Few European studies have investigated the effects of long-term exposure to both fine particulate matter (≤ 2.5 µm; PM2.5) and nitrogen dioxide (NO2) on mortality.
We studied the association of ...exposure to NO2, PM2.5, and traffic indicators on cause-specific mortality to evaluate the form of the concentration-response relationship.
We analyzed a population-based cohort enrolled at the 2001 Italian census with 9 years of follow-up. We selected all 1,265,058 subjects ≥ 30 years of age who had been living in Rome for at least 5 years at baseline. Residential exposures included annual NO2 (from a land use regression model) and annual PM2.5 (from a Eulerian dispersion model), as well as distance to roads with > 10,000 vehicles/day and traffic intensity. We used Cox regression models to estimate associations with cause-specific mortality adjusted for individual (sex, age, place of birth, residential history, marital status, education, occupation) and area (socioeconomic status, clustering) characteristics.
Long-term exposures to both NO2 and PM2.5 were associated with an increase in nonaccidental mortality hazard ratio (HR) = 1.03 (95% CI: 1.02, 1.03) per 10-µg/m3 NO2; HR = 1.04 (95% CI: 1.03, 1.05) per 10-µg/m3 PM2.5. The strongest association was found for ischemic heart diseases (IHD) HR = 1.10 (95% CI: 1.06, 1.13) per 10-µg/m3 PM2.5, followed by cardiovascular diseases and lung cancer. The only association showing some deviation from linearity was that between NO2 and IHD. In a bi-pollutant model, the estimated effect of NO2 on mortality was independent of PM2.5.
This large study strongly supports an effect of long-term exposure to NO2 and PM2.5 on mortality, especially from cardiovascular causes. The results are relevant for the next European policy decisions regarding air quality.
Health effects of air pollution, especially particulate matter (PM), have been widely investigated. However, most of the studies rely on few monitors located in urban areas for short-term ...assessments, or land use/dispersion modelling for long-term evaluations, again mostly in cities. Recently, the availability of finely resolved satellite data provides an opportunity to estimate daily concentrations of air pollutants over wide spatio-temporal domains. Italy lacks a robust and validated high resolution spatio-temporally resolved model of particulate matter. The complex topography and the air mixture from both natural and anthropogenic sources are great challenges difficult to be addressed. We combined finely resolved data on Aerosol Optical Depth (AOD) from the Multi-Angle Implementation of Atmospheric Correction (MAIAC) algorithm, ground-level PM10 measurements, land-use variables and meteorological parameters into a four-stage mixed model framework to derive estimates of daily PM10 concentrations at 1-km2 grid over Italy, for the years 2006–2012. We checked performance of our models by applying 10-fold cross-validation (CV) for each year. Our models displayed good fitting, with mean CV-R2=0.65 and little bias (average slope of predicted VS observed PM10=0.99). Out-of-sample predictions were more accurate in Northern Italy (Po valley) and large conurbations (e.g. Rome), for background monitoring stations, and in the winter season. Resulting concentration maps showed highest average PM10 levels in specific areas (Po river valley, main industrial and metropolitan areas) with decreasing trends over time. Our daily predictions of PM10 concentrations across the whole Italy will allow, for the first time, estimation of long-term and short-term effects of air pollution nationwide, even in areas lacking monitoring data.
•Estimates of air pollution levels at fine spatiotemporal scale are lacking in Italy•We combined satellite data with land use variables and ground-level PM10 measurements•We estimated daily PM10 concentrations at a 1-km2 grid over Italy, 2006-2012•Our model displayed good cross-validation fitting (R2=0.65) and negligible bias•Spatiotemporal predictions will allow estimation of short and long term health effects of PM10
Land Use Regression models (LUR) are useful to estimate the spatial variability of air pollution in urban areas. Few studies have evaluated the stability of spatial contrasts in outdoor nitrogen ...dioxide (NO₂) concentration over several years. We aimed to compare measured and estimated NO₂ levels 12 years apart, the stability of the exposure estimates for members of a large cohort study, and the association of the exposure estimates with natural mortality within the cohort.
