Publications by authors named "Massimo Stafoggia"

145 Publications

A multi-step machine learning approach to assess the impact of COVID-19 lockdown on NO attributable deaths in Milan and Rome, Italy.

Environ Health 2022 01 16;21(1):17. Epub 2022 Jan 16.

Department of Epidemiology, Lazio Regional Health Service/ASL, Roma 1, Via C. Colombo 112, 00147, Rome, Italy.

Background: Air pollution is one of the main concerns for the health of European citizens, and cities are currently striving to accomplish EU air pollution regulation. The 2020 COVID-19 lockdown measures can be seen as an unintended but effective experiment to assess the impact of traffic restriction policies on air pollution. Our objective was to estimate the impact of the lockdown measures on NO concentrations and health in the two largest Italian cities.

Methods: NO concentration datasets were built using data deriving from a 1-month citizen science monitoring campaign that took place in Milan and Rome just before the Italian lockdown period. Annual mean NO concentrations were estimated for a lockdown scenario (Scenario 1) and a scenario without lockdown (Scenario 2), by applying city-specific annual adjustment factors to the 1-month data. The latter were estimated deriving data from Air Quality Network stations and by applying a machine learning approach. NO spatial distribution was estimated at a neighbourhood scale by applying Land Use Random Forest models for the two scenarios. Finally, the impact of lockdown on health was estimated by subtracting attributable deaths for Scenario 1 and those for Scenario 2, both estimated by applying literature-based dose-response function on the counterfactual concentrations of 10 μg/m.

Results: The Land Use Random Forest models were able to capture 41-42% of the total NO variability. Passing from Scenario 2 (annual NO without lockdown) to Scenario 1 (annual NO with lockdown), the population-weighted exposure to NO for Milan and Rome decreased by 15.1% and 15.3% on an annual basis. Considering the 10 μg/m counterfactual, prevented deaths were respectively 213 and 604.

Conclusions: Our results show that the lockdown had a beneficial impact on air quality and human health. However, compliance with the current EU legal limit is not enough to avoid a high number of NO attributable deaths. This contribution reaffirms the potentiality of the citizen science approach and calls for more ambitious traffic calming policies and a re-evaluation of the legal annual limit value for NO for the protection of human health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12940-021-00825-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761378PMC
January 2022

Air pollution as a risk factor for Cognitive Impairment no Dementia (CIND) and its progression to dementia: A longitudinal study.

Environ Int 2022 Jan 12;160:107067. Epub 2022 Jan 12.

Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.

Background And Aim: Accumulation of evidence has raised concern regarding the harmful effect of air pollution on cognitive function, but results are diverging. We aimed to investigate the longitudinal association of long-term exposure to air pollutants and cognitive impairment and its further progression to dementia in older adults residing in an urban area.

Methods: Data were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Cognitive impairment, no dementia (CIND) was assessed by a comprehensive neuropsychological battery (scoring ≥1.5 standard deviations below age-specific means in ≥1 cognitive domain). We assessed long-term residential exposure to particulate matters (PM and PM) and nitrogen oxides (NO) with dispersion modeling. The association with CIND was estimated using Cox proportional hazards models with 3-year moving average air pollution exposure. We further estimated the effect of long-term air pollution exposure on the progression of CIND to dementia using Cox proportional hazards models.

Results: Among 1987 cognitively intact participants, 301 individuals developed CIND during the 12-year follow-up. A 1-μg/m increment in PM exposure was associated with a 75% increased risk of incident CIND (HR = 1.75, 95 %CI: 1.54, 1.99). Weaker associations were found for PM (HR for 1-μg/m = 1.08, 95 %CI: 1.03-1.14) and NO (HR for 10 μg/m = 1.18, 95 %CI: 1.04-1.33). Among those with CIND at baseline (n = 607), 118 participants developed dementia during follow-up. Results also show that exposure to air pollution was a risk factor for the conversion from CIND to dementia (PM: HR for 1-μg/m = 1.90, 95 %CI: 1.48-2.43; PM: HR for 1-μg/m = 1.14, 95 %CI: 1.03-1.26; and NO: HR for 10 μg/m = 1.34, 95 %CI: 1.07-1.69).

Conclusion: We found evidence of an association between long-term exposure to ambient air pollutants and incidence of CIND. Of special interest is that air pollution also was a risk factor for the progression from CIND to dementia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2021.107067DOI Listing
January 2022

Long-term exposure to low ambient air pollution concentrations and mortality among 28 million people: results from seven large European cohorts within the ELAPSE project.

Lancet Planet Health 2022 Jan;6(1):e9-e18

Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.

Background: Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE).

Methods: In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000-11; follow-up until 2011-17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM), nitrogen dioxide (NO), black carbon, and tropospheric warm-season ozone (O) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis.

Findings: We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM, NO, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m increment in PM, 1·044 (1·019-1·069) per 10 μg/m NO, and 1·039 (1·018-1·059) per 0·5 × 10/m black carbon. Associations with PM, NO, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM (10 μg/m) and NO (40 μg/m) were 1·078 (1·046-1·111) per 5 μg/m PM and 1·049 (1·024-1·075) per 10 μg/m NO. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032-1·092) for exposure lower than 1·5× 10/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10/m.

Interpretation: Long-term exposure to concentrations of PM and NO lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions.

Funding: Health Effects Institute.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2542-5196(21)00277-1DOI Listing
January 2022

Acute Effects of Particulate Matter on All-Cause Mortality in Urban, Rural, and Suburban Areas, Italy.

