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Background: Although numerous studies have provided evidence of an association between ambient air pollution and acute cardiac morbidity, little is known regarding susceptibility factors. Methods: We conducted a time-stratified case-crossover study in 9 Italian cities between 2001 and 2005 to estimate the short-term association between airborne particles with aerodynamic diameter <10 μm (PM 10 ) and cardiac hospital admissions, and to identify susceptible groups. We estimated associations between daily PM 10 and all cardiac diseases, acute coronary syndrome, arrhythmias and conduction disorders, and heart failure for 167,895 hospitalized subjects ≥65 years of age. Effect modification was assessed for age, sex, and a priori-defined hospital diagnoses (mainly cardiovascular and respiratory conditions) from the previous 2 years as susceptibility factors. Results: The increased risk of cardiac admissions was 1.0% (95% confidence interval [CI] = 0.7% to 1.4%) per 10 μg/m 3 PM 10 at lag 0. The effect was slightly higher for heart failure (lag 0, 1.4% [0.7% to 2.0%]) and acute coronary syndrome (lag 0-1, 1.1% [0.4% to 1.9%]) than for arrhythmias (lag 0, 1.0% [0.2% to 1.8%]). Women were at higher risk of heart failure (2.0% [1.2% to 2.8%]; test for interaction, P = 0.022), whereas men were at higher risk of arrhythmias (1.9% [0.8% to 3.0%]; test for interaction, P = 0.020). Subjects aged 75-84 years were at higher risk of admissions for coronary events (2.6% [1.5% to 3.8%]; test for interaction, P = 0.001). None of the identified chronic conditions was a clear marker of susceptibility. Conclusions: An important effect of PM 10 on hospitalizations for cardiac diseases was found in Italian cities. Sex and older age were susceptibility factors.

Abstract Rationale Acute effects of ozone on mortality have been extensively documented in clinical and epidemiological research. However, only a few studies have focused on subgroups of the population especially vulnerable to these effects. Objectives To estimate the association between exposure to ozone and cause-specific mortality, and to evaluate whether individual sociodemographic characteristics or chronic conditions confer greater susceptibility to the adverse effects of ozone. Methods A case-crossover analysis was conducted in 10 Italian cities. Data on mortality were collected for the period 2001 to 2005 (April–September) for 127,860 deceased subjects. Information was retrieved on cause of death, sociodemographic characteristics, chronic conditions from previous hospital admissions, and location of death. Daily ozone concentrations were collected from background fixed monitors. Measurements and Main Results We estimated a 1.5% (95% confidence interval [CI], 0.9–2.1) increase in total mortality for a 10 μg/m3 increase in ozone (8-h, lag 0–5). The effect lasted several days for total, cardiac and respiratory mortality (lag 0–5), and it was delayed for cerebrovascular deaths (lag 3–5). In the subgroup analysis, the effect was more pronounced in people older than 85 years of age (3.5%; 95% CI, 2.4–4.6) than in 35- to 64-year-old subjects (0.8%; 95% CI, −0.8 to 2.5), in women (2.2%; 95% CI, 1.4–3.1) than in men (0.8%; 95% CI, −0.1 to 1.8), and for out-of-hospital deaths (2.1%; 95% CI, 1.0–3.2), especially among patients with diabetes (5.5%; 95% CI, 1.4–9.8). Conclusions A greater vulnerability of elderly people and women was indicated; subjects who died at home and had diabetes emerged as especially affected.

Noise is one of the most diffused environmental stressors affecting modern life. As such, the scientific community is committed to studying the main emission and transmission mechanisms aiming at reducing citizens’ exposure, but is also actively studying the effects that noise has on health. However, scientific literature lacks data on multiple sources of noise and cardiovascular outcomes. The present cross-sectional study aims to evaluate the impact that different types of noise source (road, railway, airport and recreational) in an urban context have on blood pressure variations and hypertension. 517 citizens of Pisa, Italy, were subjected to a structured questionnaire and five measures of blood pressure in one day. Participants were living in the same building for at least 5 years, were aged from 37 to 72 years old and were exposed to one or more noise sources among air traffic, road traffic, railway and recreational noise. Logistic and multivariate linear regression models have been applied in order to assess the association between exposures and health outcomes. The analyses showed that prevalence of high levels of diastolic blood pressure (DBP) is consistent with an increase of 5 dB (A) of night-time noise (β = 0.50 95% CI: 0.18–0.81). Furthermore, increased DBP is also positively associated with more noise sensitive subjects, older than 65 years old, without domestic noise protection, or who never close windows. Among the various noise sources, railway noise was found to be the most associated with DBP (β = 0.68; 95% CI: −1.36, 2.72). The obtained relation between DBP and night-time noise levels reinforces current knowledge.

