[Short-term effects of PM10 on cause-specific mortality and the role of long-term environmental pressures in the industrial areas of Brindisi and Civitavecchia]. / Effetti a breve termine del PM10 sulla mortalità causa-specifica e ruolo delle pressioni ambientali di lungo periodo nelle aree industriali di Brindisi e Civitavecchia.

OBJECTIVES: the health status of people living near industrial plants is often exposed to several environmental risk factors, including air pollution. The aim of this study is to assess the relationship between daily PM10 levels and cause-specific mortality in a selection of municipalities near two industrial plants from 2006 to 2015. DESIGN: a time-series design with Poisson regression adjusted for a predefined set of confounders was used to quantify the association between exposure, calculated as daily PM10 levels extrapolated from machine-learning models using satellite data, and cause-specific mortality. SETTING AND PARTICIPANTS: twenty municipalities near the thermal power plants in Civitavecchia and Brindisi were selected. The municipalities were then divided into three scenarios of chronic exposure derived from SPRAY simulation models of pollutant deposition. MAIN OUTCOME MEASURES: daily cause-specific non-accidental, cardiovascular, and respiratory deaths defined according to the International Classification of Diseases code at the municipality level. RESULTS: a total of 41,942 deaths were observed in the entire area (10,503 in the Civitavecchia area and 31,439 in the Brindisi area), of which approximately 41% were due to cardiovascular causes and 8% due to respiratory causes. The association showed an increase in shortterm effects in municipalities with higher chronic levels of pollution exposure. For example, risk estimates reported as percentage increases per 10-unit increase in PM10 were 6.7% (95% CI 0.9, 12.7%) in scenario 3 (highest exposure) compared to 4.2% (-1.2, 9.9%) and 2.7% (-4.2, 10.2%) in scenarios 2 and 1, respectively, in the area near the Civitavecchia plant. Similar effects were observed for the Brindisi area. CONCLUSIONS: despite the well-documented relationship between short-term pollution and mortality, it appears that greater chronic exposure to industrial pollutants leads to increased short-term effects of PM10. The limited number of events suggests that this study could serve as a starting point for a larger investigation.

[The Integrated Environmental Health Impact of emissions from a steel plant in Taranto and from a power plant in Brindisi, (Apulia Region, Southern Italy)]. / L'impatto ambientale e sanitario delle emissioni dell'impianto siderurgico di Taranto e della centrale termoelettrica di Brindisi.

OBJECTIVES: to estimate the environmental and health impact attributable to PM2.5 emissions from the ex-ILVA steel plant in Taranto and the ENEL power plant in Brindisi (Apulia Region, Southern Italy). DESIGN: a SPRAY Lagrangian dispersion model was used to estimate PM2.5 concentrations and population weighted exposures following the requirements of the Integrated Environmental Authorization (IEA) of the two plants under study. Available concentration-response functions (OMS/HRAPIE and updates) were used to estimate the number of attributable premature deaths. SETTING AND PARTICIPANTS: residents in the 40 municipalities of the domains of the VDS (assessment of health damage, according to the Regional Law n. 21/2012) of Brindisi (source: Italian National Institute of Statistics 2011 Census) and residents in Taranto, Statte, and Massafra (source: cohort study). MAIN OUTCOME MEASURES: mortality from natural causes, cardiovascular and respiratory diseases, and lung cancer attributable to PM2.5. Incremental lifetime cumulative risks (ILCRs) for lung cancer associated to PM2.5 exposure. RESULTS: there was a reduction of the estimated impacts from the pre to the post IEA-scenarios in both Taranto and Brindisi. In Taranto, ILCRs greater than 1x10-4; were estimated in 2010 and 2012; the ILCR was greater than 1x10-4; in the district of Tamburi (near the plant) also for the 2015 scenario. ILCRs estimated for Brindisi were between 1x10-6; and 4x10-5;. CONCLUSIONS: the Integrated Environmental Health Impact Assessment confirmed the results of the VDS conducted according to the toxicological risk assessment approach. An unacceptable risk was estimated for Tamburi also for the 2015 scenario, characterized by a production of 4.7 million tons of steel, about half compared to one foreseen by the IEA (8 mt.).

Industrial air pollution and mortality in the Taranto area, Southern Italy: A difference-in-differences approach.

BACKGROUND: A large steel plant close to the urban area of Taranto (Italy) has been operating since the sixties. Several studies conducted in the past reported an excess of mortality and morbidity from various diseases at the town level, possibly due to air pollution from the plant. However, the relationship between air pollutants emitted from the industry and adverse health outcomes has been controversial. We applied a variant of the "difference-in-differences" (DID) approach to examine the relationship between temporal changes in exposure to industrial PM10 from the plant and changes in cause-specific mortality rates at area unit level. METHODS: We examined a dynamic cohort of all subjects (321,356 individuals) resident in the Taranto area in 1998-2010 and followed them up for mortality till 2014. In this work, we included only deaths occurring on 2008-2014. We observed a total of 15,303 natural deaths in the cohort and age-specific annual death rates were computed for each area unit (11 areas in total). PM10 and NO2 concentrations measured at air quality monitoring stations and the results of a dispersion model were used to estimate annual average population weighted exposures to PM10 of industrial origin for each year, area unit and age class. Changes in exposures and in mortality were analyzed using Poisson regression. RESULTS: We estimated an increased risk in natural mortality (1.86%, 95% confidence interval [CI]: -0.06, 3.83%) per 1 µg/m3 annual change of industrial PM10, mainly driven by respiratory causes (8.74%, 95% CI: 1.50, 16.51%). The associations were statistically significant only in the elderly (65+ years). CONCLUSIONS: The DID approach is intuitively simple and reduces confounding by design. Under the multiple assumptions of this approach, the study indicates an effect of industrial PM10 on natural mortality, especially in the elderly population.