We measured NO₂ at 67 locations in Rome in 1995/96 and 78 sites in 2007, over three one-week-long periods. To develop LUR models, several land-use and traffic variables were used. NO₂ concentration at each residential address was estimated for a cohort of 684,000 adults. We used Cox regression to analyze the association between the two estimated exposures and mortality.
The mean NO₂ measured concentrations were 45.4 μg/m³ (SD 6.9) in 1995/96 and 44.6 μg/m³ (SD 11.0) in 2007, respectively. The correlation of the two measurements was 0.79. The LUR models resulted in adjusted R2 of 0.737 and 0.704, respectively. The correlation of the predicted exposure values for cohort members was 0.96. The association of each 10 μg/m³ increase in NO₂ with mortality was 6 % for 1995/96 and 4 % for 2007 LUR models. The increased risk per an inter-quartile range change was identical (4 %, 95 % CI:3-6 %) for both estimates of NO₂.
Measured and predicted NO₂ values from LUR models, from samples collected 12 years apart, had good agreement, and the exposure estimates were similarly associated with mortality in a large cohort study.
•Environmental risks in urban areas are important determinants of population health.•Multiple environmental dimensions were integrated in a composite spatial indicator.•56% of Rome residents live in ...areas with high-very high environmental vulnerability.•The highest environmental and climatic vulnerability was found in the city centre.•There are some spatial clusters with both environmental and social vulnerability in the eastern area of Rome.
Urban areas are disproportionately affected by multiple pressures from overbuilding, traffic, air pollution, and heat waves that often interact and are interconnected in producing health effects. A new synthetic tool to summarize environmental and climatic vulnerability has been introduced for the city of Rome, Italy, to provide the basis for environmental and health policies.
From a literature overview and based on the availability of data, several macro-dimensions were identified on 1,461 grid cells with a width of 1 km2 in Rome: land use, roads and traffic-related exposure, green space data, soil sealing, air pollution (PM2.5, PM10, NO2, C6H6, SO2), urban heat island intensity. The Geographically Weighted Principal Component Analysis (GWPCA) method was performed to produce a composite spatial indicator to describe and interpret each spatial feature by integrating all environmental dimensions. The method of natural breaks was used to define the risk classes. A bivariate map of environmental and social vulnerability was described.
The first three components explained most of the variation in the data structure with an average of 78.2% of the total percentage of variance (PTV) explained by the GWPCA, with air pollution and soil sealing contributing most in the first component; green space in the second component; road and traffic density and SO2 in the third component. 56% of the population lives in areas with high or very high levels of environmental and climatic vulnerability, showing a periphery-centre trend, inverse to the deprivation index.
A new environmental and climatic vulnerability indicator for the city of Rome was able to identify the areas and population at risk in the city, and can be integrated with other vulnerability dimensions, such as social deprivation, providing the basis for risk stratification of the population and for the design of policies to address environmental, climatic and social injustice.
Recent epidemiological research suggests that near road traffic-related pollution may cause chronic disease, as well as exacerbation of related pathologies, implying that the entire "chronic disease ...progression" should be attributed to air pollution, no matter what the proximate cause was. We estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of 1) asthma caused by near road traffic-related pollution, and 2) acute asthma events related to urban air pollution levels. We then expanded our approach to include coronary heart diseases in adults. Derivation of attributable cases required combining concentration-response function between exposures and the respective health outcome of interest (obtained from published literature), an estimate of the distribution of selected exposures in the target population, and information about the frequency of the assessed morbidities. Exposure to roads with high vehicle traffic, a proxy for near road traffic-related pollution, accounted for 14% of all asthma cases. When a causal relationship between near road traffic-related pollution and asthma is assumed, 15% of all episodes of asthma symptoms were attributable to air pollution. Without this assumption, only 2% of asthma symptoms were attributable to air pollution. Similar patterns were found for coronary heart diseases in older adults. Pollutants along busy roads are responsible for a large and preventable share of chronic disease and related acute exacerbations in European urban areas.
