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

Risk of prostate cancer in the proximity of industrial installations: A multicase-control study in Spain (MCC-Spain)

BACKGROUND

Prostate cancer (PC) is the second most frequent tumor in men worldwide; however, its etiology remains largely unknown, with the exception of age and family history. The wide variability in incidence/mortality across countries suggests a certain role for environmental exposures that has not yet been clarified.

OBJECTIVE

To evaluate the association between risk of PC (by clinical profile) and residential proximity to pollutant industrial installations (by industrial groups, groups of carcinogens, and specific pollutants released), within the context of a Spanish population-based multicase-control study of incident cancer (MCC-Spain).

METHODS

This study included 1186 controls and 234 PC cases, frequency matched by age and province of residence. Distances from participants' residences to the 58 industries located in the study area were calculated and categorized into "near" (considering different limits between ≤1 km and ≤ 3 km) or "far" (>3 km). Odds ratios (ORs) and 95 % confidence intervals (95%CIs) were estimated using mixed and multinomial logistic regression models, adjusted for potential confounders and matching variables.

RESULTS

No excess risk was detected near the overall industries, with ORs ranging from 0.66 (≤2 km) to 1.11 (≤1 km). However, positive associations (OR; 95%CI) were found, by industrial group, near (≤3 km) industries of ceramic (2.54; 1.28-5.07), food/beverage (2.18; 1.32-3.62), and disposal/recycling of animal waste (2.67; 1.12-6.37); and, by specific pollutant, near plants releasing fluorine (4.65; 1.45-14.91 at ≤1.5 km) and chlorine (5.21; 1.56-17.35 at ≤1 km). In contrast, inverse associations were detected near industries releasing ammonia, methane, dioxins+furans, polycyclic aromatic hydrocarbons, trichloroethylene, and vanadium to air.

CONCLUSIONS

The results suggest no association between risk of PC and proximity to the overall industrial installations. However, some both positive and inverse associations were detected near certain industrial groups and industries emitting specific pollutants.

An ecological study shows increased prevalence of autism spectrum disorder in children living in a heavily polluted area

The burden of autism spectrum disorder (ASD) is increasing worldwide with genetic, epigenetic, and environmental factors being possibly responsible for the observed epidemiological figures. In the setting of environmental exposure, the city of Taranto, in Southern Italy, represents an interesting case study as it hosts well inside the city one of the biggest steel plants in Europe. This is a cross-sectional ecological study carried out in the year 2020 in the province of Taranto designed to estimate the burden of ASD in the municipalities of Taranto and Statte, classified as high environmental risk areas (Contaminated Site of National Interest-SIN), compared to the other 27 municipalities of the same province. Differences have been evaluated using the Chi Square Test. Children aged 6-11 years identified in SIN municipalities had a statistically significant higher prevalence of ASD than children of other municipalities (9.58 vs. 6.66/1000 respectively, p = 0.002). No statistically significant difference was observed for the 12-18 years group (3.41 vs. 2.54/1000, p = 0.12). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence.

Using a novel 'difference-in-differences' method and syndromic surveillance to estimate the change in local healthcare utilisation during periods of media reporting in the early stages of the COVID-19 pandemic in England

OBJECTIVES

Syndromic surveillance supplements traditional laboratory reporting for infectious diseases monitoring. Prior to widespread COVID-19 community surveillance, syndromic surveillance was one of several systems providing real-time information on changes in healthcare-seeking behaviour. The study objective was to identify changes in healthcare utilisation during periods of high local media reporting in England using 'difference-in-differences' (DiD).

STUDY DESIGN

A retrospective observational study was conducted using five media events in January-February 2020 in England on four routinely monitored syndromic surveillance indicators.

METHODS

Dates 'exposed' to a media event were estimated using Google Trends internet search intensity data (terms = 'coronavirus' and local authority [LA]). We constructed a negative-binomial regression model for each indicator and event time period to estimate a direct effect.

RESULTS

We estimated a four-fold increase in telehealth 'cough' calls and a 1.4-fold increase in emergency department (ED) attendances for acute respiratory illness in Brighton and Hove, when a so-called 'superspreading event' in this location was reported in local and national media. Significant decreases were observed in the Buxton (telehealth and ED attendance) and Wirral (ED attendance) areas during media reports of a returnee from an outbreak abroad and a quarantine site opening in the area respectively.

CONCLUSIONS

We used a novel approach to directly estimate changes in syndromic surveillance reporting during the early phase of the COVID-19 pandemic in England, providing contextual information on the interpretation of changes in health indicators. With careful consideration of event timings, DiD is useful in producing real-time estimates on specific indicators for informing public health action.

Sex, environment, and death rate in a dementia cohort: a seven-years Bayesian survival analysis using medications data from a contaminated area in Italy

Introduction

Studies have analyzed the effects of industrial installations on the environment and human health in Taranto, Southern Italy. Literature documented associations between different variables and dementia mortality among both women and men. The present study aims to investigate the associations between sex, environment, age, disease duration, pandemic years, anti-dementia drugs, and death rate.

Methods

Data from the regional medication registry were used. All women and men with an anti-dementia medication between 2015 and 2021 were included and followed-up to 2021. Bayesian mixed effects logistic and Cox regression models with time varying exposures were fitted using integrated nested Laplace approximations and adjusting for patients and therapy characteristics.

Results

A total of 7,961 person-years were observed. Variables associated with lower prevalence of acetylcholinesterase inhibitors (AChEIs) medication were male sex (OR 0.63, 95% CrI 0.42-0.96), age 70-79 years (OR 0.17, 95% CrI 0.06-0.47) and ≥ 80 years (OR 0.08, 95% CrI 0.03-0.23), disease duration of 2-3 years (OR 0.43, 95% CrI 0.32-0.56) and 4-6 years (OR 0.21, 95% CrI 0.13-0.33), and pandemic years 2020 (OR 0.50, 95% CrI 0.37-0.67) and 2021 (OR 0.47, 95% CrI 0.33-0.65). Variables associated with higher mortality were male sex (HR 2.14, 95% CrI 1.75-2.62), residence in the contaminated site of national interest (SIN) (HR 1.25, 95% CrI 1.02-1.53), age ≥ 80 years (HR 6.06, 95% CrI 1.94-18.95), disease duration of 1 year (HR 1.50, 95% CrI 1.12-2.01), 2-3 years (HR 1.90, 95% CrI 1.45-2.48) and 4-6 years (HR 2.21, 95% CrI 1.60-3.07), and pandemic years 2020 (HR 1.38, 95% CrI 1.06-1.80) and 2021 (HR 1.56, 95% CrI 1.21-2.02). Variables associated with lower mortality were therapy with AChEIs alone (HR 0.69, 95% CrI 0.56-0.86) and in combination with memantine (HR 0.54, 95% CrI 0.37-0.81).