Int J Environ Res Public Health 2021 12 7;18(24). Epub 2021 Dec 7.

Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, 00147 Rome, Italy.

Background: Short-term exposure to particulate matter (PM) has been related to mortality worldwide. Most evidence comes from studies conducted in major cities, while little is known on the effects of low concentrations of PM and in less urbanized areas. We aim to investigate the relationship between PM and all-cause mortality at national level in Italy.

Methods: Daily numbers of all-cause mortality were collected for all 8092 municipalities of Italy, from 2006 to 2015. A satellite-based spatiotemporal model was developed to estimate daily PM (inhalable particles) and PM (fine particles) concentrations at 1-km resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and mortality at province level, and then, results were pooled with a random-effects meta-analysis. Associations were estimated by combination of age and sex and degree of urbanization of the municipalities. Flexible functions were estimated to explore the shape of the associations at low PM concentrations.

Results: We analyzed 5,884,900 deaths (40% among subjects older than 85 years, 60% occurring outside the main urban areas). National daily mean (interquartile range) PM and PM concentrations were 23 (14) μg/m and 15 (11) μg/m, respectively. Relative increases of mortality per 10 μg/m variation in lag 0-5 (average of last six days since death) PM and PM were 1.47% (95% Confidence Intervals (CI): 1.15%, 1.79%) and 1.96% (1.33%, 2.59%), respectively. Associations were highest among elderly and women for PM only, similar between rural and urbanized areas, and were present even at low concentrations, e.g., below WHO guidelines.

Conclusions: Air pollution was robustly associated with peaks in daily all-cause mortality in Italy, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines (2021) for PM and PM are not sufficient to protect public health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph182412895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701500PMC
December 2021

Differential mortality risks associated with PM2.5 components: a multi-country, multi-city study.

Epidemiology 2021 Dec 7. Epub 2021 Dec 7.

Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK European Centre for Medium-Range Weather Forecast, Reading, UK Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada Air Health Science Division, Health Canada, Ottawa, Canada Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan Health Canada, Ottawa, Canada Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA School of the Environment, Yale University, New Haven CT, USA National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan Swiss Tropical and Public Health Institute, Basel, Switzerland Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland Department of Public Health and Clinical Medicine, Umeå University, Sweden Department of Statistics and Computational Research. Universitat de València, València, Spain Ciberesp, Madrid. Spain Natural Resources and the Environment Unit, Council for Scientific and Industrial Research, Pretoria 0001, South Africa Unit for Environmental Sciences and Management, North-West University, Potchefstroom 2520, South Africa Department of Geography, Geo-informatics and Meteorology, University of Pretoria, Pretoria 0001, South Africa Gangarosa Department of Environmental Health. Rollins School of Public Health, Emory University, Atlanta, USA Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece School of Population Health and Environmental Sciences, King's College, London, UK Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany IBE-Chair of Epidemiology, LMU Munich, Munich, Germany Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland Finnish Meteorological Institute, Helsinki, Finland Estonian Environmental Research Centre, Tallinn, Estonia Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Department of Public Health, Universidad de los Andes, Santiago, Chile Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK.

Background: The association between fine particulate matter (PM2.5) and mortality widely differs between as well as within countries. Differences in PM2.5 composition can play a role in modifying the effect estimates, but there is little evidence about which components have higher impacts on mortality.

Methods: We applied a two-stage analysis on data collected from 210 locations in 16 countries. In the first stage, we estimated location-specific relative risks (RR) for mortality associated with daily total PM2.5 through time series regression analysis. We then pooled these estimates in a meta-regression model that included city-specific logratio-transformed proportions of seven PM2.5 components as well as meta-predictors derived from city-specific socio-economic and environmental indicators.

Results: We found associations between RR and several PM2.5 components. Increasing the ammonium (NH4+) proportion from 1% to 22%, while keeping a relative average proportion of other components, increased the RR from 1.0063 (95%CI: 1.0030-1.0097) to 1.0102 (95%CI:1.0070-1.0135). Conversely, an increase in nitrate (NO3-) from 1% to 71% resulted in a reduced RR, from 1.0100 (95%CI: 1.0067-1.0133) to 1.0037 (95%CI: 0.9998- 1.0077). Differences in composition explained a substantial part of the heterogeneity in PM2.5 risk.

Conclusions: These findings contribute to the identification of more hazardous emission sources. Further work is needed to understand the health impacts of PM2.5 components and sources given the overlapping sources and correlations among many components.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/EDE.0000000000001455DOI Listing
December 2021

Long-term exposure to fine particle elemental components and mortality in Europe: Results from six European administrative cohorts within the ELAPSE project.

Sci Total Environ 2022 Feb 8;809:152205. Epub 2021 Dec 8.

Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands. Electronic address:

Evidence for the association between long-term exposure to ambient particulate matter components and mortality from natural causes is sparse and inconsistent. We evaluated this association in six large administrative cohorts in the framework of the Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) project. We analyzed data from country-wide administrative cohorts in Norway, Denmark, the Netherlands, Belgium, Switzerland and in Rome (Italy). Annual 2010 mean concentrations of copper (Cu), iron (Fe), potassium (K), nickel (Ni), sulfur (S), silicon (Si), vanadium (V) and zinc (Zn) in fine particulate matter (PM) were estimated using 100 × 100 m Europe-wide hybrid land use regression models assigned to the participants' residential addresses. We applied cohort-specific Cox proportional hazard models controlling for area- and individual-level covariates to evaluate associations with natural mortality. Two pollutant models adjusting for PM total mass or nitrogen dioxide (NO) were also applied. We pooled cohort-specific estimates using a random effects meta-analysis. We included almost 27 million participants contributing more than 240 million person-years. All components except Zn were significantly associated with natural mortality [pooled Hazard Ratios (HRs) (95% CI): 1.037 (1.014, 1.060) per 5 ng/m Cu; 1.069 (1.031, 1.108) per 100 ng/m Fe; 1.039 (1.018, 1.062) per 50 ng/m K; 1.024 (1.006, 1.043) per 1 ng/m Ni; 1.036 (1.016, 1.057) per 200 ng/m S; 1.152 (1.048, 1.266) per 100 ng/m Si; 1.020 (1.006, 1.034) per 2 ng/m V]. Only K and Si were robust to PM or NO adjustment [pooled HRs (95% CI) per 50 ng/m in K: 1.025 (1.008, 1.044), 1.020 (0.999, 1.042) and per 100 ng/m in Si: 1.121 (1.039, 1.209), 1.068 (1.022, 1.117) adjusted for PM and NO correspondingly]. Our findings indicate an association of natural mortality with most components, which was reduced after adjustment for PM and especially NO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2021.152205DOI Listing
February 2022

Transportation noise exposure and cardiovascular mortality: 15-years of follow-up in a nationwide prospective cohort in Switzerland.

Environ Int 2022 01 11;158:106974. Epub 2021 Nov 11.

Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

Background: Death from cardiovascular diseases (CVD) has been associated with transportation noise. This nationwide cohort, with state-of-the-art exposure assessment, evaluates these associations by noise source.

Methods: Road traffic, railway and aircraft noise for 2001 and 2011 were linked to 4.1 million adults in the Swiss National Cohort, accounting for address history. Mean noise exposure in 5-year periods was calculated. Time-varying Cox regression models, with age as timescale, were applied to all and cause-specific cardiovascular causes of death. Models included all three noise sources plus PM, adjusted for individual and spatial covariates. Nighttime noise events for all sources combined (expressed as intermittency ratio or number of events) were considered in sensitivity analyses. Absolute excess risk was calculated by multiplying deaths/100,000 person-years by the excess risk (hazard ratio-1) within each age/sex group.

Results: During a 15-year follow-up, there were 277,506 CVD and 34,200 myocardial infarction (MI) deaths. Associations (hazard ratio; 95%-CIs) for road traffic, railway and aircraft noise and CVD mortality were 1.029 (1.024-1.034), 1.013 (1.010-1.017), and 1.003 (0.996-1.010) per 10 dB L, respectively. Associations for MI mortality were a respective 1.043 (1.029-1.058), 1.020 (1.010-1.030) and 1.040 (1.020-1.060) per 10 dB L. Blood pressure-related, ischemic heart disease, and all stroke mortality were significantly associated with road traffic and railway noise, while ischemic stroke mortality was associated with aircraft noise. Associations were mostly linear, often starting below 40 dB L for road traffic and railway noise. Higher levels of noise intermittency were also independently associated with each outcome. While the absolute number of deaths attributed to noise increased with age, the hazard ratios declined with age. Relative and absolute risk was higher in males compared to females.

Conclusion: Independent of air pollution, transportation noise exposure is associated with all and cause-specific CVD mortality, with effects starting below current guideline limits.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2021.106974DOI Listing
January 2022

Association between Exposure to Particulate Matter during Pregnancy and Multidimensional Development in School-Age Children: A Cross-Sectional Study in Italy.

Int J Environ Res Public Health 2021 11 5;18(21). Epub 2021 Nov 5.

Department of Developmental and Social Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy.

Air pollutants can potentially affect the development of children. However, data on the effect of exposure to air pollution during pregnancy and developmental outcomes in school children are rare. We investigated the link between prenatal exposure to particulate matters smaller than 10 microns (PM) and the development of school-age children in multiple domains. Cross-sectional data were collected in Italy between 2013 and 2014. Children aged between 5 and 8 years (n = 1187) were assessed on cognitive, communication, socio-emotional, adaptive, and motor developmental domains using the Developmental Profile 3 questionnaire. The monthly average concentration of PM during the entire fetal period was linked to the municipality of residence of the children. The increase in the prenatal PM was associated with a decrease in the cognitive score during the second (+13.2 µg/m PM increase: -0.30 points; 95%CI: -0.12--0.48) and third trimesters of pregnancy (-0.31 points; 95%CI: -0.11--0.50). The communicative domain was also negatively influenced by PM increases in the second trimester. The development of cognitive and communicative abilities of children was negatively associated with the exposure to PM during the period of fetal development, confirming that exposure to air pollution during pregnancy can potentially hinder the development of the brain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph182111648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8582713PMC
November 2021

Association between air temperature, air pollution and hospital admissions for pulmonary embolism and venous thrombosis in Italy.

Eur J Intern Med 2021 Oct 23. Epub 2021 Oct 23.

Department of Epidemiology, Lazio Region Health Service / ASL Roma1.

Background: Previous studies reported a link between short-term exposure to environmental stressors (air pollution and air temperature) and atherothrombotic cardiovascular diseases. However, only few of them reported consistent associations with venous thromboembolism (VTE). Our aim was to estimate the association between daily air temperature and particulate matter (PM) air pollution with hospital admissions for pulmonary embolism (PE) and venous thrombosis (VT) at national level in Italy.

