......................................................................................................... The European Journal of Public Health, Vol. 29, No. 5, 871–876 ß The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/cky210 Advance Access published on 10 October 2018 ......................................................................................................... Impact of modelled PM2.5, NO 2 and O 3 annual air concentrations on some causes of mortality in Tuscany municipalities Raffaella Uccelli 1 , Marina Mastrantonio 1 , Pierluigi Altavista 1 , Francesca Pacchierotti 1 , Antonio Piersanti 2 , Luisella Ciancarella 2 1 ENEA, National Agency for New technologies, Energy and Sustainable Economic Development, Health Protection Technology Division, Rome, Italy 2 ENEA, National Agency for New technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna, Italy Correspondence: Raffaella Uccelli, SSPT–TECS-BIORISC, ENEA CR Casaccia, Via Anguillarese 301, 00123 S. Maria di Galeria, Rome, Italy, Tel: +39 06 30486417, Fax: +39 06 3048 6559, e-mail: raffaella.uccelli@enea.it Background: In 2014, the European Environment Agency estimated 59 630 premature deaths in Italy attributable to long-term exposure to PM2.5, 17 290 to NO 2 and 2900 to O 3 . The aim of this study was to test an approach for assessing health impact of the above pollutants analyzing possible associations between annual municipal concen- trations, estimated by the national dispersion model developed by ENEA, and mortality rates for trachea, bronchus and lung (TBL) cancer, total respiratory diseases (RD) and chronic obstructive pulmonary diseases (COPD). Tuscany was selected as test case. Methods: For the 287 municipalities, 2009–13 standardized mortality rates (SMRates) for each cause of death were calculated by the ENEA epidemiological database. The SMRates of municipalities, aggregated on the basis of the 2003 or 2010 estimated pollutant concentration tertiles, were also computed. Results: TBL cancer SMRate in municipalities with 2003 PM2.5 levels >15.2 g/m 3 was significantly higher than the SMRates of the two lowest tertiles and COPD SMRates in the two highest O 3 tertiles were significantly higher than that of the lower tertile. No association between PM2.5 or NO 2 concentrations and RD and COPD was detected. Approximately 625 TBL cancer deaths attributable to PM2.5 levels above 10 g/m 3 in 2003 were estimated in the region. Smoking habits and deprivation index were homogeneously distributed among municipalities. Conclusions: This methodological approach allowed detecting associations between mortality and specific air pollutants even at levels below the Italian normative limits and could be employed to evaluate the potential health impact of air pollution in areas where direct measures of concentration are unavailable. ......................................................................................................... Introduction S cientific evidences of health impact from air pollution have been accumulating over the years through epidemiological studies, which have shown a large spectrum of acute and chronic health outcomes ranging from respiratory symptoms up to respiratory, cardiovascular and cancer mortality. 1–14 In 2013, both air pollution and particulate matter (PM) have been classified in Group 1 by the International Agency for Research on Cancer (IARC). Chronic exposure to air pollutants is considered responsible for cancer induction, mainly trachea bronchus and lung (TBL) but also bladder cancer. 15 In 2014, the European Environment Agency estimated 59 630 premature deaths in Italy attributable to long-term exposure to PM2.5, 17 290 premature deaths attributable to NO 2 and 2900 premature deaths attributable to O 3 . 16 These data place our country among those with the highest health impact from pollution. As far as each specific pollutant is concerned, the carcinogenic potential of PM is well established in humans, whereas the causal association between cancer and nitrogen dioxide (NO 2 ) is still con- troversial, even though some evidences associating NO 2 with lung cancer 15,17–20 or even with breast cancer 15,21–24 are accumulating. However up to now NO 2 has been mainly considered an irritant of the respiratory apparatus by IARC and World Health Organization (WHO) and not classified among human carcino- gens. 14,15 Also O 3 can affect the respiratory apparatus causing lung diseases, but it is not considered carcinogenic. 1,14,25 Nowadays, the main problem in Italy as in many other countries, in carrying out epidemiological studies aimed at associating pollutant con- centrations with health effects, is the lack of monitored data for most municipalities, with the consequent small dimension of the investigable sample and of the representativeness of the results. The objective of the present study was to assess the association between modelled long-term exposure to PM2.5, NO 2 and O 3 , estimated by the national dispersion model (MINNI) developed by ENEA, and mortality for the most commonly expected causes of death in Tuscany region, in order to test an approach also applicable to municipalities where monitored data are not available. TBL cancer, total respiratory diseases (RD) and chronic obstructive pulmunary diseases (COPD) were the selected causes of mortality, and Tuscany, a central Italian region with a population of about 3.8 million inhabitants, was the investigated test area. Annual average concentrations for each of the 287 municipalities of Tuscany region were derived from the model results and the relative SMRates for the selected causes of death were then calculated by the ENEA epidemiological database. Moreover, the number of TBL cancer deaths attributable to PM2.5 exposures above the WHO guidelines of 10 g/m 3 in the population over 30 years of age was estimated at provincial and regional levels. Methods PM2.5, NO 2 and O 3 levels were estimated by the national dispersion model (MINNI) (www.minni.org) developed by ENEA for the Impact of modelled PM2.5, NO 2 and O 3 annual air concentrations on mortality in Tuscany municipalities 871 Downloaded from https://academic.oup.com/eurpub/article/29/5/871/5126425 by guest on 27 November 2023