Discussion

Male sex, age, disease duration, and pandemic years appeared to be associated with lower AChEIs medications. Male sex, residence in the SIN of Taranto, age, disease duration, and pandemic years seemed to be associated with an increased death rate, while AChEIs medication seemed to be associated with improved survival rate.

Air Pollution in Cardio-Oncology and Unraveling the Environmental Nexus: JACC: CardioOncology State-of-the-Art Review

Although recent advancements in cancer therapies have extended the lifespan of patients with cancer, they have also introduced new challenges, including chronic health issues such as cardiovascular disease arising from pre-existing risk factors or cancer therapies. Consequently, cardiovascular disease has become a leading cause of non-cancer-related death among cancer patients, driving the rapid evolution of the cardio-oncology field. Environmental factors, particularly air pollution, significantly contribute to deaths associated with cardiovascular disease and specific cancers, such as lung cancer. Despite these statistics, the health impact of air pollution in the context of cardio-oncology has been largely overlooked in patient care and research. Notably, the impact of air pollution varies widely across geographic areas and among individuals, leading to diverse exposure consequences. This review aims to consolidate epidemiologic and preclinical evidence linking air pollution to cardio-oncology while also exploring associated health disparities and environmental justice issues.

Impact of comprehensive air pollution control policies on six criteria air pollutants and acute myocardial infarction morbidity, Weifang, China: A quasi-experimental study

Comprehensive air pollution control policies may reduce pollutant emissions. However, the impact on disease morbidity of the change for the concentration of air pollutants following the policies has been insufficiently studied. We aim to assess the impact of comprehensive air pollution control policies on the levels of six criteria air pollutants and acute myocardial infarction (AMI) morbidity in Weifang, China. This study performed an interrupted time series analysis. The linear model with spline terms and generalized additive quasi-Poisson model were used to estimate the immediate change from 2016 to 2019 in the daily concentration of six air pollutants (PM2.5, PM10, SO2, NO2, O3, and, CO) and AMI incident cases (Age ≥35) associated with the implementation of air pollution control policies in Weifang, respectively. After the implementation of air pollution control policies, air quality in Weifang had been improved. Specifically, the daily concentrations of PM2.5, PM10, SO2, and, CO immediately decreased by 27.9 % (95 % CI: 6.6 % to 44.3 %), 32.9 % (95 % CI: 17.5 % to 45.5 %), 14.6 % (95 % CI: 0.4 % to 26.8 %), and 33.9 % (95 % CI: 22.0 % to 44.0 %), respectively. In addition, the policies implementation was also associate with the immediate decline in the AMI morbidity (-6.5 %, 95 % CI: -10.4 % to -2.3 %). And subgroup analyses indicate that the health effects of the policy intervention were only observed in female (-9.4 %, 95 % CI: -14.4 % to -4.2 %) and those aged ≥65 years (-10.5 %, 95 % CI: -14.6 % to -6.2 %). During the final 20 months of the study period, the policy intervention was estimated to prevent 1603 (95 % CI: 574 to 2587) cases of incident AMI in Weifang. Our results provide strong rationale that the policy intervention significantly reduced ambient pollutant concentrations and AMI morbidity, which highlighted the importance for a comprehensive and rigorous air pollution control policy in regions with severe air pollution.

Creating safety amidst chronic contamination: A mixed-method analysis of residents' experiences in a Southern Italian steel town

This study analyses how residents create safety in Taranto, Italy, a city located next to one of the largest steel plants in Europe. Combining long-term ethnographic research with an online-based survey, our study shows that most respondents recognise and criticise the presence of environmental risks in their daily lives but encounter such risks in complex ways. Contrary to previous scholarship suggesting that pollution can result in alienating residents from their lived environment, this research shows that acute awareness of environmental risks does not necessarily undermine attachment to place but rather can co-exist with or even strengthen it. Our findings propose first that residents experience and understand environmental risk mostly through air pollution, but often situate risks outside of their own neighbourhood and inscribe different meanings to such risk. Second, residents mitigate environmental risk through practices aimed at creating safety, such as moving away from the industrial area or using everyday practices and reflecting on their responsibility for actions. Third, we argue that residents create safety through an attachment and entitlement to place and emotional detachment from pollution and institutional failures. Finally, in line with residents' concerns about safety and how to secure it, this study embraces a shift in its analytical focus from risk to the quest for safety. By doing so, it provides novel insights into environmental risk perception in industrially polluted areas and reveals the often-contradictory sentiments and practices that such areas invoke in residents.

Gender differences, environmental pressures, tumor characteristics, and death rate in a lung cancer cohort: a seven-years Bayesian survival analysis using cancer registry data from a contaminated area in Italy

Introduction

In Taranto, Southern Italy, adverse impacts on the environment and human health due to industrial installations have been studied. In the literature, associations have been reported between gender, environmental factors, and lung cancer mortality in women and men. The aim of this study was to investigate the relationships between gender, residence in areas with high environmental pressures, bronchus/lung cancer characteristics, and death rate.

Methods

Data from the Taranto Cancer Registry were used, including all women and men with invasive bronchus/lung cancer diagnosed between 1 January 2016 and 31 December 2020 and with follow-up to 31 December 2022. Bayesian mixed effects logistic and Cox regression models were fitted with the approach of integrated nested Laplace approximation, adjusting for patients and disease characteristics.