Methods: We collected daily hospital PE and VT admissions from the Italian Ministry of Health during 2006-2015 in all the 8,084 municipalities of Italy, and we merged them with air temperature and daily PM10 concentrations estimated by satellite-based spatiotemporal models. First, we applied multivariate Poisson regression models at province level. Then, we obtained national overall effects by random-effects meta-analysis.

Results: This analysis was conducted on 219,952 PE and 275,506 VT hospitalizations. Meta-analytical results showed weak associations between the two exposures and the study outcomes in the full year analysis. During autumn and winter, PE hospital admissions increased by 1.07% (95% confidence intervals [CI]: 0.21%; 1.92%) and 0.96% (95% CI: 0.07%; 1.83%) respectively, per 1 °C decrement of air temperature in the previous 10 days (lag 0-10). In summer we observed adverse effects at high temperatures, with a 1% (95% CI: 0.10%; 1.91%) increasing risk per 1 °C increment. We found no association between VT and cold temperatures.

Conclusion: Results show a significant effect of air temperature on PE hospitalizations in the cold seasons and summer. No effect of particulate matter was detected.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejim.2021.09.019DOI Listing
October 2021

A nationwide study of air pollution from particulate matter and daily hospitalizations for respiratory diseases in Italy.

Sci Total Environ 2022 Feb 17;807(Pt 3):151034. Epub 2021 Oct 17.

CNR-IFC, Pisa, Italy.

Background/aim: The relationship between air pollution and respiratory morbidity has been widely addressed in urban and metropolitan areas but little is known about the effects in non-urban settings. Our aim was to assess the short-term effects of PM10 and PM2.5 on respiratory admissions in the whole country of Italy during 2006-2015.

Methods: We estimated daily PM concentrations at the municipality level using satellite data and spatiotemporal predictors. We collected daily counts of respiratory hospital admissions for each Italian municipality. We considered five different outcomes: all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), lower and upper respiratory tract infections (LRTI and URTI). Meta-analysis of province-specific estimates obtained by time-series models, adjusting for temperature, humidity and other confounders, was applied to extrapolate national estimates for each outcome. At last, we tested for effect modification by sex, age, period, and urbanization score. Analyses for PM were restricted to 2013-2015 cause the goodness of fit of exposure estimation.

Results: A total of 4,154,887 respiratory admission were registered during 2006-2015, of which 29% for LRTI, 12% for COPD, 6% for URTI, and 3% for asthma. Daily mean PM and PM concentrations over the study period were 23.3 and 17 μg/m, respectively. For each 10 μg/m increases in PM and PM at lag 0-5 days, we found excess risks of total respiratory diseases equal to 1.20% (95% confidence intervals, 0.92, 1.49) and 1.22% (0.76, 1.68), respectively. The effects for the specific diseases were similar, with the strongest ones for asthma and COPD. Higher effects were found in the elderly and in less urbanized areas.

Conclusions: Short-term exposure to PM is harmful for the respiratory system throughout an entire country, especially in elderly patients. Strong effects can be found also in less urbanized areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2021.151034DOI Listing
February 2022

Variability in the association between long-term exposure to ambient air pollution and mortality by exposure assessment method and covariate adjustment: A census-based country-wide cohort study.

Sci Total Environ 2022 Jan 4;804:150091. Epub 2021 Sep 4.

Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands. Electronic address:

Background: Ambient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions.

Methods: We used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM), nitrogen dioxide (NO), black carbon (BC) and ozone (O) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43).

Results: We found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 μg/m increase for NO were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 μg/m increase for PM for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3].

Conclusion: Long-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2021.150091DOI Listing
January 2022

Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project.

Lancet Planet Health 2021 09;5(9):e620-e632

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Background: Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM), nitrogen dioxide (NO), black carbon, and warm-season ozone (O) with the incidence of stroke and acute coronary heart disease.

Methods: We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.

Findings: From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8-19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM (hazard ratio 1·10 [95% CI 1·01-1·21] per 5 μg/m increase), NO (1·08 [1·04-1·12] per 10 μg/m increase), and black carbon (1·06 [1·02-1·10] per 0·5 10/m increase), whereas coronary heart disease incidence was only associated with NO (1·04 [1·01-1·07]). Warm-season O was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM and NO remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m for PM and 40 μg/m for NO.

Interpretation: Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values.

Funding: Health Effects Institute.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2542-5196(21)00195-9DOI Listing
September 2021

Mortality risk attributable to wildfire-related PM pollution: a global time series study in 749 locations.

Lancet Planet Health 2021 09;5(9):e579-e587

Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Background: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM and mortality across various regions of the world.

Methods: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM exposure was calculated.

Findings: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM exposure during the study period.

Interpretation: Short-term exposure to wildfire-related PM was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires.

Funding: Australian Research Council, Australian National Health & Medical Research Council.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2542-5196(21)00200-XDOI Listing
September 2021

Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis.

BMJ 2021 09 1;374:n1904. Epub 2021 Sep 1.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Objective: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.

Design: Pooled analysis of eight cohorts.

Setting: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.

Participants: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM), nitrogen dioxide, ozone, and black carbon.

Main Outcome Measures: Deaths due to natural causes and cause specific mortality.

Results: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m in PM was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m an increase of 5 µg/m in PM was associated with 29.6% (14% to 47.4%) increase in natural deaths.

Conclusions: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmj.n1904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409282PMC
September 2021

Long-term exposure to air pollution and liver cancer incidence in six European cohorts.

Int J Cancer 2021 12 14;149(11):1887-1897. Epub 2021 Aug 14.

Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Particulate matter air pollution and diesel engine exhaust have been classified as carcinogenic for lung cancer, yet few studies have explored associations with liver cancer. We used six European adult cohorts which were recruited between 1985 and 2005, pooled within the "Effects of low-level air pollution: A study in Europe" (ELAPSE) project, and followed for the incidence of liver cancer until 2011 to 2015. The annual average exposure to nitrogen dioxide (NO ), particulate matter with diameter <2.5 μm (PM ), black carbon (BC), warm-season ozone (O ), and eight elemental components of PM (copper, iron, zinc, sulfur, nickel, vanadium, silicon, and potassium) were estimated by European-wide hybrid land-use regression models at participants' residential addresses. We analyzed the association between air pollution and liver cancer incidence by Cox proportional hazards models adjusting for potential confounders. Of 330 064 cancer-free adults at baseline, 512 developed liver cancer during a mean follow-up of 18.1 years. We observed positive linear associations between NO (hazard ratio, 95% confidence interval: 1.17, 1.02-1.35 per 10 μg/m ), PM (1.12, 0.92-1.36 per 5 μg/m ), and BC (1.15, 1.00-1.33 per 0.5 10 /m) and liver cancer incidence. Associations with NO and BC persisted in two-pollutant models with PM . Most components of PM were associated with the risk of liver cancer, with the strongest associations for sulfur and vanadium, which were robust to adjustment for PM or NO . Our study suggests that ambient air pollution may increase the risk of liver cancer, even at concentrations below current EU standards.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijc.33743DOI Listing
December 2021

Long-term exposure to low-level air pollution and incidence of asthma: the ELAPSE project.

Eur Respir J 2021 06 4;57(6). Epub 2021 Jun 4.

Dept of Environmental Science, Aarhus University, Roskilde, Denmark.

Background: Long-term exposure to ambient air pollution has been linked to childhood-onset asthma, although evidence is still insufficient. Within the multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we examined the associations of long-term exposures to particulate matter with a diameter <2.5 µm (PM), nitrogen dioxide (NO) and black carbon (BC) with asthma incidence in adults.

Methods: We pooled data from three cohorts in Denmark and Sweden with information on asthma hospital diagnoses. The average concentrations of air pollutants in 2010 were modelled by hybrid land-use regression models at participants' baseline residential addresses. Associations of air pollution exposures with asthma incidence were explored with Cox proportional hazard models, adjusting for potential confounders.

Results: Of 98 326 participants, 1965 developed asthma during a mean follow-up of 16.6 years. We observed associations in fully adjusted models with hazard ratios of 1.22 (95% CI 1.04-1.43) per 5 μg·m for PM, 1.17 (95% CI 1.10-1.25) per 10 µg·m for NO and 1.15 (95% CI 1.08-1.23) per 0.5×10m for BC. Hazard ratios were larger in cohort subsets with exposure levels below the European Union and US limit values and possibly World Health Organization guidelines for PM and NO. NO and BC estimates remained unchanged in two-pollutant models with PM, whereas PM estimates were attenuated to unity. The concentration-response curves showed no evidence of a threshold.

Conclusions: Long-term exposure to air pollution, especially from fossil fuel combustion sources such as motorised traffic, was associated with adult-onset asthma, even at levels below the current limit values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.03099-2020DOI Listing
June 2021

Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis.

Eur J Prev Cardiol 2020 Nov 12. Epub 2020 Nov 12.

Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden.

Aims: We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy.

Methods And Results: Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013-2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0-5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines.

Conclusion: PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurjpc/zwaa084DOI Listing
November 2020

Long-Term Exposure to Fine Particle Elemental Components and Natural and Cause-Specific Mortality-a Pooled Analysis of Eight European Cohorts within the ELAPSE Project.

Environ Health Perspect 2021 04 12;129(4):47009. Epub 2021 Apr 12.

Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Background: Inconsistent associations between long-term exposure to particles with an aerodynamic diameter [fine particulate matter ()] components and mortality have been reported, partly related to challenges in exposure assessment.

Objectives: We investigated the associations between long-term exposure to elemental components and mortality in a large pooled European cohort; to compare health effects of components estimated with two exposure modeling approaches, namely, supervised linear regression (SLR) and random forest (RF) algorithms.

Methods: We pooled data from eight European cohorts with 323,782 participants, average age 49 y at baseline (1985-2005). Residential exposure to 2010 annual average concentration of eight components [copper (Cu), iron (Fe), potassium (K), nickel (Ni), sulfur (S), silicon (Si), vanadium (V), and zinc (Zn)] was estimated with Europe-wide SLR and RF models at a scale. We applied Cox proportional hazards models to investigate the associations between components and natural and cause-specific mortality. In addition, two-pollutant analyses were conducted by adjusting each component for mass and nitrogen dioxide () separately.

Results: We observed 46,640 natural-cause deaths with 6,317,235 person-years and an average follow-up of 19.5 y. All SLR-modeled components were statistically significantly associated with natural-cause mortality in single-pollutant models with hazard ratios (HRs) from 1.05 to 1.27. Similar HRs were observed for RF-modeled Cu, Fe, K, S, V, and Zn with wider confidence intervals (CIs). HRs for SLR-modeled Ni, S, Si, V, and Zn remained above unity and (almost) significant after adjustment for both and . HRs only remained (almost) significant for RF-modeled K and V in two-pollutant models. The HRs for V were 1.03 (95% CI: 1.02, 1.05) and 1.06 (95% CI: 1.02, 1.10) for SLR- and RF-modeled exposures, respectively, per , adjusting for mass. Associations with cause-specific mortality were less consistent in two-pollutant models.

