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Background: Epidemiological evidences support the existence of an effect of airborne particulate on population health. However, few studies evaluated the robustness of the results to different exposure assessment approaches. In this paper, we estimated short term effects and impacts of high levels of particulate matter with aerodynamic diameter ≤10 μm (PM 10 ) and ≤2.5 μm (PM 2.5 ) in the Emilia-Romagna region (Northern Italy), one of the most polluted areas in Europe, in the period 2006-2010, and checked if the results changed when different exposure definitions were used., Methods: Short-term impact of particles on population mortality was assessed, both considering the 9 provincial capitals of the Emilia-Romagna and the region as a whole. We estimated the effects of PM 10 and PM 2.5 on natural mortality by combining city-specific results in a Bayesian random-effects meta-analysis, and we used these estimates to calculate impacts in terms of attributable deaths. For PM 10 , we considered different definitions of exposure, based on the use of the air pollutant levels measured by different monitoring stations (background or traffic monitors) or predicted by a dispersion model., Results: Annual average concentrations of PM 10 and PM 2.5 exceeding the WHO limits of 20 and 10 μg/m 3 were respectively responsible for 5.9 and 3.0 deaths per 100 000 inhabitants per year in the provincial capitals, during the period 2006-2010. The total impact in the region in 2010 amounted to 4.4 and 2.8 deaths per 100 000 for PM 10 and PM 2.5 , respectively. The impact estimates for PM 10 did not substantially change when the exposure levels were derived from background or traffic monitoring stations, or arose from the dispersion model, in particular when the counterfactual value of 20 μg/m 3 was considered. The effect estimates appeared more sensitive to the exposure definition., Conclusions: A reduction in particle concentrations could have produced significant health benefits in the region. This general conclusion did not change when different exposure definitions were used, provided that the same exposure assessment approach was used for both effect and impact estimations. Caution is therefore recommended when using effect estimates from the literature to assess health impacts of air pollution in actual contexts.

We performed a multisite study to evaluate demographic and clinical conditions as potential modifiers of the particulate matter (PM)-mortality association. We selected 228,619 natural deaths of elderly persons (ages ≥65 years) that occurred in 12 Italian cities during the period 2006-2010. Individual data on causes of death, age, sex, location of death, and preexisting chronic and acute conditions from the previous 5 years' hospitalizations were collected. City-specific conditional logistic regression models were applied within the case-crossover "time-stratified" framework, followed by random-effects meta-analysis. Particulate matter less than or equal to 2.5 µm in aerodynamic diameter (PM2.5) and particulate matter less than or equal to 10 µm in aerodynamic diameter (PM10) were positively associated with natural mortality (1.05% and 0.74% increases in mortality risk for increments of 10 µg/m3 and 14.4 µg/m3, respectively), with greater effects being seen among older people, those dying out-of-hospital or during the warm season, and those affected by 2 or more chronic diseases. Limited associations were found among persons with no previous hospital admissions. Diabetes (1.98%, 95% confidence interval (CI): 0.54, 3.44) and cardiac arrhythmia (1.65%, 95% CI: 0.37, 2.95) increased risk of PM2.5-related mortality, while heart conduction disorders increased risk of mortality related to both PM2.5 (4.22%, 95% CI: 0.15, 8.46) and PM10 (4.19%, 95% CI: 0.38, 8.14). Among acute conditions, recent hospital discharge for heart failure modified the PM10-mortality association. The study found increases in natural mortality from PM exposure among people with chronic morbidity; diabetes and cardiac disorders were the main susceptibility factors.

Background: Evidence on the association between short-term exposure to desert dust and health outcomes is controversial., Objectives: We aimed to estimate the short-term effects of particulate matter ≤ 10 μm (PM10) on mortality and hospital admissions in 13 Southern European cities, distinguishing between PM10 originating from the desert and from other sources., Methods: We identified desert dust advection days in multiple Mediterranean areas for 2001-2010 by combining modeling tools, back-trajectories, and satellite data. For each advection day, we estimated PM10 concentrations originating from desert, and computed PM10 from other sources by difference. We fitted city-specific Poisson regression models to estimate the association between PM from different sources (desert and non-desert) and daily mortality and emergency hospitalizations. Finally, we pooled city-specific results in a random-effects meta-analysis., Results: On average, 15% of days were affected by desert dust at ground level (desert PM10 > 0 μg/m3). Most episodes occurred in spring-summer, with increasing gradient of both frequency and intensity north-south and west-east of the Mediterranean basin. We found significant associations of both PM10 concentrations with mortality. Increases of 10 μg/m3 in non-desert and desert PM10 (lag 0-1 days) were associated with increases in natural mortality of 0.55% (95% CI: 0.24, 0.87%) and 0.65% (95% CI: 0.24, 1.06%), respectively. Similar associations were estimated for cardio-respiratory mortality and hospital admissions., Conclusions: PM10 originating from the desert was positively associated with mortality and hospitalizations in Southern Europe. Policy measures should aim at reducing population exposure to anthropogenic airborne particles even in areas with large contribution from desert dust advections., Citation: Stafoggia M, Zauli-Sajani S, Pey J, Samoli E, Alessandrini E, Basagaña X, Cernigliaro A, Chiusolo M, Demaria M, Díaz J, Faustini A, Katsouyanni K, Kelessis AG, Linares C, Marchesi S, Medina S, Pandolfi P, Pérez N, Querol X, Randi G, Ranzi A, Tobias A, Forastiere F, MED-PARTICLES Study Group. 2016. Desert dust outbreaks in Southern Europe: contribution to daily PM10 concentrations and short-term associations with mortality and hospital admissions. Environ Health Perspect 124:413-419; http://dx.doi.org/10.1289/ehp.1409164.

