Geo-climatic heterogeneity in self-reported asthma, allergic rhinitis and chronic bronchitis in Italy G. Pesce a, ⁎, M. Bugiani b , A. Marcon a , P. Marchetti a , A. Carosso b , S. Accordini a , L. Antonicelli c , E. Cogliani d , P. Pirina e , G. Pocetta f , F. Spinelli d , S. Villani g , R. de Marco a,1 a Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy b Unit of Respiratory Medicine and Allergology, CPA-ASL TO-2, Turin, Italy c Dept of Internal Medicine, Immuno-Allergic and Respiratory Diseases, Ospedali Riuniti di Ancona, Ancona, Italy d Casaccia Research Centre, Italian National Agency for New Technologies, Energy, and Substainable Economic Development (ENEA), Rome, Italy e Institute of Respiratory Diseases, University of Sassari, Sassari, Italy f Dept of Experimental Medicine, University of Perugia, Perugia, Italy g Dept of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy HIGHLIGHTS • Asthma and chronic bronchitis preva- lence rates are heterogeneous across Italy • A climatic and a topographic compo- nent explain most geo-climatic variabil- ity in Italy • Greater asthma prevalence is found in cities with warmer and drier climate GRAPHICAL ABSTRACT abstract article info Article history: Received 21 July 2015 Received in revised form 29 October 2015 Accepted 4 December 2015 Available online xxxx Editor: D. Barcelo Background: Several studies highlighted a great variability, both between and within countries, in the prevalence of asthma and chronic airways diseases. Aim: To evaluate if geo-climatic variations can explain the heterogeneity in the prevalence of asthma and respi- ratory diseases in Italy. Methods: Between 2006 and 2010, a postal screening questionnaire on respiratory health was administered to 18,357 randomly selected subjects, aged 20–44, living in 7 centers in northern, central, and southern Italy. A random-effects meta-analysis was fitted to evaluate the between-centers heterogeneity in the prevalence of asthma, asthma-like symptoms, allergic rhinitis, and chronic bronchitis (CB). A principal component analysis (PCA) was performed to synthetize the geo-climatic information (annual mean temperature, range of tempera- ture, annual rainfalls, global solar radiations, altitude, distance from the sea) of all the 110 Italian province capital Keywords: Epidemiology Asthma Science of the Total Environment 544 (2016) 645–652 ⁎ Corresponding author at: Università di Verona c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, VR, Italy. E-mail address: giancarlo.pesce@univr.it (G. Pesce). 1 Deceased. http://dx.doi.org/10.1016/j.scitotenv.2015.12.015 0048-9697/© 2015 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Science of the Total Environment journal homepage: www.elsevier.com/locate/scitotenv