Conclusion: Long-term exposure to V in was most consistently associated with increased mortality. Associations for the other components were weaker for exposure modeled with RF than SLR in two-pollutant models. https://doi.org/10.1289/EHP8368.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/EHP8368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041432PMC
April 2021

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities.

Lancet Planet Health 2021 04;5(4):e191-e199

Environmental and Occupational Medicine, National Taiwan University and NTU Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.

Background: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting.

Methods: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected.

Findings: Overall, a 1 mg/m increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide.

Interpretation: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants.

Funding: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2542-5196(21)00026-7DOI Listing
April 2021

Short-term health effects from outdoor exposure to biomass burning emissions: A review.

Sci Total Environ 2021 Aug 26;781:146739. Epub 2021 Mar 26.

Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona 08034, Spain.

Biomass burning (BB) including forest, bush, prescribed fires, agricultural fires, residential wood combustion, and power generation has long been known to affect climate, air quality and human health. With this work we supply a systematic review on the health effects of BB emissions in the framework of the WHO activities on air pollution. We performed a literature search of online databases (PubMed, ISI, and Scopus) from year 1980 up to 2020. A total of 81 papers were considered as relevant for mortality and morbidity effects. High risk of bias was related with poor estimation of BB exposure and lack of adjustment for important confounders. PM10 and PM2.5 concentrations originating from BB were associated with all-cause mortality: the meta-analytical estimate was equal to 1.31% (95% CI 0.71, 1.71) and 1.92% (95% CI -1.19, 5.03) increased mortality per each 10 μg m increase of PM10 and PM2.5, respectively. Regarding cardiovascular mortality 8 studies reported quantitative estimates. For smoky days and for each 10 μg m increase in PM2.5 concentrations, the risk of cardiovascular mortality increased by 4.45% (95% CI 0.96, 7.95) and by 3.30% (95% CI -1.97, 8.57), respectively. Fourteen studies evaluated whether respiratory morbidity was adversely related to PM2.5 (9 studies) or PM10 (5 studies) originating from BB. All found positive associations. The pooled effect estimates were 4.10% (95% CI 2.86, 5.34) and 4.83% (95% CI 0.06, 9.60) increased risk of total respiratory admissions/emergency visits, per 10 μg m increases in PM2.5 and PM10, respectively. Regarding cardiovascular morbidity, sixteen studies evaluated whether this was adversely related to PM2.5 (10 studies) or PM10 (6 studies) originating from BB. They found both positive and negative results, with summary estimates equal to 3.68% (95% CI -1.73, 9.09) and 0.93% (95% CI -0.18, 2.05) increased risk of total cardiovascular admissions/emergency visits, per 10 μg m increases in PM2.5 and PM10, respectively. To conclude, a significant number of studies indicate that BB exposure is associated with all-cause and cardiovascular mortality and respiratory morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2021.146739DOI Listing
August 2021

Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy.

Int J Environ Res Public Health 2021 02 16;18(4). Epub 2021 Feb 16.

Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), 00144 Rome, Italy.

Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006-2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18041896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922734PMC
February 2021

Sex differences in factors associated with heart failure and diastolic left ventricular dysfunction: a cross-sectional population-based study.

BMC Public Health 2021 02 27;21(1):415. Epub 2021 Feb 27.

Quisisana Clinic, Rome, Italy.

Background: Although sex differences in cardiovascular diseases are recognised, including differences in incidence, clinical presentation, response to treatments, and outcomes, most of the practice guidelines are not sex-specific. Heart failure (HF) is a major public health challenge, with high health care expenditures, high prevalence, and poor clinical outcomes. The objective was to analyse the sex-specific association of socio-demographics, life-style factors and health characteristics with the prevalence of HF and diastolic left ventricular dysfunction (DLVD) in a cross-sectional population-based study.

Methods: A random sample of 2001 65-84 year-olds underwent physical examination, laboratory measurements, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrocardiography, and echocardiography. We selected the subjects with no missing values in covariates and echocardiographic parameters and performed a complete case analysis. Sex-specific multivariable logistic regression models were used to identify the factors associated with the prevalence of the diseases, multinomial logistic regression was used to investigate the factors associated to asymptomatic and symptomatic LVD, and spline curves to display the relationship between the conditions and both age and NT-proBNP.

Results: In 857 men included, there were 66 cases of HF and 408 cases of DLVD (77% not reporting symptoms). In 819 women, there were 51 cases of HF and 382 of DLVD (79% not reporting symptoms). In men, the factors associated with prevalence of HF were age, ischemic heart disease (IHD), and suffering from three or more comorbid conditions. In women, the factors associated with HF were age, lifestyles (smoking and alcohol), BMI, hypertension, and atrial fibrillation. Age and diabetes were associated to asymptomatic DLVD in both genders. NT-proBNP levels were more strongly associated with HF in men than in women.

Conclusions: There were sex differences in the factors associated with HF. The results suggest that prevention policies should consider the sex-specific impact on cardiac function of modifiable cardiovascular risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-021-10442-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912519PMC
February 2021

Long-Term Exposure to PM2.5 and Cognitive Decline: A Longitudinal Population-Based Study.

J Alzheimers Dis 2021 ;80(2):591-599

Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.

Background: A growing but contrasting evidence relates air pollution to cognitive decline. The role of cerebrovascular diseases in amplifying this risk is unclear.

