Effetti dell'inquinamento outdoor sulla salute respiratoria di un campione di popolazione generale di Pisa/Cascina: metodi tradizionali e innovativi per la valutazione dell'esposizione individuale

Riassunto Background: L’inquinamento atmosferico outdoor costituisce uno dei più gravi problemi di salute pubblica a livello globale in quanto associato ad effetti avversi sulla salute, in particolare respiratoria. La valutazione dell’esposizione all’inquinamento atmosferico è un aspetto cruciale sia per la valutazione dell’impatto sulla salute sia per la gestione del rischio. Scopo dello studio: Lo scopo di questo studio è stato quello di valutare la relazione tra l’esposizione individuale di un campione di popolazione adulta all’inquinamento atmosferico e il rischio di avere o sviluppare effetti respiratori cronici, utilizzando e confrontando, in termini di impatto sulla salute, metodi differenti per la valutazione dell’esposizione individuale: dati da questionario (metodi tradizionali) e da modellistica ambientale (metodi innovativi). Metodi: Il campione di popolazione generale investigato è relativo a due indagini trasversali condotte dall’Unità di Epidemiologia Ambientale Polmonare dell’Istituto di Fisiologia Clinica del CNR nell’area di Pisa/Cascina: l’indagine Pisa 2 (PI2) svolta nel 1991-1993 e l’indagine Pisa 3 (PI3) svolta nel 2009-2011. In particolare, sono stati analizzati i dati del campione trasversale PI3 (n= 1615) e del campione longitudinale partecipante all’indagine PI2 e PI3 (n=1107). L’esposizione individuale all’inquinamento atmosferico è stata valutata mediante: dati di esposizione al traffico veicolare derivati da questionario (PI3); dati ambientali (PM10, PM2.5, NO2 e O3 estivo) relativi all’anno 2013, con risoluzione spaziale a 1 km e 200 m, ottenuti nell’ambito del progetto nazionale Bigdata in Epidemiologia AmbiEntale ed occuPazionale (BEEP) mediante metodologie statistiche avanzate (modelli machine learning). I dati sanitari, ottenuti da questionari standardizzati e prove di funzionalità respiratoria, sono stati raccolti nelle indagini PI2 e PI3. Le analisi statistiche sono state effettuate mediante il software SPSS versione 17. In particolare, sono state stimate prevalenza, incidenza cumulativa e rischio di effetti respiratori in relazione all’esposizione ad inquinamento atmosferico sul campione totale e stratificato per gruppi di età, aggiustando per i principali fattori di confondimento. Risultati: Il campione generale di popolazione di PI3 risulta esposto a livelli di concentrazione media annuale degli inquinanti inferiori agli attuali standard di qualità dell’aria. Nel campione trasversale, l’esposizione individuale al traffico veicolare valutata mediante questionario (metodo tradizionale), è risultata associata in maniera significativa con: rinite allergica (OR=1.46, IC 95% 1.17-1.82) e attacchi di asma (OR=1.88, IC 95% 1.00-3.54) nel campione di popolazione generale; rinite allergica (OR=1.88, IC 95% 1.28-2.76) nei soggetti con età ≥ 65 anni. L’esposizione individuale agli inquinanti valutata mediante modellistica ambientale (metodi innovativi), ha mostrato le seguenti associazioni significative fra outcome sanitari e incrementi di 1 µg/m3 di inquinanti: sintomi respiratori cronici (SRC) ed NO2 (OR=1.06, IC 95% 1.00-1.12) nel campione generale; BPCO ed ostruzione bronchiale ed NO2 (OR=1.12, IC 95% 1.01-1.24; OR=1.19, IC 95% 1.06-1.34, rispettivamente), rinite allergica e PM10 (OR=1.25, IC 95% 1.03-1.51) nei soggetti ≤ 64 anni. Nel campione longitudinale (follow-up di 18 anni), utilizzando metodi tradizionali, si evidenziano le seguenti associazioni significative con l’incidenza di: rinite allergica (RR=1.67, IC 95% 1.21-2.30) e attacchi di difficoltà di respiro (RR=1.78, IC 95% 1.04-3.02) nel campione generale; rinite allergica (RR=1.55, IC 95% 1.01-2.39) nei soggetti con età ≤ 46 anni a PI2; rinite allergica (RR=1.83, IC 95% 1.13-2.97) nei soggetti con età ≥ 47 anni. Invece, utilizzando metodi innovativi, si evidenziano le seguenti associazioni significative fra incidenza di outcome sanitari e incrementi di 1 µg/m3 di inquinanti: attacchi di asma e NO2 (RR=1.18, IC 95% 