Results

A total of 2,535 person-years were observed. Male gender was associated with a higher prevalence of histological grade 3 (OR 2.45, 95% CrI 1.35-4.43) and lung squamous-cell carcinoma (OR 3.04, 95% CrI 1.97-4.69). Variables associated with higher death rate were male gender (HR 1.24, 95% CrI 1.07-1.43), pathological/clinical stage II (HR 2.49, 95% CrI 1.63-3.79), III (HR 3.40, 95% CrI 2.33-4.97), and IV (HR 8.21, 95% CrI 5.95-11.34), histological grade 3 (HR 1.80, 95% CrI 1.25-2.59), lung squamous-cell carcinoma (HR 1.18, 95% CrI 1.00-1.39), and small-cell lung cancer (HR 1.62, 95% CrI 1.31-1.99). Variables associated with lower death rate were other-type lung cancer (HR 0.65, 95% CrI 0.44-0.95), high immune checkpoint ligand expression (HR 0.75, 95% CrI 0.59-0.95), lung localization (HR 0.73, 95% CrI 0.62-0.86), and left localization (HR 0.85, 95% CrI 0.75-0.95).

Discussion

The results among patients with lung cancer did not show an association between residence in the contaminated site of national interest (SIN) and the prevalence of the above mentioned prognostic factors, nor between residence in SIN and death rate. The findings confirmed the independent prognostic values of different lung cancer characteristics. Even after adjusting for patients and disease characteristics, male gender appeared to be associated with a higher prevalence of poorly differentiated cancer and squamous-cell carcinoma, and with an increased death rate.

Environmental pressures, tumor characteristics, and death rate in a female breast cancer cohort: a seven-years Bayesian survival analysis using cancer registry data from a contaminated area in Italy

Introduction

In Taranto, Southern Italy, adverse impacts on the environment and human health due to industrial installations have been studied. In the literature, few associations have been reported between environmental factors and breast cancer mortality in women. The aim of this study was to investigate the relationships between residence in areas with high environmental pressures, female breast cancer characteristics, and death rate.

Methods

Data from the Taranto Cancer Registry were used, including all women with invasive breast cancer diagnosed between 01 January 2015 and 31 December 2020 and with follow-up to 31 December 2021. Bayesian mixed effects logistic and Cox regression models were fitted with the approach of integrated nested Laplace approximation, adjusting for patients and disease characteristics.

Results

A total of 10,445 person-years were observed. Variables associated with higher death rate were residence in the contaminated site of national interest (SIN) (HR 1.22, 95% CrI 1.01-1.48), pathological/clinical stage III (HR 2.77, 95% CrI 1.93-3.97) and IV (HR 17.05, 95% CrI 11.94-24.34), histological grade 3 (HR 2.50, 95% CrI 1.20-5.23), Ki-67 proliferation index of 21-50% (HR 1.42, 95% CrI 1.10-1.83) and > 50% (HR 1.81, 95% CrI 1.29-2.55), and bilateral localization (HR 1.65, 95% CrI 1.01-2.68). Variables associated with lower death rate were estrogen and/or progesterone receptor positivity (HR 0.61, 95% CrI 0.45-0.81) and HER2/neu oncogene positivity (HR 0.59, 95% CrI 0.44-0.79).

Discussion

The findings confirmed the independent prognostic values of different female breast cancer characteristics. Even after adjusting for patients and disease characteristics, residence in the SIN of Taranto appeared to be associated with an increased death rate.

Implementing co-created citizen science in five environmental epidemiological studies in the CitieS-Health project

BACKGROUND AND AIM

Scientists and scientific institutions are adopting more extensive participatory models, hoping to revisit the existing relationship between science and society. Though citizen science has become more common in environmental monitoring, it is seldom utilized in environmental epidemiology. In the CitieS-Health project, we co-created epidemiological studies with citizens in five European countries. The aim of this paper is to share our experiences and impart methodological insight into the application of co-created citizen science strategies in environmental epidemiology.

METHODS

We applied the CitieS-Health framework, involving citizens in all the phases of the studies: identifying research questions, designing research protocols, collecting data, analysing data, interpreting data, formulating conclusions, authoring scientific articles and communicating the results to diverse audiences. These epidemiological studies, conducted in specific areas in Italy, Lithuania, the Netherlands, Slovenia and Spain, covered diverse local environmental issues and health effects ranging from air pollution and mental health to industrial pollution and kidney disease.

RESULTS

Together with citizens, we successfully conducted environmental epidemiological studies that generated new scientific knowledge reflecting the concerns and knowledge of citizens. Citizens contributed in all the research activities, including activities beyond formulating the research questions, though the researchers initiated several design discussions and conducted time-consuming and complex tasks (e.g. data analysis, measurement of specific exposures and health outcomes). The challenges we encountered were engaging effectively with citizens throughout the study, harmonizing citizens' knowledge and values with the academics' expertise, managing civic expectations, making complex concepts understandable to citizens and representativeness of participating citizens. The co-created studies were able to empower citizens to address local health concerns by sharing and using scientific knowledge generated from studies.

CONCLUSIONS

Integration of co-created citizen science in environmental epidemiology is feasible and has the potential to improve the quality of research whilst promoting civic trust in research and results.

Long-Term Exposure to Ambient PM2.5 and Hospitalizations for Myocardial Infarction Among US Residents: A Difference-in-Differences Analysis

Background Air pollution has been recognized as an untraditional risk factor for myocardial infarction (MI). However, the MI risk attributable to long-term exposure to fine particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) is unclear, especially in younger populations, and few studies have represented the general population or had power to examine comorbidities. Methods and Results We applied the difference-in-differences approach to estimate the relationship between annual PM2.5 exposure and hospitalizations for MI among US residents and further identified potential susceptible subpopulations. All hospital admissions for MI in 10 US states over the period 2002 to 2016 were obtained from the Healthcare Cost and Utilization Project State Inpatient Database. In total, 1 914 684 MI hospital admissions from 8106 zip codes were included in this study. We observed a 1.35% (95% CI, 1.11-1.59) increase in MI hospitalization rate for 1-μg/m3 increase in annual PM2.5 exposure. The estimate was robust to adjustment for surface pressure, relative humidity, and copollutants. In the population exposed to ≤12 μg/m3, there was a larger increment of 2.17% (95% CI, 1.79-2.56) in hospitalization rate associated with 1-μg/m3 increase in PM2.5. Young people (0-34 years of age) and elderly people (≥75 years of age) were the 2 most susceptible age groups. Residents living in more densely populated or poorer areas and individuals with comorbidities were observed to be at a greater risk. Conclusions This study indicates long-term residential exposure to PM2.5 could increase risk of MI among the general US population, people with comorbidities, and poorer individuals. The association persists below current standards.

