Association between short-term exposure to air pollutants and cause-specific daily mortality in Italy. A nationwide analysis
Claudio Gariazzo, Matteo Renzi, Alessandro Marinaccio, Paola Michelozzi, Stefania Massari, Camillo Silibello, Giuseppe Carlino, Paolo Giorgi Rossi, Sara Maio, Giovanni Viegi, Massimo Stafoggia, Sandra Baldacci, Sara Maio, Federico Pirona, Sofia Tagliaferro, Giovanni Viegi, Salvatore Fasola, Stefania La Grutta, Carla Ancona, Lisa Bauleo, Giulia Cesaroni, Paola Michelozzi, Matteo Renzi, Massimo Stafoggia, Giuseppe Costa, Nicolàs Zengarini, Simone Giannini, Andrea Ranzi, Letizia Bartolini, Paolo Giorgi Rossi, Marta Ottone, Nicola Caranci, Chiara Di Girolamo, Lucia Bisceglia, Achille Cernigliaro, Salvatore Scondotto, Francesca Locatelli, Pierpaolo Marchetti, Alessandro Marcon, Jessica Miotti, Lorena Torroni, Giuseppe Verlato, Claudio Gariazzo, Alessandro Marinaccio, Stefania Massari, Camillo Silibello, G. Tinarelli
Abstract
Daily air pollution has been linked with mortality from urban studies. Associations in rural areas are still unclear and there is growing interest in testing the role that air pollution has on other causes of death. This study aims to evaluate the association between daily air pollution and cause-specific mortality in all 8092 Italian municipalities. Natural, cardiovascular, cardiac, ischemic, cerebrovascular, respiratory, metabolic, diabetes, nervous and psychiatric causes of death occurred in Italy were extracted during 2013–2015. Daily ambient PM10, PM2.5 and NO2 concentrations were estimated through machine learning algorithms. The associations between air pollutants and cause-specific mortality were estimated with a time-series approach using a two-stage analytic protocol where area-specific over-dispersed Poisson regression models where fit in the first stage, followed by a meta-analysis in the second. We tested for effect modification by sex, age class and the degree of urbanisation of the municipality. We estimated a positive association between PM10 and PM2.5 and the mortality from natural, cardiovascular, cardiac, respiratory and nervous system causes, but not with metabolic or psychiatric causes of death. In particular, mortality from nervous diseases increased by 4.55% (95% CI: 2.51–6.63) and 9.64% (95% CI: 5.76–13.65) for increments of 10 μg/m3 in PM10 and PM2.5 (lag 0–5 days), respectively. NO2 was positively associated with respiratory (6.68% (95% CI: 1.04–12.62)) and metabolic (7.30% (95% CI: 1.03–13.95)) mortality for increments of 10 μg/m3 (lag 0–5). Higher associations with natural mortality were found among the elderly, while there were no differential effects between sex or between rural and urban areas. Short-term exposure to particulate matter was associated with mortality from nervous diseases. Mortality from metabolic diseases was associated with NO2 exposure. Other associations are confirmed and updated, including the contribution of lowly urbanised areas. Health effects were also found in suburban and rural areas.