Health impact of air pollution at eegional level (Lombardy region, Italy)

Background: Currently health impact assessment of air pollution was applied to urban areas. The present study aims to calculate the burden of disease at regional level using data from the Lombardy Health Impact Assessment Project. Data and Methods Risk estimation: We estimate the effects of air pollution on hospital admissions for cardiac and respiratory acute conditions using data from all Lombardy towns with more than 50000 inhabitants, smaller towns provided they represent Province capitals and from the Lodi area, a homogeneous country site, for the period 2003–2006. The statistical analysis was based on a two stage procedure [1]. At the first stage we model the city-specific daily time series of cause-specific morbidity with respect to each air pollutant (NO2, CO, PM10, O3). At the second stage of the analysis, first stage estimates are combined in a Bayesian random effects meta-analysis. Exposure Assessment: We use a Bayesian kriging model to predict the average level of each air pollutant over the whole region during reference year 2006 [2]. Monitor data, population density, altitude and land use characteristics were included in the kriging model. Health Impact Evaluation: Meta-analytic effect estimates, predicted exposure surface and morbidity information were combined to compute the number of events attributable to air pollution during 2006 in all the Lombardy municipalities. Results: For example, we report results for nitrogen dioxide. City-specific effects appeared substantially homogeneous. The overall meta-analytic estimate of the percent increase in hospital admissions associated to a 10 Hg/m3 increase in air pollutant level is equal to 2.7% (95% credibility interval = 0.6 to 4.7%) for cardiac diseases and 2.4% (1.0 to 3.7%) for respiratory diseases (lag 0–3). The impact estimates on reference year 2006 for the Province capitals of Lombardy are reported in the table (percent of cause-specific hospital admissions attributable to NO2 concentrations higher than 10 Hg/m3 and attributable number of events per year in brackets). Conclusion: The number of attributable cases depends on the air pollution level and the baseline rate observed in each municipality. The smaller impact in terms of attributable fractions is observed in the Lodi area, in Mantua and Sondrio, where the average daily levels of NO2 are lowest. The highest impact is observed in Milan (MI), Como (CO), Lecco (LC) and Brescia (BS). Ovid: Health Impact of Air Pollution at Regional Level (Lomba... http://ovidsp.tx.ovid.com/spa/ovidweb.cgi 1