A Retrospective Observational Study Using Administrative Databases to Assess the Risk of Spontaneous Abortions Related to Environmental and Socioeconomic Conditions

Miscarriage is one of the most frequent adverse events that occurs during pregnancy. This retrospective study aimed to verify if the environmental and socioeconomic conditions related to geographical areas where women live, and the socio-demographic and clinical factors play a role in the risk of spontaneous abortion (SA). The analyses were conducted by hospital discharge records (HDRs) from public and private hospitals in Apulia from 1 January 2021 to 31 December 2021. Women with an age over 40 years old had a major risk of SA compared with women under 18 years (OR 2.30, IC95%1.16-4.54). A reduction in the risk of SA was found for women with an endocrinological or metabolic disease (OR 0.28, 95% CI 0.19-0.41), while genetic disease greatly increases the risk (OR 9.63, IC95% 1.98-46.86). The greatest risk of spontaneous abortion was found in the province of Taranto compared to the province of Foggia (OR 2.01, 95% CI 1.52-2.64). The provinces with a higher risk of SA in the multiple comparisons were Taranto, Brindisi, and BAT. Municipalities with socioeconomic disadvantages classified as very low, low, and medium had a higher risk of SA compared to the municipalities with a high disadvantage. In conclusion, our study indicates the possible association between SA rate and environmental conditions. Additionally, the socioeconomic, clinical, and demographic factors were related to the risk of SAs.

No Excess of Mortality from Lung Cancer during the COVID-19 Pandemic in an Area at Environmental Risk: Results of an Explorative Analysis

BACKGROUND

The COVID-19 pandemic and the restrictive measures associated with it placed enormous pressure on health facilities and may have caused delays in the treatment of other diseases, leading to increases in mortality compared to the expected rates. Areas with high levels of air pollution already have a high risk of death from cancer, so we aimed to evaluate the possible indirect effects of the pandemic on mortality from lung cancer compared to the pre-pandemic period in the province of Taranto, a polluted site of national interest for environmental risk in the south of Italy.

METHODS

We carried out a retrospective observational study on lung cancer data (ICD-10: C34) from the Registry of Mortality (ReMo) for municipalities in Taranto Province over the period of 1 January 2011 to 31 December 2021. Seasonal exponential smoothing, Holt-Winters additive, Holt-Winters multiplicative, and auto-regressive integrated moving average (ARIMA) models were used to forecast the number of deaths during the pandemic period. Data were standardized by sex and age via an indirect method and shown as monthly mortality rates (MRs), standardized mortality ratios (SMRs), and adjusted mortality rates (AMRs).

RESULTS

In Taranto Province, 3108 deaths from lung cancer were recorded between 2011 and 2021. In the province of Taranto, almost all of the adjusted monthly mortality rates during the pandemic were within the confidence interval of the predicted rates, with the exception of significant excesses in March (+1.82, 95% CI 0.11-3.08) and August 2020 (+2.09, 95% CI 0.20-3.44). In the municipality of Taranto, the only significant excess rate was in August 2020 (+3.51, 95% CI 0.33-6.69). However, in total, in 2020 and 2021, the excess deaths from lung cancer were not significant both for the province of Taranto (+30 (95% CI -77; +106) for 2020 and +28 (95% CI -130; +133) for 2021) and for the municipality of Taranto alone (+14 (95% CI -47; +74) for 2020 and -2 (95% CI -86; +76) for 2021).

CONCLUSIONS

This study shows that there was no excess mortality from lung cancer as a result of the COVID-19 pandemic in the province of Taranto. The strategies applied by the local oncological services during the pandemic were probably effective in minimizing the possible interruption of cancer treatment. Strategies for accessing care in future health emergencies should take into account the results of continuous monitoring of disease trends.

Long-term exposure to fine particulate matter and site-specific cancer mortality: A difference-in-differences analysis in Jiangsu province, China

BACKGROUND

Accumulating studies have reported that chronic exposure to ambient fine particulate matter (PM_2.5) can lead to adverse effects on lung cancer mortality; however, such chronic effects are less clear for mortality from other site-specific cancers.

OBJECTIVE

To explore the causal effect of long-term PM_2.5 exposure on mortality from all-site and a variety of site-specific cancers in Jiangsu province, China during 2015-2020 using a difference-in-differences analysis.

METHODS

For each of 53 county-based spatial units in Jiangsu province, we calculated annual death counts for all-site cancer and 23 site-specific cancers. Using a validated high-resolution PM_2.5 grid dataset, long-term PM_2.5 exposure of a spatial unit within a given year was evaluated as the average of population-weighted annual concentrations during recent 10 years. Conditional Poisson regression models were employed to evaluate exposure-response associations adjusting for spatial and temporal variables, seasonal temperatures, relative humidity, and gross domestic product (GDP).

RESULTS

During the study period, we identified 947,337 adult cancer deaths in Jiangsu province. Each 1 μg/m³ increment in PM_2.5 exposure was significantly associated with a 2.7% increase in the risk of all-site cancer mortality. PM_2.5-mortality associations were also observed in cancer of lip, oral cavity and pharynx, stomach, colorectum, pancreas, lung, bone and joints, ovary, prostate, and lymphoma (all adjusted P < 0.05), with the relative risks ranging from 1.028 (95% confidence interval [CI]: 1.011, 1.046) for stomach cancer to 1.201 (95% CI: 1.120, 1.308) for bone and joints cancers. Exposure-response curves showed that these associations were close to linearity, though most of them had increasing slopes at high exposure levels. Overall, women and subjects in low GDP regions were more vulnerable to PM_2.5 exposures.

CONCLUSIONS

Long-term exposure to ambient PM_2.5 contributes to a higher risk of mortality from multiple site-specific cancers.

