title: Short-Term Effects of Nitrogen Dioxide on Mortality and Susceptibility Factors in 10 Italian Cities: The EpiAir Study.
abstract: 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.
  
  
  OBJECTIVE
  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, particulate 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., ischemic 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.
authors.affiliation: Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont, Turin, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Chiusolo
authors.forename: Ennio
authors.initials: E
authors.lastname: Cadum
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
authors.forename: Claudia
authors.initials: C
authors.lastname: Galassi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Berti
authors.forename: Annunziata
authors.initials: A
authors.lastname: Faustini
authors.forename: Luigi
authors.initials: L
authors.lastname: Bisanti
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Vigotti
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Dessì
authors.forename: Achille
authors.initials: A
authors.lastname: Cernigliaro
authors.forename: Sandra
authors.initials: S
authors.lastname: Mallone
authors.forename: Barbara
authors.initials: B
authors.lastname: Pacelli
authors.forename: Sante
authors.initials: S
authors.lastname: Minerba
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Simonato
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000633:toxicity; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000401:mortality*; D018592:Cross-Over Studies; D003920:Diabetes Mellitus / Q000401:mortality; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000032:analysis / Q000633:toxicity*; D010126:Ozone / Q000032:analysis / Q000633:toxicity; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity; D011159:Population Surveillance; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012959:Socioeconomic Factors; D013997:Time Factors; D014504:Urban Health / Q000706:statistics & numerical data
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone; D009585:Nitrogen Dioxide