Objectives: 1) Investigate the association between long-term exposure to air pollution and cognitive decline; 2) Test whether cerebrovascular diseases amplify this association.

Methods: We examined 2,253 participants of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). One major air pollutant (particulate matter ≤2.5μm, PM2.5) was assessed yearly from 1990, using dispersion models for outdoor levels at residential addresses. The speed of cognitive decline (Mini-Mental State Examination, MMSE) was estimated as the rate of MMSE decline (linear mixed models) and further dichotomized into the upper (25%fastest cognitive decline), versus the three lower quartiles. The cognitive scores were used to calculate the odds of fast cognitive decline per levels of PM2.5 using regression models and considering linear and restricted cubic splines of 10 years exposure before the baseline. The potential modifier effect of cerebrovascular diseases was tested by adding an interaction term in the model.

Results: We observed an inverted U-shape relationship between PM2.5 and cognitive decline. The multi-adjusted piecewise regression model showed an increased OR of fast cognitive decline of 81%(95%CI = 1.2-3.2) per interquartile range difference up to mean PM2.5 level (8.6μg/m3) for individuals older than 80. Above such level we observed no further risk increase (OR = 0.89;95%CI = 0.74-1.06). The presence of cerebrovascular diseases further increased such risk by 6%.

Conclusion: Low to mean PM2.5 levels were associated with higher risk of accelerated cognitive decline. Cerebrovascular diseases further amplified such risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/JAD-200852DOI Listing
September 2021

A systematic review on the association between total and cardiopulmonary mortality/morbidity or cardiovascular risk factors with long-term exposure to increased or decreased ambient temperature.

Sci Total Environ 2021 Jun 27;772:145383. Epub 2021 Jan 27.

Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece; Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, UK. Electronic address:

The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2021.145383DOI Listing
June 2021

Spatial variability of nitrogen dioxide and formaldehyde and residential exposure of children in the industrial area of Viadana, Northern Italy.

Environ Sci Pollut Res Int 2021 Jun 2;28(22):28096-28106. Epub 2021 Feb 2.

Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, strada Le Grazie 8, 37134, Verona, Italy.

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 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 measurements with average weekly concentrations from continuous monitors. We compared interpolated NO 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, PM, and PM. The correlation between NO concentrations from continuous and passive sampling was high (Pearson's r = 0.89), although passive sampling underestimated NO especially during winter. For both 2010 and 2017-2018, we observed higher NO and formaldehyde concentrations in the south of Viadana, with hot-spots in proximity to the industry. PM and PM exposures were higher for children at < 1 km compared to the children living at > 3.5 km to the industry, whereas NO 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11356-020-12015-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164570PMC
June 2021

Short-Term Effects of Air Pollution on Cardiovascular Hospitalizations in the Pisan Longitudinal Study.

Int J Environ Res Public Health 2021 01 28;18(3). Epub 2021 Jan 28.

Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy.

Air pollution effects on cardiovascular hospitalizations in small urban/suburban areas have been scantly investigated. Such effects were assessed among the participants in the analytical epidemiological survey carried out in Pisa and Cascina, Tuscany, Italy (2009-2011). Cardiovascular hospitalizations from 1585 subjects were followed up (2011-2015). Daily mean pollutant concentrations were estimated through random forests at 1 km (particulate matter: PM, 2011-2015; PM, 2013-2015) and 200 m (PM, PM, NO, O, 2013-2015) resolutions. Exposure effects were estimated using the case-crossover design and conditional logistic regression (odds ratio-OR-and 95% confidence interval-CI-for 10 μg/m increase; lag 0-6). During the period 2011-2015 (137 hospitalizations), a significant effect at lag 0 was observed for PM (OR = 1.137, CI: 1.023-1.264) at 1 km resolution. During the period 2013-2015 (69 hospitalizations), significant effects at lag 0 were observed for PM (OR = 1.268, CI: 1.085-1.483) and PM (OR = 1.273, CI: 1.053-1.540) at 1 km resolution, as well as for PM (OR = 1.365, CI: 1.103-1.690), PM (OR = 1.264, CI: 1.006-1.589) and NO (OR = 1.477, CI: 1.058-2.061) at 200 m resolution; significant effects were observed up to lag 2. Larger ORs were observed in males and in subjects reporting pre-existent cardiovascular/respiratory diseases. Combining analytical and routine epidemiological data with high-resolution pollutant estimates provides new insights on acute cardiovascular effects in the general population and in potentially susceptible subgroups living in small urban/suburban areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18031164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908381PMC
January 2021

Modeling multi-level survival data in multi-center epidemiological cohort studies: Applications from the ELAPSE project.

Environ Int 2021 02 12;147:106371. Epub 2021 Jan 12.

Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, Roskilde, Denmark.

Background: We evaluated methods for the analysis of multi-level survival data using a pooled dataset of 14 cohorts participating in the ELAPSE project investigating associations between residential exposure to low levels of air pollution (PM and NO) and health (natural-cause mortality and cerebrovascular, coronary and lung cancer incidence).

Methods: We applied five approaches in a multivariable Cox model to account for the first level of clustering corresponding to cohort specification: (1) not accounting for the cohort or using (2) indicator variables, (3) strata, (4) a frailty term in frailty Cox models, (5) a random intercept under a mixed Cox, for cohort identification. We accounted for the second level of clustering due to common characteristics in the residential area by (1) a random intercept per small area or (2) applying variance correction. We assessed the stratified, frailty and mixed Cox approach through simulations under different scenarios for heterogeneity in the underlying hazards and the air pollution effects.