Health impact of natural gas emission at Cava dei Selci residential zone (metropolitan city of Rome, Italy)

Natural gas hazard was assessed at Cava dei Selci, a residential neighbourhood of Marino (Rome) by a joint study of gas emissions and related health problems. Here a densely urbanized zone with 4000 residents surrounds a dangerous natural gas discharge where, along the years, dozens of animals were killed by the gas. Gas originates from Colli Albani volcano and consists mostly of CO₂ with ~ 1 vol% of H₂S. In recent years, several gas-related accidents occurred in the urbanized zone (gas blowouts and road collapses). Some houses were evacuated because of hazardous indoor air gas concentration. Gas hazard was assessed by soil CO₂ flux and concentration surveys and indoor and outdoor air CO₂ and H₂S concentration measurements. Open fields and house gardens release a high quantity of CO₂ (32.23 tonnes * day^-1). Inside most houses, CO₂ air concentration exceeds 0.1 vol%, the acceptable long-term exposure range. In several houses both CO₂ and H₂S exceed the IDLH level (Immediately Dangerous to Life and Health). An epidemiological cohort study was carried out on the residents of two Cava dei Selci zones with high (zone A) and medium (zone B) gas hazard exposure, using the rest of Marino as reference zone. We found excess mortality and emergency room visits (ERV) related to high exposure to CO₂ and H₂S; in particular, an increased risk of mortality and ERV for diseases of central nervous system (HR 1.57, 95% CI 0.76-3.25 and HR 5.82, 95% CI 1.27-26.56, respectively) was found among men living in zone A.

Analysis of the Temporal Distribution Characteristics of PM2.5 Concentration and Risk Evaluation of Its Inhalation Exposure

PM_2.5 poses a threat to human health. It is important to evaluate the potential risk of PM_2.5 inhalation exposure when people are located in different spatiotemporal activity locations. In this study, the PM_2.5 concentration was detected by the atmospheric cruise monitoring system (ACMS), a new detection technology used for city-wide PM_2.5 concentration monitoring. People were divided into eight categories of five typical activity patterns, including rest (R), sedentary behavior (SB), light physical activity (LPA), moderate physical activity (MPA), and vigorous physical activity (VPA). The PM_2.5 inhalation exposure risk was then estimated for these typical activities. The research results showed that the time sequence data of the ACMS had a similar tendency to change as those of the traditional air quality monitoring stations (AQMS). Although both passed the stationarity test, the relative error (RE) of the monthly average PM_2.5 concentration between the ACMS and AQMS was 7.5-14%. RE was usually lower when the individual air quality index (IAQI) of PM_2.5 was higher. Otherwise, RE was higher. The research results also showed that PM_2.5 exposure was positively correlated with PM_2.5 concentration, respiration rate, and human activity patterns. Because adults had a higher monthly average potential exposure (MAPE) than minors and that males had a higher MAPE than females. The potential exposure generated by LPA and MPA reached 50.76% of the total potential exposure (TPE). VPA brought about a 14.7% increase in the TPE. The research findings are helpful to understand the temporal distribution characteristics of PM_2.5 concentrations and guide the potential risk evaluation of PM_2.5 inhalation exposure.

Health risk assessment and source apportionment of PM2.5-bound toxic elements in the industrial city of Siheung, Korea

The emission sources and their health risks of fine particulate matter (PM_2.5) in Siheung, Republic of Korea, were investigated as a middle-sized industrial city. To identify the PM_2.5 sources with error estimation, a positive matrix factorization model was conducted using daily mean speciated data from November 16, 2019, to October 2, 2020 (95 samples, 22 chemical species). As a result, 10 sources were identified: secondary nitrate (24.3%), secondary sulfate (18.8%), traffic (18.8%), combustion for heating (12.6%), biomass burning (11.8%), coal combustion (3.6%), heavy oil industry (1.8%), smelting industry (4.0%), sea salts (2.7%), and soil (1.7%). Based on the source apportionment results, health risks by inhalation of PM_2.5 were assessed for each source using the concentration of toxic elements portioned. The estimated cumulative carcinogenic health risks from the coal combustion, heavy oil industry, and traffic sources exceeded the benchmark, 1E-06. Similarly, carcinogenic health risks from exposure to As and Cr exceeded 1E-05 and 1E-06, respectively, needing a risk reduction plan. The non-carcinogenic risk was smaller than the hazard index of one, implying low potential for adverse health effects. The probable locations of sources with relatively higher carcinogenic risks were tracked. In this study, health risk assessment was performed on the elements for which mass concentration and toxicity information were available; however, future research needs to reflect the toxicity of organic compounds, elemental carbon, and PM_2.5 itself.

Beyond "toxic bodies": Multiplied rationalities of women's reproductive health in a high-risk environmental area (Taranto, Italy)

This study investigates women's reproductive health concerns in Taranto, a steel town and a "high-risk environmental area" in Italy. It draws on participatory ethnographic research (body mapping, interviews and fieldnotes) and analyses political and social aspects of women's reproductive health in relation to pollution. I argue that in highly polluted environments, both political rationalities and women's health concerns over their bodies are multiplied, extending beyond a focus on their bodies as shaped by toxic exposure. Women make sense of knowledge about their reproductive health and questions of responsibility in relation not only to societal norms, but also through reference to the wider polluted environment and the political-economic structures they inhabit. By focusing on women's own experiences, the study contributes to our understanding of women's agency over their environment-health relations and seeks to complicate women's role as environmental subjects beyond "toxic bodies".

Use of official municipal demographics for the estimation of mortality in cities suffering from heavy environmental pollution: Results of the first study on all the neighborhoods of Taranto from 2011 to 2020

BACKGROUND

In cities suffering from heavy environmental pressure or pollution, it is extremely important to rapidly access municipal demographics that can be used as indicators of population health status. Among those, mortality rates represent the most reliable data as they are officially retained and available to municipality with high level of details, thus allowing epidemiological comparison between different neighborhoods of the city across several years. Our study was aimed at validating and propose as universally applicable approach the use of municipal demographics as first-line tool to rapidly assess population health and drive health policies or urban planning in cities characterized by heavy environmental pressure. The case study of Taranto has been chosen due to the presence of the biggest European steel plant since 1960s resulting in heavy burden on environment and population health.

