V). For neither pollutant is there is a rise in mortality as
quintile concentrations increase. In fact, mean mortality for both pollutants is lower in the highest
concentration quintile than in the lowest quintile. It is noteworthy that the mean daily standardized
mortality for all quintiles within the offensive synoptic category is well above the overall mean.
Considering that there is no systematic increase in this value as concentration quintiles increase, it appears
that the magnitude of standardized mortality within the offensive category (which averages about 7.4) is
related to the stressful weather conditions, rather than pollution levels, which occur within this air mass.
Given the differing results for Birmingham and Philadelphia, as well as the pollution add-on effect
suggested by Birmingham’s pollution quintile analysis that is not evident from the regression analysis, we
wanted to explore the pollution/mortality relationship further, and thus devised two additional tests. The
first involves a stepwise regression for the top 150 ozone days and the top 150 TSP days, using the same
explanatory variables as in the offensive category models. The purpose of this analysis was to uncover
which variables, if any, are associated with elevated mortality under high pollution concentrations. The
second test is to analyse mortality by TSP and ozone quintiles for non-offensive days to determine if a
pollution/mortality relationship is evident when the weather is not oppressive.
For the regression models of the highest 150 ozone and TSP days (Table VI), the variables that are
statistically significantly related to mortality are generally related to meteorology, ‘time’, or the consecu-
tive day variable. In Philadelphia, the two variables which are statistically significant in both the ozone
and TSP regressions are maximum temperature (direct) and ‘time’ (inverse). Thus, in Philadelphia, the
days with the highest mortality within the 150 highest ozone and TSP concentration days are not
associated with pollution concentration but are more closely related to heat and the timing of the
offensive air mass within the summer season. Apparently, pollution concentrations contribute minimally
to heightened mortality during the most polluted days. However, there is abundant evidence that stressful
weather is a major contributor to mortality on highly polluted days. In the case of Birmingham, only the
consecutive day (of the offensive air mass) variable was significant. The fact that the consecutive day in
sequence variable and not maximum temperature is significantly associated with mortality on the highest
TSP and ozone days may suggest a synergistic relationship between the hot and humid conditions of the
offensive air mass and pollution that results in elevated mortality. The lack of statistical significance for
both ozone and TSP levels on the most polluted days suggests that no direct relationship between
pollution levels and mortality is evident at high pollution concentrations, at least in cities like Birmingham
and Philadelphia where pollution levels rarely reach extreme levels because of clean air legislation. Past

Table VI. Multple regressions for mortality within the 150 highest ozone and TSP concentration days

Step Variable Coefficient Partial R 2 Model R 2 S.E. F Probability\F

(%) (%)

Birmingham ozone
Intercept −2.3068666 0.63 20.20 0.0001
1 Day 1.4674091 12.65 12.65 0.32 21.42 0.0001
Birmingham TSP
Intercept −2.3842447 0.59 16.25 0.0001
1 Day 1.2751412 13.32 13.32 0.27 22.75 0.0001
Philadelphia ozone
Intercept −88.457354 16.58 28.46 0.0001
1 MaxT 1.1039738 13.37 13.37 0.20 30.59 0.0001
2 Time −0.1243639 5.18 18.55 0.04 9.34 0.0027
Philadelphia TSP
Intercept −71.531072 19.05 14.09 0.0002
1 MaxT 0.9200489 9.85 9.85 0.22 17.45 0.0001
2 Time −0.1122587 4.52 14.37 0.04 7.76 0.0061

Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
 WEATHER, POLLUTION AND HUMAN MORTALITY 893

research, however, has demonstrated a relationship between mortality and air pollution at low pollution
concentrations (Schwartz and Dockery, 1992a,b; Pope et al., 1992; Schwartz, 1993; Burnett et al.,
1998a,b).
The final test of the weather/pollution/mortality relationship was to determine if mortality increases
with higher pollution levels on days with non-offensive weather. In Birmingham, mean mortality does not
increase with higher pollution concentration quintiles (Table VII). Thus for the large majority of summer
days in Birmingham, air pollution levels do not appear to contribute significantly to mortality. The
opposite is true, however, for Philadelphia. For both pollutants, an increase in mean standardized
mortality is noted from the lowest to the highest quintile. The trend for ozone, although not systematic,
shows a increase of 3.69 deaths from the lowest quintile (− 4.58 deaths) to the highest quintile (− 0.89
deaths). A trend of similar magnitude is apparent for TSP, with a difference of 3.75 deaths between the
lowest and highest quintiles (Table VII). For both pollutants, the difference between mean mortality in the
lowest and highest pollution quintiles is statistically significant at the 0.01 level. This finding suggests that
increasing concentrations of ozone and TSP may induce an increase in mortality in Philadelphia when the
weather is not offensive. However, it should be noted that: (i) the difference in mean mortality between
the lowest and highest ozone and TSP quintiles is still considerably less than the high daily mortality
values associated with Philadelphia’s offensive category; (ii) mean mortality values for all pollution
quintiles, even the highest ones, are less than zero and thus below the overall standardized mean for
Philadelphia, and (iii) the relationship between pollution levels and mortality on non-offensive air mass
days is not evident in Birmingham. Thus, although increasing pollution concentrations may have an
impact on acute mortality (during offensive air mass days in Birmingham and non-offensive air mass days
in Philadelphia), the magnitude of this impact appears to be considerably less than that of stressful
weather and the relationship is not consistent between cities.

Table VII. Mortality by ozone and TSP quintiles for non-offensive category days

Pollution Mortality

Concentration N Mean S.D. Minimum Maximum

Birmingham ozone, all categories except 6

0.010–0.045 180 0.12 4.49 −10.93 12.25
0.046–0.056 179 −0.39 4.71 −11.47 11.97
0.057–0.067 188 1.08 4.78 −9.21 14.97
0.068–0.081 182 0.26 4.60 −10.18 14.35
0.082–0.169 184 −0.31 4.23 −11.09 10.79
Birmingham TSP, all categories except 6
16–44 113 −0.87 4.77 −10.84 9.07
45–57 122 −0.19 4.79 −10.93 10.88
58–70 113 1.00 4.34 −9.4 10.53
71–90 116 0.17 4.78 −11.47 12.25
91–244 113 −0.58 4.25 −11.09 14.97
Philadelphia ozone, all categories except 2
0.02–0.05 178 −4.58 11.55 −37 23
0.06–0.06 121 −1.70 12.94 −33 32
0.07–0.08 198 −2.29 11.53 −37 37
0.09–0.10 169 −2.24 13.33 −35 41
0.11–0.22 179 −0.89 12.34 −41 31
Philadelphia TSP, all categories except 2
16–47 161 −3.94 11.11 −33 23
48–58 169 −3.06 12.63 −37 32
59–71 178 −2.82 13.01 −31 37
72–88 167 −1.94 12.16 −31 36
89–172 170 −0.19 12.36 −41 41

Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
894 K.E. SMOYER ET AL.

