Association between long-term exposure to air pollution and cause-specific mortality within five Italian longitudinal metropolitan studies

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/m 3 of PM 10, 1 μg/m 3 of PM 2.5 and 10 μg/m 3 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. • 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.

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Journal
Atmospheric Environment
Published
2024-10-17
DOI
https://doi.org/10.1016/j.atmosenv.2024.120873
Citations
1
Primary Topic
Air Quality and Health Impacts
Type
article
Field-Weighted Citation Impact
0.31

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Association between long-term exposure to air pollution and cause-specific mortality within five Italian longitudinal metropolitan studies

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article

Association between long-term exposure to air pollution and cause-specific mortality within five Italian longitudinal metropolitan studies

Giovanni Viegi, Nicolàs Zengarini, Lorena Torroni, Claudio Gariazzo, Lisa Bauleo, Pierpaolo Marchetti, Giulia Cesaroni, G. Tinarelli, Achille Cernigliaro, Andrea Ranzi, Lucia Bisceglia, Alessandro Marinaccio, Sofia Tagliaferro, Stefania La Grutta, Paola Michelozzi, Salvatore Scondotto, Camillo Silibello, Sara Maio, Ida Galise, Elena Strippoli, Federica Nobile, Massimo Stafoggia, Stefania Massari, Jessica Miotti, Paolo Giorgi Rossi, Petter Ljungman, Sandra Baldacci, Chiara Di Blasi, Francesca Locatelli, Ilaria Stanisci, Walter Pollina Addario, Alessandro Marcon, Giuseppe Costa, Alessandra Allotta, Claudio Rubino, Marta Ottone, Carla Ancona, Sebastiano Pollina Addario, Giuseppe Verlato, Nicola Caranci, Valentina Adorno, Letizia Bartolini, Matteo Renzi, Salvatore Fasola, Antonio Chieti, Simone Giannini, Maria Serinelli
article en
1 citations

Abstract

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/m 3 of PM 10, 1 μg/m 3 of PM 2.5 and 10 μg/m 3 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. • 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.

Atmospheric EnvironmentVol. 339
Agenzia Regionale per la Protezione Ambientale del Piemonte (IT), Danderyds sjukhus (SE), Karolinska Institutet (SE), Regional Health (US), Istituto di Fisiologia Clinica (IT), Agenzia Regionale Sanitaria della Puglia (IT), Regione Siciliana (IT), Agenzia Regionale Prevenzione e Ambiente della Regione Emilia-Romagna (IT), Istituto Nazionale per l'Assicurazione Contro gli Infortuni sul Lavoro (IT), Agenzia Regionale Parchi (IT), National Research Council (IT), Bitron (Italy) (IT), Azienda Sanitaria Locale Roma 3 (IT)
Istituto Nazionale per l'Assicurazione Contro Gli Infortuni sul Lavoro
Good health and well-being
Openalex Percentile: Top 37%
Air Quality and Health Impacts
0.31
DOIOpen Access PDFOpenAlex
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