Background The burden of cancer is difficult to study in the context of the occupied Palestinian territory because of the limited data available. This study aims to evaluate the quality of mortality data and to investigate cancer mortality patterns in the occupied Palestinian territory’s West Bank governorates from 1999 to 2009. Methods Death certificates collected by the Palestinian Ministry of Health for Palestinians living in the West Bank were used. Direct and indirect age-standardised mortality rates were computed and used to compare different governorates according to total and specific cancer mortality. Furthermore, standardised proportional mortality ratios were calculated to compare mortality by urban, rural and camp locales. Results The most common cause of death out of all cancer types was lung cancer among males (22.8 %) and breast cancer among females (21.5 %) followed by prostate cancer for males (9.5 %) and by colon cancer for females (11.4 %). Regional variations in cancer-specific causes of death were observed. The central- West Bank governorates had the lowest mortality for most cancer types among men and women. Mortality for lung cancer was highest in the north among men (SMR 109.6; 95%CI 99.5-120.4). For prostate cancer, mortality was highest in the north (SMR 103.6; 95%CI 88.5-120.5) and in the south (SMR 118.6; 95%CI 98.9-141.0). Breast cancer mortality was highest in the south (SMR 119.3; 95%CI 103.9-136.2). Similar mortality rate patterns were found in urban, rural and camp locales. Conclusion The quality of the Palestinian mortality registry has improved over time. Results in the West Bank governorates present different mortality patterns. The differences might be explained by personal, contextual and environmental factors that need future in-depth investigations.

Objectives: We investigated the short-term effects of carbon monoxide on total and cardiovascular mortality in 19 European cities participating in the APHEA-2 (Air Pollution and Health: A European Approach) project. Methods: We examined the association using hierarchical models implemented in two stages. In the first stage, data from each city were analyzed separately, whereas in the second stage the city-specific air pollution estimates were regressed on city-specific covariates to obtain overall estimates and to explore sources of possible heterogeneity. We evaluated the sensitivity of our results by applying different degrees of smoothing for seasonality control in the city-specific analysis. Results: We found significant associations of CO with total and cardiovascular mortality. A$1-mg/m^3$increase in the 2-day mean of CO levels was associated with a 1.20% [95% confidence interval (CI), 0.63-1.77%] increase in total deaths and a 1.25% (95% CI, 0.30-2.21%) increase in cardiovascular deaths. There was indication of confounding with black smoke and nitrogen dioxide, but the pollutant-adjusted effect of CO on mortality remained at least marginally statistically significant. The effect of CO on total and cardiovascular mortality was observed mainly in western and southern European cities and was larger when the standardized mortality rate was lower. Conclusions: The results of this large study are consistent with an independent effect of CO on mortality. The heterogeneity found in the effect estimates among cities may be explained partly by specific city characteristics.

ObjectivesWe evaluated the association between PM10 concentration and out-of-hospital coronary deaths in eight Italian cities during 1997–2004.Methods16 989 subjects aged >35 years who died out-of-hospital from coronary causes were studied and hospital admissions in the previous 2 years identified. We studied the effect of the mean of current and previous day PM10 values (lag 0–1). A city-specific case-crossover analysis was applied using a time-stratified approach considering as confounders weather, holidays, influenza epidemics, and summer decrease in population. The pooled percentage increase (95% CI) in mortality per 10 μg/m3 increase in PM10 was estimated.ResultsA statistically significant increase in out-of-hospital coronary deaths was related to a 10 μg/m3 increase in PM10: 1.46% (95% CI 0.50 to 2.43). Although no statistically significant effect modification by age was found, the effect was stronger among subjects aged >65 years (1.60%, 0.59 to 2.63), particularly those aged 65–74 (3.01%, 0.74 to 5.34). People in the lowest socio-economic category (3.34%, 1.28 to 5.45) had a stronger effect than those in the highest category. No clear effect modification was seen for gender, season or any specific comorbidity. An indication of negative effect modification was seen for previous admission for cardiac dysrhythmias. Subjects without hospital admissions in the previous 2 years were slightly more affected by PM10 effects (1.91%, 0.28 to 3.47) than those with at least one previous hospital admission (1.44%, 0.09 to 2.82).ConclusionsOur results show that short term exposure to PM10 is associated with coronary mortality especially among the elderly and socio-economically disadvantaged. No clear effect modification by previous hospitalisations was detected except for cardiac dysrhythmias, possibly due to protective treatment.

