Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis
Author:
Stafoggia Massimo12ORCID, Renzi Matteo1, Forastiere Francesco34, Ljungman Petter25ORCID, Davoli Marina1, de’ Donato Francesca1, Gariazzo Claudio6, Michelozzi Paola1, Scortichini Matteo1, Solimini Angelo7, Viegi Giovanni38ORCID, Bellander Tom29ORCID, Ancona Carla, Angelini Paola, Argentini Stefania, Baldacci Sandra, Bisceglia Lucia, Bonafede Michela, Bonomo Sergio, Bonvicini Laura, Broccoli Serena, Brusasca Giuseppe, Bucci Simone, Calori Giuseppe, Carlino Giuseppe, Cernigliaro Achille, Chieti Antonio, Colacci Annamaria, de' Donato Francesca, Demaria Moreno, Fasola Salvatore, Finardi Sandro, Forastiere Francesco, Galassi Claudia, Gariazzo Claudio, Rossi Paolo Giorgi, La Grutta Stefania, Licitra Gaetano, Maio Sara, Marinaccio Alessandro, Michelozzi Paola, Migliore Enrica, Moro Antonino, Nanni Alessandro, Ottone Marta, Parmagnani Federica, Pepe Nicola, Radice Paola, Ranzi Andrea, Renzi Matteo, Scondotto Salvatore, Scortichini Matteo, Silibello Camillo, Sozzi Roberto, Stafoggia Massimo, Tinarelli Gianni, Uboldi Francesco, Viegi Giovanni, Zengarini Nicolas,
Affiliation:
1. Department of Epidemiology, Lazio Region Health Service—ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy 2. Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden 3. Institute for Research and Biomedical Innovation, National Research Council, Via Ugo la Malfa 153, 90146 Palermo, Italy 4. Environmental Research Group, King’s College, 150 Stamford Street, SE1 9NH London, UK 5. Department of Cardiology, Danderyds Hospital, Entrévägen 2, 182 57 Danderyd, Sweden 6. Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Via di Fontana Candida, 1, 00078 Monte Porzio Catone, Italy 7. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy 8. Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy 9. Center for Occupational and Environmental Medicine, Stockholm Region, Solnavägen 4 plan 10, 113 65 Stockholm, Sweden
Abstract
Abstract
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.
Funder
Italian Workers’ Compensation Authority
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Epidemiology
Cited by
27 articles.
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