1.00-1.39) nel campione generale; rinite allergica e PM10 (RR=1.29, IC 95% 1.02-1.64) e attacchi di asma e NO2 (RR=1.27, IC 95% 1.02-1.60) nei soggetti con età ≤ 46 anni; SRC e NO2 (RR=1.14, IC 95% 1.00-1.29) e O3 estivo (RR=1.17, IC 95% 1.01-1.34, rispettivamente), tra diagnosi di asma e O3 estivo (RR=1.48, IC 95% 1.07-2.06) nei soggetti con età ≥ 47 anni. I risultati mostrano anche effetti protettivi dell’esposizione agli inquinanti sul rischio di avere o sviluppare asma, attacchi di asma, attacchi di difficoltà di respiro e sibili. Conclusioni: I risultati ottenuti forniscono nuove informazioni sugli effetti a lungo termine dell’inquinamento atmosferico sulla salute respiratoria in un campione di popolazione generale, in particolare in relazione al rischio di incidenza di rinite allergica, asma e sintomi respiratori bronchitici e asmatici, sia con metodi innovativi sia con quelli tradizionali. A differenza dei metodi tradizionali, i metodi innovativi forniscono informazioni più specifiche sull’esposizione all’inquinamento atmosferico ed il relativo impatto sulla salute. L’inquinamento atmosferico si conferma essere un fattore di rischio per la salute respiratoria della popolazione adulta, anche al di sotto dei correnti standard di qualità dell’aria, suggerendo la necessità di considerare nel futuro prossimo valori limite più stringenti. Abstract Background: Outdoor air pollution is a major public health issue. It is associated with adverse health effects, particularly on respiratory system. Air pollution exposure assessment is a crucial aspect both for the evaluation of health impact and for risk management. Methods: a general population sample was investigated within two cross-sectional surveys in Pisa/Cascina (PI2, 1991-1993; PI3, 2009-2011) carried out by Pulmonary Environmental Epidemiology Unit of the Institute of Clinical Physiology, CNR. Data from the cross-sectional sample PI3 (n=1615) and the longitudinal sample participating in both PI2 and PI3 (n=1107) were analyzed. Individual air pollution exposure was estimated using: vehicular traffic exposure from questionnaire (PI3) (traditional method); PM10, PM2.5, NO2, summer O3 (year 2013), at 1 km and 200 m spatial resolution, estimated in Bigdata in Environmental and occuPational Epidemiology (BEEP) project, with machine learning model (innovative method). Health data, from standardized questionnaires and spirometry, was collected in the PI2 and PI3 surveys. Prevalence and cumulative incidence and logistic regression analyses, adjusted for the main confounding factors, were run (SPSS 17) to assess the risk of respiratory effects due to air pollution exposure in the total sample and stratified by age. Results: cross-sectional sample statistically significant associations between traffic exposure, assessed through questionnaire, and: allergic rhinitis (OR=1.46) and asthma attacks (OR=1.88) in the total sample; allergic rhinitis (OR=1.88) in subjects ≥ 65 years. Statistically significant associations between air pollutants increase of 1 µg/m3 and the following outcomes: CRS and NO2 (OR=1.06) in the total sample; COPD and bronchial obstruction and NO2 (OR=1.12; OR=1.19, respectively), allergic rhinitis and PM10 (OR=1.25) in subjects ≤ 64 years. Longitudinal sample: positive associations between traffic exposure and allergic rhinitis (RR=1.67) and attacks of breathlessness (RR=1.78) in the total sample; allergic rhinitis (RR=1.55) in subjects ≤ 46 years; allergic rhinitis (RR=1.83) in subjects ≥ 47 years. Associations between asthma attacks and NO2 (RR=1.18) in the total sample; allergic rhinitis and PM10 (RR=1.29) and asthma attacks and NO2 (RR=1.27) in subjects ≤ 46 years; CRS and NO2 and summer O3 (RR=1.14; RR=1.17, respectively), asthma diagnosis and summer O3 (RR=1.48) in subjects ≥ 47 years. Moreover, air pollution protective effects on asthma and asthma symptoms were showed. Conclusions: These results provide new insights into the long-term respiratory health effects of air pollution exposure estimated through both traditional and innovative methods

The Italian severe/uncontrolled asthma registry (RItA): A 12-month clinical follow-up