ObjectivesFew studies have assessed the effects of policies aimed to reduce traffic-related air pollution. The aims of this study were to evaluate the impact, in terms of air quality and health ...effects, of two low-emission zones established in Rome in the period 2001–2005 and to assess the impact by socioeconomic position (SEP) of the population.MethodsWe evaluated the effects of the intervention on various stages in the full-chain model, that is, pressure (number and age distribution of cars), emissions, PM10 and NO2 concentrations, population exposure and years of life gained (YLG). The impact was evaluated according to a small-area indicator of SEP.ResultsDuring the period 2001–2005, there was a decrease in the total number of cars (−3.8%), NO2 and PM10 emissions and concentrations (from 22.9 to 17.4 μg/m3 for NO2 and from 7.8 to 6.2 μg/m3 for PM10), and in the residents' exposure. In the two low-emission zones, there was an additional decrease in air pollution concentrations (NO2: −4.13 and −2.99 μg/m3; PM10: −0.70 and −0.47 μg/m3). As a result of the policy, 264 522 residents living along busy roads gained 3.4 days per person (921 YLG per 100 000) for NO2 reduction. The gain was larger for people in the highest SEP group (1387 YLG per 100 000) than for residents in the lowest SEP group (340 YLG per 100 000).ConclusionThe traffic policy in Rome was effective in reducing traffic-related air pollution, but most of the health gains were found in well-off residents.
Chipboard production is a source of ambient air pollution. We assessed the spatial variability of outdoor pollutants and residential exposure of children living in proximity to the largest chipboard ...industry in Italy and evaluated the reliability of exposure estimates obtained from a number of available models. We obtained passive sampling data on NO
2
and formaldehyde collected by the Environmental Protection Agency of Lombardy region at 25 sites in the municipality of Viadana during 10 weeks (2017–2018) and compared NO
2
measurements with average weekly concentrations from continuous monitors. We compared interpolated NO
2
and formaldehyde surfaces with previous maps for 2010. We assessed the relationship between residential proximity to the industry and pollutant exposures assigned using these maps, as well as other available countrywide/continental models based on routine data on NO
2
, PM
10
, and PM
2.5
. The correlation between NO
2
concentrations from continuous and passive sampling was high (Pearson’s
r
= 0.89), although passive sampling underestimated NO
2
especially during winter. For both 2010 and 2017–2018, we observed higher NO
2
and formaldehyde concentrations in the south of Viadana, with hot-spots in proximity to the industry. PM
10
and PM
2.5
exposures were higher for children at < 1 km compared to the children living at > 3.5 km to the industry, whereas NO
2
exposure was higher at 1–1.7 km to the industry. Road and population densities were also higher close to the industry. Findings from a variety of exposure models suggest that children living in proximity to the chipboard industry in Viadana are more exposed to air pollution and that exposure gradients are relatively stable over time.
