title: Mortality and morbidity among people living close to incinerators: a cohort study based on dispersion modeling for exposure assessment.
abstract: BACKGROUND
  Several studies have been conducted on the possible health effects for people living close to incinerators and well-conducted reviews are available. Nevertheless, several uncertainties limit the overall interpretation of the findings. We evaluated the health effects of emissions from two incinerators in a pilot cohort study.
  
  
  METHODS
  The study area was defined as the 3.5 km radius around two incinerators located near Forlì (Italy). People who were residents in 1/1/1990, or subsequently became residents up to 31/12/2003, were enrolled in a longitudinal study (31,347 individuals). All the addresses were geocoded. Follow-up continued until 31/12/2003 by linking the mortality register, cancer registry and hospital admissions databases. Atmospheric Dispersion Model System (ADMS) software was used for exposure assessment; modelled concentration maps of heavy metals (annual average) were considered the indicators of exposure to atmospheric pollution from the incinerators, while concentration maps of nitrogen dioxide (NO2) were considered for exposure to other pollution sources. Age and area-based socioeconomic status adjusted rate ratios and 95% Confidence Intervals were estimated with Poisson regression, using the lowest exposure category to heavy metals as reference.
  
  
  RESULTS
  The mortality and morbidity experience of the whole cohort did not differ from the regional population. In the internal analysis, no association between pollution exposure from the incinerators and all-cause and cause-specific mortality outcomes was observed in men, with the exception of colon cancer. Exposure to the incinerators was associated with cancer mortality among women, in particular for all cancer sites (RR for the highest exposure level = 1.47, 95% CI: 1.09, 1.99), stomach, colon, liver and breast cancer. No clear trend was detected for cancer incidence. No association was found for hospitalizations related to major diseases. NO2 levels, as a proxy from other pollution sources (traffic in particular), did not exert an important confounding role.
  
  
  CONCLUSIONS
  No increased risk of mortality and morbidity was found in the entire area. The internal analysis of the cohort based on dispersion modeling found excesses of mortality for some cancer types in the highest exposure categories, especially in women. The interpretation of the findings is limited given the pilot nature of the study.
authors: Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy.
authors: Andrea
authors: A
authors: Ranzi
authors: Valeria
authors: V
authors: Fano
authors: Laura
authors: L
authors: Erspamer
authors: Paolo
authors: P
authors: Lauriola
authors: Carlo A
authors: CA
authors: Perucci
authors: Francesco
authors: F
authors: Forastiere
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000145:classification / Q000633:toxicity*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D015994:Incidence; D017745:Incineration; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D019216:Metals, Heavy / Q000145:classification / Q000633:toxicity; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D009585:Nitrogen Dioxide / Q000145:classification / Q000633:toxicity; D010865:Pilot Projects; D016012:Poisson Distribution; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000401:mortality*; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D000393:Air Pollutants; D019216:Metals, Heavy; D009585:Nitrogen Dioxide