Background: follow-up studies on registries of severe/uncontrolled asthma (SUA) patients are scanty. Objective: to analyze baseline and follow-up characteristics of SUA patients and their longitudinal patterns. Methods: 180 adult patients (age ≥15 yrs) were investigated at baseline and 12-month follow-up through the Italian SUA registry (RItA). Latent transition analysis (LTA) was performed to detect cross-sectional SUA phenotypes and longitudinal patterns. Risk factors for longitudinal patterns were assessed through logistic regression. Results: a significant/borderline improvement of asthma control outcomes in the last 2-4 weeks emerged at follow-up with respect to baseline for: daily activities limitations (Δ -16%), frequent diurnal symptoms (Δ -25%), uncontrolled asthma symptoms according to ACT (Δ -26%). Last 12-month use of oral corticosteroids was less frequent at follow-up than at baseline (Δ -25%). Health status improvement was confirmed by lung function test results. Through LTA, two longitudinal patterns were detected considering last 12-month control outcomes: "persistence/worsening" (53.9%), "under control/improvement" (46.1%). A lower likelihood of having "persistence/worsening" SUA was exhibited by patients under anti-IgE (OR 0.38, 95% CI 0.17-0.84) and inhaled corticosteroids-bronchodilator association treatment (OR 0.13, 95% CI 0.01-1.26, borderline value), while a higher likelihood was shown by older age at first asthma diagnosis (OR 1.04, 95% CI 1.01-1.07). Conclusion: the implementation of a SUA registry, the availability of patient-level data and the application of an innovative longitudinal analysis allowed to observe a general improvement in asthma control, one year after baseline, and a lower risk of SUA "persistence/worsening" in patients under anti-IgE and regular ICS-bronchodilator association use

Effects of traffic-related air and noise pollution exposure on allergic diseases in the elderly: an observational study

IntroductionTraffic-related air and noise pollution are important public health issues. The aim of this study was to estimate their effects on allergic/respiratory outcomes in adult and elderly subjects.Materials and methodsSix hundred and forty-five subjects living in Pisa (Tuscany, Italy) were investigated through a questionnaire on allergic/respiratory symptoms and diseases. Traffic-related air pollution and noise exposures were assessed at residential address by questionnaire, modelled annual mean NO2 concentrations (1 km and 200 m resolution), and noise level over a 24-h period (Lden). Exposure effects were assessed through logistic regression models stratified by age group (18-64 years, >= 65 years), and adjusted for sex, educational level, occupational exposure, and smoking habits.Results63.6% of the subjects reported traffic exposure near home. Mean exposure levels were: 28.24 (+/- 3.26 SD) and 27.23 (+/- 3.16 SD) mu g/m3 for NO2 at 200 m and 1 km of resolution, respectively; 57.79 dB(A) (+/- 6.12 SD) for Lden. Exposure to vehicular traffic (by questionnaire) and to high noise levels [Lden >= 60 dB(A)] were significantly associated with higher odds of allergic rhinitis (OR 2.01, 95%CI 1.09-3.70, and OR 1.99, 95%CI 1.18-3.36, respectively) and borderline with rhino-conjunctivitis (OR 2.20, 95%CI 0.95-5.10, and OR 1.76, 95%CI 0.91-3.42, respectively) only in the elderly. No significant result emerged for NO2.ConclusionsOur findings highlighted the need to better assess the effect of traffic-related exposure in the elderly, considering the increasing trend in the future global population's ageing.Global population is ageing.Allergic diseases are globally widespread even on adult population.The susceptibility due to ageing may increase the impact of air pollution on the elderly.Traffic-related air and noise pollution affects allergic status of the elderly

Relationship of long-term air pollution exposure with asthma and rhinitis in Italy: an innovative multipollutant approach