Additional insight can be gained by comparing descriptive statistics for all days, offensive days, and
non-offensive days in both cities. In Birmingham, it is apparent that, although the offensive category does
not have the highest pollution levels (Table II), it does have higher mean TSP and ozone concentrations
than the remaining non-offensive days (Table VIII). Minimum pollution values are higher for the
offensive category, but the highest ozone and TSP concentrations occurred on non-offensive air mass
days. Philadelphia’s offensive air mass also has higher pollution levels than the remaining non-offensive
days, with the highest TSP concentration occurring when the offensive air mass was present (Table VIII).
These results underscore the difficulty in separating pollution from weather effects. The occurrence of an
offensive air mass at either city thus will likely entail hot and humid weather with elevated TSP and ozone
levels. In Birmingham, the hottest offensive air mass days are expected to have the greatest mortality
impact, although there is evidence that high pollution levels may further contribute to elevated mortality.
In Philadelphia, however, variation in pollution levels in the already highly polluted offensive air mass
does not appear to affect mortality.
The results of our analysis are consistent with past work with a synoptic approach, which found that
stressful weather has a more profound impact on acute human mortality than high concentrations of TSP
and ozone (Kalkstein, 1991). A recent air mass-based study of hospital respiratory admissions and winter
air masses provides additional insight into weather/air quality/human health relationships (McGregor et
al., 1999). This study found that above-average hospital admissions occurred during three winter air
masses, but only two of them had high particulate (PM10) concentrations. These findings, similar to our
results, suggest that some types of weather events may be offensive despite low pollution levels, but that
other air masses with poor air quality also can be associated with elevated human morbidity and
mortality.
Our results suggest that TSP and ozone may have a background impact on mortality when stressful
weather is not present, and this impact should not be ignored. It is, however, clear that an offensive air
mass has the potential to increase human mortality quite sharply in areas where oppressive weather occurs
on an irregular basis. Thus, much of the eastern USA, which is occasionally under the influence of hot,
humid maritime tropical air masses, is vulnerable to increased acute mortality when these air masses are
present. This relationship also extends to southern Ontario and Quebec (Kalkstein and Smoyer, 1993).
It is difficult to ascertain why these results differ significantly from those derived by some other
researchers who believe that certain pollutants, rather than stressful weather, are most responsible for
significant increases in acute human mortality. We suggest that in trying to separate weather from
pollution, other research methods may de-emphasize the impact of weather while possibly exaggerating
the impact of pollutants. For example, rarely has previous research recognized the importance of synoptic
situations, which represent the holistic impact of meteorology upon the human body. Rather, previous
studies have relied on individual meteorological variables or arbitrarily defined temperature and humidity
classes to assess the impact of weather on human mortality. A synoptic evaluation is advantageous as it
combines weather elements into groups or categories that are representative of realistic meteorological
situations at a moment in time (Davis and Kalkstein, 1990; McGregor et al., 1999). A synoptic approach
facilitates analyses of weather’s impact on a variety of environmental variables, since responses to
atmospheric conditions are based on a combination of factors that exist at any given time. It is our
opinion that any attempt to evaluate the impact of individual meteorological elements upon human
mortality is less likely to yield significant results, because it does not simulate the holistic nature of
climate.
Future work will entail using longer mortality and air pollution time series as they become available.
Additionally, TSP, although the only such measure available for the period and cities of record in this
study, is not the best measurement of smaller, and more harmful, particulate matter such as PM10 and
PM2.5. In ongoing work, we are using an air mass-based approach to investigate the weather/air
quality/mortality relationship in selected USA and Canadian cities with longer and more inclusive
records, including PM10 and PM2.5.
Copyright © 2000 Royal Meteorological Society Int. J. Climatol. 20: 881 – 897 (2000)
 Table VIII. Descriptive statistics for offensive and non-offensive category days

Birmingham

Variable All days Offensive category (category 6) days Remaining (non-category 6) days
N=992 (621)a N= 79 (44)a N= 913 (577)a

Mean S.D. Minimum Maximum Mean S.D. Minimum Maximum Mean S.D. Minimum Maximum

Mortality 0.25 4.70 −11.47 20.35 1.27 5.81 −8.21 20.35 0.16 4.59 −11.47 14.97

Copyright © 2000 Royal Meteorological Society

MaxTem 30.89 3.10 19.44 41.11 35.02 2.44 27.78 41.11 30.53 2.89 19.44 37.78
MinTem 21.35 2.52 8.33 28.33 23.45 1.82 19.44 28.33 21.17 2.50 8.33 26.67
MaxDpt 21.35 2.36 8.89 26.11 22.70 1.21 19.44 26.11 21.23 2.40 8.89 25.56
MinDpt 18.62 2.91 1.11 23.33 19.85 1.68 16.11 22.78 18.51 2.96 1.11 23.33
CCPM 6.27 2.73 0 10 4.75 2.19 0 9 6.41 2.74 0 10
WSPM 7.36 2.70 0 25 8.47 2.51 4 15 7.27 2.70 0 25
TSP 70.26 31.86 16 244 83.75 28.76 38 161 69.23 31.87 16 244
Ozone 0.065 0.024 0.010 0.169 0.072 0.023 0.023 0.157 0.065 0.024 0.010 0.169
Philadelphia
All days Offensive category (category 2) days Remaining (non-category 2) days
N=953 N=108 N= 845