Spatial distribution of kidney disease in the contaminated site of Taranto (Italy).

BACKGROUND: Exposure to heavy metals has been associated with kidney disease. We investigated the spatial distribution of kidney disease in the industrially contaminated site of Taranto. METHODS: Cases were subjects with a first hospital discharge diagnosis of kidney disease. Cases affected by specific comorbidities were excluded. Standardized Hospitalization Ratios (SHRs) were computed for low/high exposure area and for modeled spatial distribution of cadmium and fine particulate matter. RESULT: Using the high/low exposure approach, in subjects aged 20-59 years residing in the high exposure area a significant excess of hospitalization was observed in males and a non-significant excess in females. No excesses were observed in subjects aged 60 years and over. The analysis by the modeling approach did not show a significant association with the greatest pollution impact area. CONCLUSION: Due to the excesses of hospitalization observed in the high/low exposure approach, a continuing epidemiological surveillance of residents and occupational groups is warranted.

Contribution of harbour activities and ship traffic to PM2.5, particle number concentrations and PAHs in a port city of the Mediterranean Sea (Italy).

In this work, an assessment of the impact of ship traffic and related harbour activities (loading/unloading of ships and hotelling in harbour) on PM 2.5 and particle number concentrations (PNC) separating the contribution associated to ship traffic from that of harbour-related activities is reported. Further, an assessment of the impact and environmental risks associated to polycyclic aromatic hydrocarbon (PAH) concentrations was performed. Results refer to the city of Brindisi (88,500 inhabitants) in the south-eastern part of Italy and its harbour (with yearly 9.5 Mt of goods, over 520,000 passengers and over 175,000 vehicles). PM2.5 and PNC concentrations show a clear daily pattern correlated with daily ship traffic pattern in the harbour. High temporal resolution measurements and correlations with wind direction were used to estimate the average direct contribution to measured concentrations of this source. The average relative contribution of ship traffic was 7.4% (±0.5%) for PM2.5 and 26% (±1%) for PNC. When the contribution associated to harbour-related activities is added, the percentages become 9.3% (±0.5%) for PM2.5 and 39% (±1%) for PNC. In the site analysed, air coming from the harbour/industrial sector was richer in PAHs (5.34 ng/m3) than air sampled from all directions (3.89 ng/m3). The major compounds were phenanthrene, fluoranthene and pyrene, but the congener profiles were different in the two direction sectors: air from the harbour/industrial sector was richer in phenanthrene and fluorene, which are the most abundant PAHs in ship emissions. Results showed that lighter PAHs are associated to the gas phase, while high molecular weight congeners are mostly present in the particulate phase. The impact on the site studied of the harbour/industrial source to PAHs was 56%(range, 29-87%).

[Environmental indicators in EpiAir2 project: air quality data for epidemiological surveillance]. / Indicatori ambientali nello studio EpiAir2: i dati di qualità dell'aria per la sorveglianza epidemiologica.

OBJECTIVE: construction of environmental indicators of air pollution suitable for epidemiological surveillance in 25 Italian cities for EpiAir2 project (2006-2010) and presentation of the results from a 10 years of surveillance system (2001-2010) in 10 Italian cities. DESIGN: data on particulate matter (PM10 and its fine fraction PM2.5), nitrogen dioxide (NO2), and ozone (O3), measured in the 2006-2010 calendar period, were collected. Meteorological data needed to estimate unbiased measures of the effect of pollutants are: temperature, relative humidity (estimated "apparent temperature"), and barometric pressure. In continuity with the previous EpiAir project, the same criteria for the selection of monitoring stations were applied and standard methods to estimate daily environmental indicators were used. Furthermore, it was checked the adequacy of the selected data to represent the population exposure. SETTING AND PARTICIPANTS: EpiAir2 project, relative to the period 2006-2010, involves the cities of Milano, Mestre-Venezia, Torino, Bologna, Firenze, Pisa, Roma, Taranto, Cagliari, and Palermo, already included in the previous study. The city of Treviso, Trieste, Padova, Rovigo, Piacenza, Parma, Ferrara, Reggio Emilia, Modena, Genova, Rimini, Ancona, Bari, Brindisi, and Napoli are added to the previous group. RESULTS: particulate matter concentrations have decreased in most cities during the study period, while concentrations of NO2 and ozone do not show a similar clear trend. The analysis of the trend showed annual mean values of PM10 higher than 40 µg/m(3) in some areas of the Po Valley, and annual mean values of NO2 higher than 40 µg/m(3) in the cities of Trieste, Milano, Padova, Torino, Modena, Bologna, Roma, and Napoli. CONCLUSION: the enlargement of the EpiAir project to 13 other cities has highlighted critical issues related to the different geographical areas under study. Results of EpiAir2 project point out the need of a monitoring system of air pollution concentrations in both urban and industrial sites, in order to obtain reliable estimates of exposure for resident populations and to evaluate the related time trend.