Background: Epidemiological evidences support the existence of an effect of airborne particulate on population health. However, few studies evaluated the robustness of the results to different exposure assessment approaches. In this paper, we estimated short term effects and impacts of high levels of particulate matter with aerodynamic diameter ≤10 μm (PM10) and ≤2.5 μm (PM2.5) in the Emilia-Romagna region (Northern Italy), one of the most polluted areas in Europe, in the period 2006-2010, and checked if the results changed when different exposure definitions were used.Methods: Short-term impact of particles on population mortality was assessed, both considering the 9 provincial capitals of the Emilia-Romagna and the region as a whole. We estimated the effects of PM10 and PM2.5 on natural mortality by combining city-specific results in a Bayesian random-effects meta-analysis, and we used these estimates to calculate impacts in terms of attributable deaths. For PM10, we considered different definitions of exposure, based on the use of the air pollutant levels measured by different monitoring stations (background or traffic monitors) or predicted by a dispersion model.Results: Annual average concentrations of PM10 and PM2.5 exceeding the WHO limits of 20 and 10 μg/m3 were respectively responsible for 5.9 and 3.0 deaths per 100 000 inhabitants per year in the provincial capitals, during the period 2006-2010. The total impact in the region in 2010 amounted to 4.4 and 2.8 deaths per 100 000 for PM10 and PM2.5, respectively. The impact estimates for PM10 did not substantially change when the exposure levels were derived from background or traffic monitoring stations, or arose from the dispersion model, in particular when the counterfactual value of 20 μg/m3 was considered. The effect estimates appeared more sensitive to the exposure definition.Conclusions: A reduction in particle concentrations could have produced significant health benefits in the region. This general conclusion did not change when different exposure definitions were used, provided that the same exposure assessment approach was used for both effect and impact estimations. Caution is therefore recommended when using effect estimates from the literature to assess health impacts of air pollution in actual contexts. [ABSTRACT FROM AUTHOR]

We performed a multisite study to evaluate demographic and clinical conditions as potential modifiers of the particulate matter (PM)--mortality association. We selected 228,619 natural deaths of elderly persons (ages ≥65 years) that occurred in 12 Italian cities during the period 2006-2010. Individual data on causes of death, age, sex, location of death, and preexisting chronic and acute conditions from the previous 5 years' hospitalizations were collected. City-specific conditional logistic regression models were applied within the case-crossover "timestratified" framework, followed by random-effects meta-analysis. Particulate matter less than or equal to 2.5 µm in aerodynamic diameter (PM2.5) and particulate matter less than or equal to 10 µm in aerodynamic diameter (PM10) were positively associated with natural mortality (1.05% and 0.74% increases in mortality risk for increments of 10 µg/m³ and 14.4 µg/m³, respectively), with greater effects being seen among older people, those dying out-of-hospital or during the warm season, and those affected by 2 or more chronic diseases. Limited associations were found among persons with no previous hospital admissions. Diabetes (1.98%, 95% confidence interval (CI): 0.54, 3.44) and cardiac arrhythmia (1.65%, 95% CI: 0.37, 2.95) increased risk of PM2.5-related mortality, while heart conduction disorders increased risk of mortality related to both PM2.5 (4.22%, 95% CI: 0.15, 8.46) and PM10 (4.19%, 95% CI: 0.38, 8.14). Among acute conditions, recent hospital discharge for heart failure modified the PM10-mortality association. The study found increases in natural mortality from PM exposure among people with chronic morbidity; diabetes and cardiac disorders were the main susceptibility factors. [ABSTRACT FROM AUTHOR]

Background: Several studies have been conducted on the possible health effects for people living close to incinerators and well-conducted reviews are available. Nevertheless, several uncertainties limit the overall interpretation of the findings. We evaluated the health effects of emissions from two incinerators in a pilot cohort study.Methods: The study area was defined as the 3.5 km radius around two incinerators located near Forlì (Italy). People who were residents in 1/1/1990, or subsequently became residents up to 31/12/2003, were enrolled in a longitudinal study (31,347 individuals). All the addresses were geocoded. Follow-up continued until 31/12/2003 by linking the mortality register, cancer registry and hospital admissions databases. Atmospheric Dispersion Model System (ADMS) software was used for exposure assessment; modelled concentration maps of heavy metals (annual average) were considered the indicators of exposure to atmospheric pollution from the incinerators, while concentration maps of nitrogen dioxide (NO2) were considered for exposure to other pollution sources. Age and area-based socioeconomic status adjusted rate ratios and 95% Confidence Intervals were estimated with Poisson regression, using the lowest exposure category to heavy metals as reference.Results: The mortality and morbidity experience of the whole cohort did not differ from the regional population. In the internal analysis, no association between pollution exposure from the incinerators and all-cause and cause-specific mortality outcomes was observed in men, with the exception of colon cancer. Exposure to the incinerators was associated with cancer mortality among women, in particular for all cancer sites (RR for the highest exposure level = 1.47, 95% CI: 1.09, 1.99), stomach, colon, liver and breast cancer. No clear trend was detected for cancer incidence. No association was found for hospitalizations related to major diseases. NO2 levels, as a proxy from other pollution sources (traffic in particular), did not exert an important confounding role.Conclusions: No increased risk of mortality and morbidity was found in the entire area. The internal analysis of the cohort based on dispersion modeling found excesses of mortality for some cancer types in the highest exposure categories, especially in women. The interpretation of the findings is limited given the pilot nature of the study. [ABSTRACT FROM AUTHOR]

