Introduction: Outbreaks of Saharan dust have been shown to exacerbate the effect of particulate matter (PM) on mortality. Their role on PM-morbidity association is less clear. This study aims to evaluate the effect of Saharan dust on the PM-hospitalisations association in Rome, Italy.

Methods: We studied residents hospitalised in Rome between 2001 and 2004 and performed a time-series analysis to explore the effects of PM2.5, PM2.5-10 and PM10 on cardiac, cerebrovascular and respiratory emergency hospitalisations, respectively. Saharan dust days were identified by combining Light Detection and Ranging observations and analyses from operational models. We tested a dust-PM interaction to evaluate the hypothesis that the PM effect on hospitalisations would be enhanced on dust days.

Results: We studied 77 354, 26 557 and 31 620 hospitalisations for cardiac, cerebrovascular and respiratory diseases, respectively, providing effect estimates per IQR. PM2.5-10 was associated with cardiac diseases (3.93%; 95% CI 1.58 to 6.34). PM10 was associated with cardiac (3.37%; 95% CI 1.11 to 5.68), cerebrovascular (2.64%; 95% CI 0.06 to 5.29) and respiratory diseases (3.59%: 95% CI 0.18 to 7.12). No effect of PM2.5 was detected. Saharan dust modified the effect of the PM2.5-10 on respiratory hospitalisations, higher during dust days compared with dust-free days (14.63% vs -0.32%; p value of interaction=0.006). Saharan dust also increased the effect of PM10 on cerebrovascular diseases (5.04% vs 0.90%, p value of interaction=0.143).

Discussion: A clear enhanced effect of PM2.5-10 on respiratory diseases and of PM10 on cerebrovascular diseases emerged during Saharan dust outbreaks.