Background Ambient air pollution has been consistently associated with exacerbation of respiratory diseases in schoolchildren, but the role of early exposure to traffic-related air pollution in the ...first occurrence of respiratory symptoms and asthma is not yet clear. Methods We assessed the association between indexes of exposure to traffic-related air pollution during different periods of life and respiratory outcomes in a birth cohort of 672 newborns (Rome, Italy). Direct interviews of the mother were conducted at birth and at 6, 15 months, 4 and 7 years. Exposure to traffic-related air pollution was assessed for each residential address during the follow-up period using a Land-Use Regression model (LUR) for nitrogen dioxide (NO2) and a Geographic Information System (GIS) variable of proximity to high-traffic roads (HTR) (>10 000vehicles/day). We used age-specific NO2 levels to develop indices of exposure at birth, current, and lifetime time-weighted average. The association of NO2 and traffic proximity with respiratory disorders were evaluated using logistic regression in a longitudinal approach (Generalised Estimating Equation). The exposure indexes were used as continuous and categorical variables (cut-off points based on the 75th percentile for NO2 and the 25th percentile for distance from HTRs). Results The average NO2 exposure level at birth was 37.2 μg/m3 (SD 7.2, 10–90th range 29.2–46.1). There were no statistical significant associations between the exposure indices and the respiratory outcomes in the longitudinal model. The odds ratios for a 10-µg/m3 increase in time-weighted average NO2 exposure were: asthma incidence OR=1.09; 95 CI% 0.78 to 1.52, wheezing OR=1.07; 95 CI% 0.90 to 1.28, shortness of breath with wheezing OR=1.16; 95 CI% 0.94 to 1.43, cough or phlegm apart from cold OR=1.11; 95 CI% 0.92 to 1.33, and otitis OR=1.08; 95 CI% 0.89 to 1.32. Stronger but not significant associations were found considering the 75th percentile of the NO2 distribution as a cut-off, especially for incidence of asthma and prevalence of wheeze (OR=1.41; 95 CI% 0.88 to 2.28 and OR=1.27; 95 CI% 0.95 to 1.70, respectively); the highest OR was found for wheezing (OR=2.29; 95 CI% 1.15 to 4.56) at the 7-year follow-up. No association was found with distance from HTRs. Conclusions Exposure to traffic-related air pollution is only weakly associated with respiratory symptoms in young children in the first 7 years of life.
Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely unknown. We conducted a health impact assessment of landfilling and ...incineration in three European countries: Italy, Slovakia and England.
A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km of an incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined with air pollution dispersion modelling for particulate matter (PM10) and nitrogen dioxide (NO2). For incinerators, we estimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributable cases of congenital anomalies and low birth weight infants.
About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England, respectively. The additional contribution to NO2 levels within a 3 km radius was 0.23, 0.15, and 0.14 μg/m3, respectively. Lower values were found for PM10. Assuming that the incinerators continue to operate until 2020, we are moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0, and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, the attributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. The total exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderately confident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3 whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively.
The current health impacts of landfilling and incineration can be characterized as moderate when compared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact on public health. There are several uncertainties and critical assumptions in the assessment model, but it provides insight into the relative health impact attributable to waste management.
Subjects living close to high traffic roads (HTR) are more likely to suffer from air-pollution related morbidity and mortality. The issue has large public health consequences but few studies have ...described the main socio-demographic characteristics of people exposed to traffic.
To characterise a large cohort of residents in Rome according to different measures of traffic exposure, socioeconomic position (SEP), and baseline health status.
Residents of Rome in October 2001 were selected. Individual and area-based SEP indices were available. GIS was used to obtain traffic indicators at residential addresses: distance from HTR (> = 10,000 vehicles/day), length of HTR, average daily traffic count, and traffic density within 150 meters of home. Hospitalisations in the 5-year period before enrolment were used to characterise health status. Logistic and linear regression analyses estimated the association between traffic exposure and socio-demographic characteristics.
We selected 1,898,898 subjects with complete SEP information and GIS traffic indicators. A total of 320,913 individuals (17%) lived within 50 meters of an HTR, and 14% lived between 50 and 100 meters. These proportions were higher among 75+ year-old subjects. Overall, all traffic indicators were directly associated with SEP, with people living in high or medium SEP areas or with a university degree more likely to be exposed to traffic than people living in low SEP areas or with a low level of education. However, an effect modification by area of residence within the city was seen and the association between traffic and SEP was reversed in the city centre.
A large section of the population is exposed to traffic in Rome. Elderly people and those living in areas of high and medium SEP tend to be more exposed. These findings are related to the historical stratification of the population within the city according to age and socioeconomic status.
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