Mortality −1.27 12.97 −41 62 7.43 14.59 −21 62 −2.38 12.33 −41 41
MaxTem 27.57 3.39 14.44 36.11 31.87 1.72 27.78 36.11 27.02 3.14 14.44 35.00
MinTem 19.75 3.17 7.78 27.22 23.06 1.52 20.00 27.22 19.33 3.07 7.78 26.67
MaxDpt 18.50 4.10 1.11 26.11 22.28 1.55 18.89 26.11 18.02 4.08 1.11 25.00
WEATHER, POLLUTION AND HUMAN MORTALITY

MinDpt 14.93 4.63 −2.22 24.89 19.35 2.10 18.89 23.89 14.37 4.57 −2.22 23.33
CCPM 5.59 3.66 0 10 4.07 3.19 0 10 5.79 3.68 0 10
WSPM 8.27 3.23 0 20 8.54 2.68 3 17.01 8.23 3.29 0 20
TSP 71.55 25.44 16 189 93.37 25.96 43 189 68.77 23.99 16 172
Ozone 0.085 0.033 0.020 0.220 0.108 0.029 0.030 0.200 0.082 0.033 0.020 0.220
a
Number of days with non-missing TSP data. Descriptive statistics for TSP based on values for these days.

Int. J. Climatol. 20: 881 – 897 (2000)

895
896 K.E. SMOYER ET AL.

5. CONCLUSION

The results suggest that in summer, weather strongly affects acute mortality in both Philadelphia and
Birmingham, as demonstrated by the existence of an offensive synoptic category for each city. The impact
of TSP and ozone on acute mortality appears to be less important than weather, although the relationship
among weather, these two pollutants, and mortality appear to differ in the two cities. In Birmingham,
there is evidence that high TSP and ozone concentrations may contribute to elevated mortality when an
offensive weather event is present, yet in the absence of an offensive air mass, no relationship between
pollution and mortality is evident. In Philadelphia, the relationship is reversed. Pollution does not appear
to contribute a significant mortality add-on effect on offensive air mass days in this city, while when
oppressive meteorological conditions are absent, high TSP and ozone concentrations appear to contribute
to some increases in acute mortality.
These findings should not be interpreted to mean that air pollution has a minimal negative impact on
human health. Without doubt, the long-term additive effects of air pollution could eventually lead to
shortened life expectancy and a variety of illnesses, and the economic value of avoiding these effects could
be large. It is also possible that air pollution can have a large effect on acute mortality in countries where
pollution controls are lax. These results should alert environmental policy makers to the need to
emphasize further the impact of stressful weather on human health. Pollution and its impact on human
health have justifiably garnered considerable attention, but efforts to understand the potentially enormous
impacts of weather on human health should be increased. It may be argued that something can be done
about reducing pollution while little can be done about ameliorating the weather, but the development of
weather watch-warning systems and appropriate public health planning have the potential for preventing
many excess deaths.

ACKNOWLEDGEMENTS

The authors would like to express their appreciation to the anonymous manuscript reviewers for their
helpful comments as well as to the numerous individuals who contributed significantly to this manuscript.
David Barthel, Michael Nichols, Paul Jamason, Shouquan Cheng, Deborah Mills, and Joan Hahn
provided invaluable technical and moral support, and their efforts are greatly appreciated. This research
was sponsored by the US Environmental Protection Agency under Cooperative Agreement number
CR-817693.

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