METHODS

We have performed an ecological study on general mortality data due to all causes, specific by gender, age groups and disaggregated at sub-municipal level (highest data granularity) into neighborhoods from 2011 to 2020 by using official demographics related to all people living in Taranto available at General Registry Office of the municipality. A preliminary analysis comparing data available at Municipality and those provided by the Italian National Institute of Statistics (ISTAT) was performed and confirmed the high level of reliability of the municipal source of data. For comparative analyses, we used Regional demographics and mortality from ISTAT. Indirect age-standardized mortality ratios (SMR; CI 90% and 95%), specific for gender and neighborhoods, were calculated in reference to the city of Taranto and Apulia Region; direct age-standardized and neighborhoods mortality rates were computed on city population.

RESULTS

The city of Taranto shows relevant inequalities in terms of mortality between the northern neighborhoods, closest to the industrial area (Paolo VI, Tamburi and Città Vecchia-Borgo), with excess mortality highlighted across 10 years described by SMRs always higher than those of the entire Apulia region, with peaks exceeding 50% between 2015 and 2017 both in women and men. The significant excesses of mortality have increased from 2011 to 2020 and progressively extended across several neighborhoods of Taranto city. Compared to the Apulia region, in the 3 Northern neighborhoods of the city (Paolo VI, Tamburi and Città Vecchia-Borgo) a total of 1020 excess deaths were recorded from 2011 to 2019 in both males and females (showing statistical significance), with a peak of 68% mortality excess in 2019 for men living in Paolo VI district.

CONCLUSION

The use of official mortality data allows a timely, reliable and costless assessment of population health in cities heavily impacted by environmental pollution like Taranto.

The impacts of continuous improvements in air quality on mortality in Beijing: A longitudinal comparative study

There has been increasing concern about the health effects of air pollution in China, and many measures have been implemented to control air pollution. To investigate the impacts of air quality improvement on mortality from non-accidental causes (NAD), cardiovascular disease (CD), and respiratory disease (RD), a longitudinal comparative study was conducted in Beijing. This study investigated the effects of air pollutants on outcomes across five periods (stages 1-5). Health effect data from stage1-5 (1990-2013) were obtained through a systematic literature search of studies published before 2021. Daily atmospheric pollutant, meteorological, and cause-specific death data were collected to determine the effects in stage 5 (2015-2017). Poisson generalized additive models were used to analyze the associations between short-term exposure to air pollutants and mortality. Random-effects meta-analysis models were used to estimate the pooled effects at each stage. The effects of changes in air quality were analyzed through a difference-in-differences approach. Our results indicate that the absolute change of concentrations of sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and particulate matter with aerodynamic diameter≤ 10 μm (PM₁₀₎ and≤ 2.5 μm (PM_2.5) decreased by up to 42%, 10%, 33%, and 15% (stage 5), respectively. The effects of SO₂ on deaths from CD and RD decreased by up to 2.76% and 1.43% (stage 3). The effects of NO₂ on mortality from NAD, CD, and RD decreased by up to 0.39%, 0.74%, and 0.37% (stage 5). The effects of PM₁₀ on death decreased by up to 0.11% (stage 3). The effects of PM_2.5 on deaths from CD and RD decreased by up to 0.33% and 0.13% (stage 5). The results indicate that continued improvements in air quality have reduced the acute impact of air pollutants on population health.

Long-term exposure to ambient temperature and mortality risk in China: A nationwide study using the difference-in-differences design

The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006-2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), -0.53 % (95 % CI: -0.89 %, -0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure.

Does the "Blue Sky Defense War Policy" Paint the Sky Blue?-A Case Study of Beijing-Tianjin-Hebei Region, China

Improving air quality is an urgent task for the Beijing-Tianjin-Hebei (BTH) region in China. In 2018, utilizing 365 days' daily concentration data of six air pollutants (including PM_2.5, PM₁₀, SO₂, NO₂, CO and O₃) at 947 air quality grid monitoring points of 13 cities in the BTH region and controlling the meteorological factors, this paper takes the implementation of the Blue Sky Defense War (BSDW) policy as a quasi-natural experiment to examine the emission reduction effect of the policy in the BTH region by applying the difference-in-difference method. Results show that the policy leads to the significant reduction of the daily average concentration of PM_2.5, PM₁₀, SO₂, O₃ by -1.951 μg/m³, -3.872 μg/m³, -1.902 μg/m³, -7.882 μg/m³ and CO by -0.014 mg/m³, respectively. The results of the robustness test support the aforementioned conclusions. However, this paper finds that the concentration of NO₂ increases significantly (1.865 μg/m³). In winter heating seasons, the concentration of SO₂, CO and O₃ decrease but PM_2.5, PM₁₀ and NO₂ increase significantly. Besides, resource intensive cities, non-key environmental protection cities and cities in the north of the region have great potential for air pollutant emission reduction. Finally, policy suggestions are recommended; these include setting specific goals at the city level, incorporating more cities into the list of key environmental protection cities, refining the concrete indicators of domestic solid fuel, and encouraging and enforcing clean heating diffusion.

Environmental assessment of interventions to restrain the impact of industrial pollution using a quasi-experimental design: limitations of the interventions and recommendations for public health policy

Background

In an industrial area, the asymmetry between the weights of the economic interests compared to the public-health needs can determine which interests are represented in decision-making processes. This might lead to partial interventions, whose impacts are not always evaluated. This study focuses on two interventions implemented in Taranto, Italy, a city hosting one of the largest steel plants in Europe. The first intervention deals with measures industrial plants must implement by law to reduce emissions during so called “wind days” in order to reduce PM₁₀ and benzo [a] pyrene concentrations. The second one is a warning to the population with recommendations to aerate indoor spaces from 12 pm to 6 pm, when pollutant concentrations are believed to be lower.

Methods

To analyse the impact of the first intervention, we analysed monthly PM₁₀ data in the period 2009–2016 from two monitoring stations and conducted an interrupted-time-series analysis. Coefficients of time-based covariates are estimated in the regression model. To minimise potential confounding, monthly concentrations of PM₁₀ in a neighbourhood 13 km away from the steel plant were used as a control series. To evaluate the second intervention, hourly concentrations of PM₁₀, SO₂ and polycyclic-aromatic-hydrocarbons (PAHs) were analysed.

Results

PM₁₀ concentrations in the intervention neighbourhood showed a peak just a few months before the introduction of the law. When compared to the control series, PM₁₀ concentrations were constantly higher throughout the entire study period. After the intervention, there was a reduction in the difference between the two time-series (− 25.6%). During “wind days” results suggested no reduction in concentrations of air pollutants from 12 pm to 18 pm.