Extensive epidemiological literature has documented adverse effects of ambient air pollution on human health. However, in Italy, no multicenter longitudinal studies on chronic exposure to air pollution and mortality have been conducted. Within the BIGEPI project, we aimed to investigate the association between long-term exposure to air pollution and cause-specific mortality in large Italian population-based cohorts. Five administrative cohorts from Turin, Bologna, Rome, Taranto, and Brindisi (Italy) were included. Subjects aged 30+ were enrolled from the 2011 Census, followed-up until 2018 (2019 for Bologna), and linked with population and health registries. Annual mean concentrations of particulate matter ≤10 and 2.5 μm (PM 10 and PM 2.5), dioxide nitrogen (NO 2), and warm-season ozone (O 3w) were assigned to each participant's geocoded residential address at baseline. Long-term associations between pollutants and non-accidental, cardiovascular, and respiratory mortality were investigated through single- and two-pollutant Cox proportional hazard models. Effect modification by sex and age was tested. Cohort-specific estimates were pooled in a random-effects meta-analysis. 2,709,903 subjects (contributing over 18 million person-years) generated 266,821 non-accidental deaths. Each increment of 5 μg/m3 of PM 10, 1 μg/m3 of PM 2.5 and 10 μg/m3 of NO 2 was associated with an increased risk of non-accidental mortality, with pooled Hazard Ratios (HR) of 1.018 (95% CI: 1.005–1.030), 1.004 (95% CI: 1.001–1.007) and 1.010 (95% CI: 1.002–1.018), respectively. HRs for cardiovascular and respiratory mortality were higher, the latter with CIs including the null. The associations remained quite stable after adjustment for the other pollutants. O 3w was negatively associated with mortality but estimates were not statistically significant and reduced to unity upon adjustment for NO 2. No consistent statistically significant effect modifications by sex and age emerged. Updated evidence implicates a continued risk of mortality in Italy due to long-term air pollution exposure, despite declining levels of exposure during the last years. [Display omitted] • First Italian multicenter longitudinal metropolitan study on air pollution and mortality. • Standardized protocols and fine-scale air pollution exposures. • PM and NO 2 were associated with higher risks of cause-specific mortality outcomes. • Air pollutant adverse effects did not change when adjusted for co-pollutants. • Despite declining air pollution levels, mortality effects remain consistently high. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the short-term effects of particles with aerodynamic diameter less than 2.5μm (PM2.5), between 2.5 and 10μm (PM2.5–10) and less than 10μm (PM10) on deaths from diabetes, cardiac and cerebrovascular causes, lower respiratory tract infections (LRTI) and chronic obstructive pulmonary disease (COPD) in 10 European Mediterranean metropolitan areas participating in the MED-PARTICLES project during 2001–2010. In the first stage of the analysis, data from each city were analyzed separately using Poisson regression models, whereas in the second stage, the city-specific air pollution estimates were combined to obtain overall estimates. We investigated the effects following immediate (lags 0–1), delayed (lags 2–5) and prolonged exposure (lags 0–5) and effect modification patterns by season. We evaluated the sensitivity of our results to co-pollutant exposures or city-specific model choice. We applied threshold models to investigate the pattern of selected associations. For a 10μg/m3 increase in two days' PM2.5 exposure there was a 1.23% (95% confidence interval (95% CI): −1.63%, 4.17%) increase in diabetes deaths, while six days' exposure statistically significantly increased cardiac deaths by 1.33% (95% CI: 0.27, 2.40%), COPD deaths by 2.53% (95% CI: −0.01%, 5.14%) and LRTI deaths by 1.37% (95% CI: −1.94%, 4.78%). PM2.5 results were robust to co-pollutant adjustments and alternative modeling approaches. Stronger effects were observed in the warm season. Coarse particles displayed positive, even if not statistically significant, associations with mortality due to diabetes and cardiac causes that were more variable depending on exposure period, co-pollutant and seasonality adjustment. Our findings provide support for positive associations between PM2.5 and mortality due to diabetes, cardiac causes, COPD, and to a lesser degree to cerebrovascular causes, in the European Mediterranean region, which seem to drive the particles short-term health effects. [Copyright &y& Elsevier]