Background: air pollution is a complex mixture; novel multipollutant approaches could help understanding the health effects of multiple concomitant exposures to air pollutants. Aim: to assess the relationship of long-term air pollution exposure with the prevalence of respiratory/allergic symptoms and diseases in an Italian multicenter study using single and multipollutant approaches. Methods: 14420 adults living in 6 Italian cities (Ancona, Pavia, Pisa, Sassari, Turin, Verona) were investigated in 2005-2011 within 11 different study cohorts. Questionnaire information about risk factors and health outcomes was collected. Machine learning derived mean annual concentrations of PM10, PM2.5, NO2 and mean summer concentrations of O3 (μg/m3) at residential level (1-km resolution) were used for the period 2013-2015. The associations between the four pollutants and respiratory/allergic symptoms/diseases were assessed using two approaches: a) logistic regression models (single-pollutant models), b) principal component logistic regression models (multipollutant models). All the models were adjusted for age, sex, education level, smoking habits, season of interview, climatic index and included a random intercept for cohorts. Results: the three-year average (± standard deviation) pollutants concentrations at residential level were: 20.3 ± 6.8 μg/m3 for PM2.5, 29.2 ± 7.0 μg/m3 for PM10, 28.0 ± 11.2 μg/m3 for NO2, and 70.9 ± 4.3 μg/m3 for summer O3. Through the multipollutant models the following associations emerged: PM10 and PM2.5 were related to 14-25% increased odds of rhinitis, 23-34% of asthma and 30-33% of night awakening; NO2 was related to 6-9% increased odds of rhinitis, 7-8% of asthma and 12% of night awakening; O3 was associated with 37% increased odds of asthma attacks. Overall, the Odds Ratios estimated through the multipollutant models were attenuated when compared to those of the single-pollutant models. Conclusions: this study enabled to obtain new information about the health effects of air pollution on respiratory/allergic outcomes in adults, applying innovative methods for exposure assessment and multipollutant analyses

Assessing external exposome by implementing an Environmental Data Management System using Open Data

Abstract Due to the increasing importance of exposome in environmental epidemiology, feasibility and usefulness of an Environmental Data Management System (EDMS) using Open Data was evaluated. The EDMS includes data from 10 European cities (Celje (Slovenia), Łódź (Poland), Manchester (UK), Palermo (Italy), Paris (France), Porto (Portugal), Regensburg (Germany), Reus (Spain), Rijeka (Croatia), Thessaloniki (Greece)) about external non-specific and specific exposome factors at the city or country level (2017–2020). Findings showed that the highest values of life expectancy were in Reus females (86 years) and Palermo males (81 years). UK had the highest obesity rate (28%), Croatia the highest prescribed drug consumption (62%), Greece and Portugal the highest smoking rates (37%, 42%) and daily alcohol consumption (21%), respectively. The most polluted cities were Thessaloniki for PM10 (38 µg/m3), Łódź for PM2.5 (25 µg/m3), Porto for NO2 (62 µg/m3) and Rijeka for O3 (92 µg/m3). Thessaloniki had the highest grey space (98%) and Łódź the highest cumulative amount of pollen (39,041 p/m3). The highest daily noise levels ≥ 55 dB was in Reus (81% to traffic) and Regensburg (21% to railway). In drinking water, arsenic had the highest value in Thessaloniki (6.4 µg/L), boron in Celje (24 mg/L) and lead in Paris (46.7 µg/L). Portugal and Greece showed the highest pesticide residues in food (7%). In conclusion, utilizing open-access databases enables the translation of research findings into actionable strategies for public health interventions

[BIGEPI project: environmental and health data]

Objectives: the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures. Design: the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin. Setting and participants: BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4). Main outcome measures: environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation. Results: BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 μg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P. Conclusions: BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers

Assessing external exposome by implementing an Environmental Data Management System using Open Data

Abstract Due to the increasing importance of exposome in environmental epidemiology, feasibility and usefulness of an Environmental Data Management System (EDMS) using Open Data was evaluated. The EDMS includes data from 10 European cities (Celje (Slovenia), Łódź (Poland), Manchester (UK), Palermo (Italy), Paris (France), Porto (Portugal), Regensburg (Germany), Reus (Spain), Rijeka (Croatia), Thessaloniki (Greece)) about external non-specific and specific exposome factors at the city or country level (2017–2020). Findings showed that the highest values of life expectancy were in Reus females (86 years) and Palermo males (81 years). UK had the highest obesity rate (28%), Croatia the highest prescribed drug consumption (62%), Greece and Portugal the highest smoking rates (37%, 42%) and daily alcohol consumption (21%), respectively. The most polluted cities were Thessaloniki for PM (38 µg/m ), Łódź for PM (25 µg/m ), Porto for NO (62 µg/m ) and Rijeka for O (92 µg/m ). Thessaloniki had the highest grey space (98%) and Łódź the highest cumulative amount of pollen (39,041 p/m ). The highest daily noise levels ≥ 55 dB was in Reus (81% to traffic) and Regensburg (21% to railway). In drinking water, arsenic had the highest value in Thessaloniki (6.4 µg/L), boron in Celje (24 mg/L) and lead in Paris (46.7 µg/L). Portugal and Greece showed the highest pesticide residues in food (7%). In conclusion, utilizing open-access databases enables the translation of research findings into actionable strategies for public health interventions