Conclusion

Results of our study suggest revising the warning to the population. Furthermore, they evidence that in complex highly industrialised areas, air quality interventions cannot focus on only a single pollutant, but rather should consider the complex relationships between the different contaminants. Environmental interventions should be reviewed periodically, particularly when they have implications for social constraints. While the results of our study can be related only to the specific situation reported in the article, the methodology applied might be useful for the environmental management in industrial areas with similar features.

Occurrence and spatial distribution of dioxin and dioxin-like compounds in topsoil of Taranto (Apulia, Italy) by GC-MS analysis and DR-CALUX® bioassay

The aim of the present study was to assess the occurrence and spatial distribution of PCDD/Fs and dioxin-like compounds in topsoils of Taranto (Apulia Region), one of the most heavily industrialized and contaminated area of Southern Italy. A combined approach of chemical analysis by GC-MS/MS and AhR reporter gene bioassay was applied in a subset of topsoil samples (n = 20) collected in 2017-18 from ten sites embracing three levels of risk (from high to low) in the framework of a large survey inside Taranto municipality. TCDD-BEQs and GC-MS/MS TEQ_WHO and TEQ_THEORETICAL revealed a decreasing trend with the distance from main industrial settings and landfill areas. A strong correlation between TCDD-BEQs and TEQ_WHO values (R² = 0.85) and TEQ_THEORETICAL (R² = 0.88) was also found. In 3 out of 10 topsoil investigated, BEQs and TEQ_{WHO/THEORETICAL} resulted above Italian National Regulatory Limits for ∑PCDD/Fs in green, private and recreational used soils (10 ng TEQ/kg d.w. D.Lgs 152/2006) and for ∑PCDD/F/dl-PCBs in agricultural and farming soil (6 ng TEQ/kg d.w. D.M. 46/2019). GC-MS/MS pattern revealed the highest prevalence of dl-PCBs in 6 out of 10 sites, followed by PCDFs and PCDDs. Those sites are all located in proximity of main industrial steel and iron ore sinter plant, steel plant's landfills and illegal dumping sites. An update on occurrence and spatial distribution of PCDD/Fs and dl-PCBs contamination of Taranto urban soils was obtained and the DR-CALUX® bioassay was further recommended as a suitable screening tool for environmental and human risk assessment.

Is industrial pollution detrimental to public health? Evidence from the world's most industrialised countries

BACKGROUND

Industrial pollution is considered to be a detrimental factor for human health. This study, therefore, explores the link between health status and industrial pollution for the top 20 industrialised countries of the world.

METHODS

Crude death rate is used to represent health status and CO2 emissions from manufacturing industries and construction, and nitrous oxide emissions are considered to be indicators of industrial pollution. Using annual data of 60 years (1960-2019), an unbalanced panel data estimation method is followed where (Driscoll, J. C. et al. Rev Econ Stat, 80, 549-560, 1998) standard error technique is employed to deal with heteroscedasticity, autocorrelation and cross-sectional dependence problems.

RESULTS

The research findings indicate that industrial pollution arising from both variables has a detrimental impact on human health and significantly increases the death rate, while an increase in economic growth, number of physicians, urbanisation, sanitation facilities and schooling decreases the death rate.

CONCLUSIONS

Therefore, minimisation of industrial pollution should be the topmost policy agenda in these countries. All the findings are consistent theoretically, and have empirical implications as well. The policy implication of this study is that the mitigation of industrial pollution, considering other pertinent factors, should be addressed appropriately by enunciating effective policies to reduce the human death rate and improve health status in the studied panel countries.

Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational health

Systematic reviews are powerful tools for drawing causal inference for evidence-based decision-making. Published systematic reviews and meta-analyses of environmental and occupational epidemiology studies have increased dramatically in recent years; however, the quality and utility of published reviews are variable. Most methodologies were adapted from clinical epidemiology and have not been adequately modified to evaluate and integrate evidence from observational epidemiology studies assessing environmental and occupational hazards, especially in evaluating the quality of exposure assessments. Although many reviews conduct a systematic and transparent assessment for the potential for bias, they are often deficient in subsequently integrating across a body of evidence. A cohesive review considers the impact of the direction and magnitude of potential biases on the results, systematically evaluates important scientific issues such as study sensitivity and effect modifiers, identifies how different studies complement each other, and assesses other potential sources of heterogeneity. Given these challenges of conducting informative systematic reviews of observational studies, we provide a series of specific recommendations based on practical examples for cohesive evidence integration to reach an overall conclusion on a body of evidence to better support policy making in public health.

Spatial-Temporal Modelling of Disease Risk Accounting for PM2.5 Exposure in the Province of Pavia: An Area of the Po Valley

Spatio-temporal Bayesian disease mapping is the branch of spatial epidemiology interested in providing valuable risk estimates in certain geographical regions using administrative areas as statistical units. The aim of the present paper is to describe spatio-temporal distribution of cardiovascular mortality in the Province of Pavia in 2010 through 2015 and assess its association with environmental pollution exposure. To produce reliable risk estimates, eight different models (hierarchical log-linear model) have been assessed: temporal parametric trend components were included together with some random effects that allowed the accounting of spatial structure of the region. The Bayesian approach allowed the borrowing information effect, including simpler model results in the more complex setting. To compare these models, Watanabe–Akaike Information Criteria (WAIC) and Leave One Out Information Criteria (LOOIC) were applied. In the modelling phase, the relationship between the disease risk and pollutants exposure (PM2.5) accounting for the urbanisation level of each geographical unit showed a strong significant effect of the pollutant exposure (OR = 1.075 and posterior probability, or PP, >0.999, equivalent to p < 0.001). A high-risk cluster of Cardiovascular mortality in the Lomellina subareas in the studied window was identified.