Background: Several studies have shown an association between nitrogen dioxide (NO₂) and mortality. In Italy, the EpiAir multicentric study, \"Air Pollution and Health: Epidemiological Surveillance and Primary Prevention,\" investigated short-term health effects of air pollution, including NO₂. Objectives: To study the individual susceptibility, we evaluated the association between NO₂ and cause-specific mortality, investigating individual sociodemographic features and chronic/acute medical conditions as potential effect modifiers. Methods: We considered 276,205 natural deaths of persons > 35 years of age, resident in 10 Italian cities, and deceased between 2001 and 2005. We chose a time-stratified case-crossover analysis to evaluate the short-term effects of NO₂ on natural, cardiac, cerebrovascular, and respiratory mortality. For each subject, we collected information on sociodemographic features and hospital admissions in the previous 2 years. Fixed monitors provided daily concentrations of NO₂, paniculate matter ≤ 10 μm in aerodynamic diameter (PM₁₀) and ozone (O₃). Results: We found statistically significant associations with a 10-μg/m³ increase of NO₂ for natural mortality [2.09% for lag 0-5; 95% confidence interval (CI), 0.96-3.24], for cardiac mortality (2.63% for lag 0-5; 95% CI, 1.53-3.75), and for respiratory mortality (3.48% for lag 1-5; 95% CI, 0.75-6.29). These associations were independent from those of PM₁₀ and O₃. Stronger associations were estimated for subjects with at least one hospital admission in the 2 previous years and for subjects with three or more specific chronic conditions. Some cardiovascular conditions (i.e., ischemie heart disease, pulmonary circulation impairment, heart conduction disorders, heart failure) and diabetes appeared to confer a strong susceptibility to air pollution. Conclusions: Our results suggest significant and likely independent effects of NO₂ on natural, cardiac, and respiratory mortality, particularly among subjects with specific cardiovascular preexisting chronic conditions and diabetes.

Background Congenital anomalies and their primary prevention are a crucial public health issue. This work aimed to estimate the prevalence of congenital anomalies in Brindisi, a city in southeastern Italy at high risk of environmental crisis. Methods This research concerned newborns up to 28 days of age, born between 2001 and 2010 to mothers resident in Brindisi and discharged with a diagnosis of congenital anomaly. We classified cases according to the coding system adopted by the European Network for the Surveillance of Congenital Anomalies (EUROCAT). Prevalence rates of congenital anomalies in Brindisi were compared with those reported by EUROCAT. Logistic regression models were adapted to evaluate the association between congenital anomalies and municipality of residence of the mother during pregnancy. Results Out of 8,503 newborns we recorded 194 subjects with congenital anomalies (228.2/10,000 total births), 1.2 times higher than the one reported by the EUROCAT pool of registries. We observed 83 subjects with congenital heart diseases with an excess of 49.1%. Odds Ratios for congenital heart diseases significantly increased for newborns to mothers resident in Brindisi (OR 1.75 CI 95% 1.30-2.35). Conclusions Our findings indicated an increased prevalence of Congenital Anomalies (especially congenital heart diseases) in the city of Brindisi. More research is needed in order to analyze the role of factors potentially involved in the causation of congenital anomalies.

BackgroundOn September 26th 1976 an accident occurred in a chemical plant located in Manfredonia (Apulia region, Italy) where Caprolactam (plastic) and Urea (fertilisers) were produced. More than 12 tons of arsenic compounds, used in the production of Urea, were released in the atmosphere, contaminating the plant and surrounding areas. Our study investigates late effects of arsenic exposure among workers present on the day of the accident and during the site clearance.MethodsWe performed a historical cohort study including 1467 workers (39 females). Follow-up was performed by contacting municipalities of residence in Italy. Death certificates were collected. End of follow-up was either date of death, lost to follow-up or 15th March 2016. Cause specific mortality rates for the period 1976–2015 and 5 year age group were obtained for Apulia region and Foggia Province. Standardised Mortality Ratios will be calculated. Additionally, we will analyse data with Cox regression models by assigning workers to job category (white-collars, blue-collars and contract workers) and work area (fertiliser/plastic).ResultsIn the analysis restricted to men, we observed a total number of 51 102 person-years, 32 609 for 923 workers directly employed in the plant and 18 415 for 544 contract workers. We observed 307 deaths; 161 among contract workers. Highest mortality rate (8.7 deaths per 1000 person-year) was observed among contract workers. Higher values were observed among workers of the fertiliser work area.ConclusionsThe results suggest an increased mortality for all causes among contract workers and employees in the fertiliser area. Cause-specific analysis will be presented.