Results: Effect estimates were stable under approaches used to adjust for cohort but substantially differed when no adjustment was applied. Further adjustment for the small area grouping increased the effect estimates' standard errors. Simulations confirmed identical results between the stratified and frailty models. In ELAPSE we selected a stratified multivariable Cox model to account for between-cohort heterogeneity without adjustment for small area level, due to the small number of subjects and events in the latter.

Conclusions: Our study supports the need to account for between-cohort heterogeneity in multi-center collaborations using pooled individual level data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.106371DOI Listing
February 2021

[Temporal variations in excess mortality during phase 1 and phase 2 of the COVID-19 epidemic in Italy].

Epidemiol Prev 2020 Sep-Dec;44(5-6 Suppl 2):236-243

Dipartimento di epidemiologia del Sistema sanitario regionale, Regione Lazio, ASL Roma 1, Roma.

Objectives: to assess the temporal variation in excess total mortality and the portion of excess explained by COVID-19 deaths by geographical area, gender, and age during the COVID-19 epidemic.

Design: descriptive analysis of temporal variations of total excess deaths and COVID-19 deaths in the phase 1 and phase 2 of the epidemic in Italy.

Setting And Participants: 12 Northern cities and 20 Central-Southern cities from December 2019 to June 2020: daily mortality from the National Surveillance System of Daily Mortality (SiSMG) and COVID-19 deaths from the integrated COVID-19 surveillance system.

Main Outcome Measures: total mortality excess and COVID-19 deaths, defined as deaths in microbiologically confirmed cases of SARS-CoV-2, by gender and age groups.

Results: the largest excess mortality was observed in the North and during the first phase of the epidemic. The portion of excess mortality explained by COVID-19 decreases with age, decreasing to 51% among the very old (>=85 years). In phase 2 (until June 2020), the impact was more contained and totally attributable to COVID-19 deaths and this suggests an effectiveness of social distancing measures.

Conclusions: mortality surveillance is a sensible information basis for the monitoring of health impact of the different phases of the epidemic and supporting decision making at the local and national level on containment measures to put in place in coming months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.19191/EP20.5-6.S2.123DOI Listing
January 2021

[Exposure assessment of air pollution in Italy 2016-2019 for future studies on air pollution and COVID-19].

Epidemiol Prev 2020 Sep-Dec;44(5-6 Suppl 2):161-168

Centro tematico regionale ambiente prevenzione e salute, Agenzia regionale per la prevenzione, l'ambiente e l'energia dell'Emilia-Romagna, Modena.

Air pollution is one of the leading causes of death worldwide, with adverse effects related both to short-term and long-term exposure. It has also recently been linked to COVID-19 pandemic. To analyze this possible association in Italy, studies on the entire area of the peninsula are necessary, both urban and non-urban areas. Therefore, there is a need for a homogeneous and applicable exposure assessment tool throughout the country.Experiences of high spatio-temporal resolution models for Italian territory already exist for PM estimation, using space-time predictors, satellite data, air quality monitoring data.This work completes the availability of these estimations for the most recent years (2016-2019) and is also applied to nitrogen oxides and ozone. The spatial resolution is 1x1 km.The model confirms its capability of capturing most of PM variability (R2=0.78 and 0.74 for PM10 e PM2.5, respectively), and provides reliable estimates also for ozone (R2=0.76); for NO2 the model performance is lower (R2=0.57). The model estimations were used to calculate the PWE (population-weighted exposure) as the annual mean, weighted on the resident population in each individual cell, which represents the estimation of the Italian population's chronic exposure to air pollution.These estimates are ready to be used in studies on the association between chronic exposure to air pollution and COVID-19 pathology, as well as for investigations on the role of air pollution on the health of the Italian population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.19191/EP20.5-6.S2.115DOI Listing
January 2021

A Satellite-Based Spatio-Temporal Machine Learning Model to Reconstruct Daily PM Concentrations across Great Britain.

Remote Sens (Basel) 2020 Nov 20;12(22):3803. Epub 2020 Nov 20.

Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.

Epidemiological studies on the health effects of air pollution usually rely on measurements from fixed ground monitors, which provide limited spatio-temporal coverage. Data from satellites, reanalysis, and chemical transport models offer additional information used to reconstruct pollution concentrations at high spatio-temporal resolutions. This study aims to develop a multi-stage satellite-based machine learning model to estimate daily fine particulate matter (PM) levels across Great Britain between 2008-2018. This high-resolution model consists of random forest (RF) algorithms applied in four stages. Stage-1 augments monitor-PM series using co-located PM measures. Stage-2 imputes missing satellite aerosol optical depth observations using atmospheric reanalysis models. Stage-3 integrates the output from previous stages with spatial and spatio-temporal variables to build a prediction model for PM. Stage-4 applies Stage-3 models to estimate daily PM concentrations over a 1 km grid. The RF architecture performed well in all stages, with results from Stage-3 showing an average cross-validated R of 0.767 and minimal bias. The model performed better over the temporal scale when compared to the spatial component, but both presented good accuracy with an R of 0.795 and 0.658, respectively. These findings indicate that direct satellite observations must be integrated with other satellite-based products and geospatial variables to derive reliable estimates of air pollution exposure. The high spatio-temporal resolution and the relatively high precision allow these estimates (approximately 950 million points) to be used in epidemiological analyses to assess health risks associated with both short- and long-term exposure to PM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/rs12223803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116547PMC
November 2020
-->