Changes in Air Quality during the First-Level Response to the Covid-19 Pandemic in Shanghai Municipality, China

Ongoing rapid urban population growth world-wide has led to serious environmental problems that affect ecosystems and also lower the security and happiness of urban residents about their living environment. The most frequently reported negative impact is a deterioration in urban air quality. In this study, we performed a comprehensive assessment of the effects of the city lockdown policy in response to Covid-19 on air quality in Shanghai Municipality, China, and sought to identify a balance point between human activities and improving air quality. The first-level response (FLR) by Shanghai to control the spread of Covid-19 was to launch a lockdown, which remained in place from 24 January to 23 March, 2020. We compared airborne pollutant concentrations in different regions (downtown, suburbs) of Shanghai city in three periods (Pre-FLR, During-FLR, and Post-FLR) and in the corresponding periods in the previous year. The results showed that air quality improved significantly During-FLR compared with Pre-FLR, with the concentrations of PM2.5, PM10, SO2, NO2, and CO all decreasing significantly. The concentrations of all pollutants except O3 also decreased significantly compared with the same period in the previous year. There were also some differences in pollutant concentrations between the downtown region and the suburbs of Shanghai. However, we found that the concentrations of pollutants rebounded gradually when the restrictions on human activities ended after two months of lockdown. This study provides empirical evidence of the important effect of limiting human activities on air quality. For sustainable and clean future urban management in Shanghai and beyond, central government policy regulations requiring a low-carbon lifestyle and cleaner production in industries should be established.

Impact of COVID-19 outbreak measures of lockdown on the Italian Carbon Footprint

Stringent lockdown measures implemented in Italy to mitigate the spread of COVID-19 are generating unprecedented economic impacts. However, the environmental consequences associated with the temporary shutdown and recovery of industrial and commercial activities are still not fully understood. Using the well-known carbon footprint (CF) indicator, this paper provides a comprehensive estimation of environmental effects due to the COVID-19 outbreak lockdown measures in Italy. Our aim was to quantify the CF associated with the consumption of energy by any economic activity and region in Italy during the lockdown, and then compare these environmental burdens with the CF calculated for analogous periods from 2015 to 2019 (~March and April). Complementarily, we also conducted a scenario analysis to estimate the post-lockdown CF impact in Italy. A consumption-based approach was applied according to the principles of the established Life Cycle Assessment method. The CF was therefore quantified as a sum of direct and indirect greenhouse gases (GHGs) released from domestically produced and imported energy metabolism flows, excluding the exports. Our findings indicate that the CF in the lockdown period is ~-20% lower than the mean CF calculated for the past. This means avoided GHGs in between ~5.6 and ~10.6 Mt CO₂e. Results further suggest that a tendency occurs towards higher impact savings in the Northern regions, on average ~230 kt CO₂e of GHGs avoided by province (against ~110-130 kt CO₂e in central and Southern provinces). Not surprisingly, these are the utmost industrialized areas of Italy and have been the ones mostly affected by the outbreak. Despite our CF estimates are not free of uncertainties, our research offers quantitative insights to start understanding the magnitude generated by such an exceptional lockdown event in Italy on climate change, and to complement current scientific efforts investigating the relationships between air pollution and the spread of COVID-19.

Analysis on the Temporal Distribution Characteristics of Air Pollution and Its Impact on Human Health under the Noticeable Variation of Residents' Travel Behavior: A Case of Guangzhou, China

During the large-scale outbreak of COVID-19 in China, the Chinese government adopted multiple measures to prevent the epidemic. The consequence was that a sudden variation in residents' travel behavior took place. In order to better evaluate the temporal distribution of air pollution, and to effectively explore the influence of human activities on air quality, especially under the special situation, this study was conducted based on the real data from a case city in China from this new perspective. Two case scenarios were constructed, in which the research before the changes of residents' travel behavior was taken as case one, and the research after the changes in residents' travel behavior as case two. The hourly real-time concentrations of PM_2.5, PM₁₀, SO₂, NO₂, CO and O₃ that have passed the augmented Dickey-Fuller (ADF) test were employed as a data source. A series of detailed studies have been carried out using the correlation method, entropy weight method and the Air Quality Index (AQI) calculation method. Additionally, the research found that the decrease rate of NO₂ concentration is 61.05%, and the decrease rate of PM₁₀ concentration is 53.68%. On the contrary, the average concentration of O₃ has increased significantly, and its growth rate has reached to 9.82%. Although the air quality in the first week with fewer travels was in the excellent category, and chief pollutant (CP), as well as excessive pollutant (EP), were not found, as traffic volume increased, it became worse in the second and third weeks. In addition to that, special attention should still be paid to the development trend of O₃, as its average hourly concentration has increased. The findings of this study will have some guiding significance for the study of air pollution prevention, cleaner production, and indoor environmental safety issues, especially for the study of abnormal traffic environments where residents' travel behaviors have changed significantly.

The association between long-term exposure to low-level PM2.5 and mortality in the state of Queensland, Australia: A modelling study with the difference-in-differences approach

BACKGROUND

To date, few studies have investigated the causal relationship between mortality and long-term exposure to a low level of fine particulate matter (PM2.5) concentrations.

METHODS AND FINDINGS

We studied 242,320 registered deaths in Queensland between January 1, 1998, and December 31, 2013, with satellite-retrieved annual average PM2.5 concentrations to each postcode. A variant of difference-in-differences (DID) approach was used to investigate the association of long-term PM2.5 exposure with total mortality and cause-specific (cardiovascular, respiratory, and non-accidental) mortality. We observed 217,510 non-accidental deaths, 133,661 cardiovascular deaths, and 30,748 respiratory deaths in Queensland during the study period. The annual average PM2.5 concentrations ranged from 1.6 to 9.0 μg/m3, which were well below the current World Health Organization (WHO) annual standard (10 μg/m3). Long-term exposure to PM2.5 was associated with increased total mortality and cause-specific mortality. For each 1 μg/m3 increase in annual PM2.5, we found a 2.02% (95% CI 1.41%-2.63%; p < 0.01) increase in total mortality. Higher effect estimates were observed in Brisbane than those in Queensland for all types of mortality. A major limitation of our study is that the DID design is under the assumption that no predictors other than seasonal temperature exhibit different spatial-temporal variations in relation to PM2.5 exposure. However, if this assumption is violated (e.g., socioeconomic status [SES] and outdoor physical activities), the DID design is still subject to confounding.

CONCLUSIONS

Long-term exposure to PM2.5 was associated with total, non-accidental, cardiovascular, and respiratory mortality in Queensland, Australia, where PM2.5 levels were measured well below the WHO air quality standard.