title: [Air pollution and mortality in twenty-five Italian cities: results of the EpiAir2 Project].
abstract: OBJECTIVE
  this study aims at presenting the results from the Italian EpiaAir2 Project on the short-term effects of air pollution on adult population (35+ years old) in 25 Italian cities.
  
  
  METHODS
  the short-term effects of air pollution on resident people died in their city were analysed adopting the time series approach. The association between increases in 10µg/m(3) in PM10, PM2.5, NO2 and O3 air concentration and natural, cardiac, cerebrovascular and respiratory mortality was studied. City-specific Poisson models were fitted to estimate the association of daily concentrations of pollutants with daily counts of deaths. The analysis took into account temporal and meteorological factors to control for potential confounding effect. Pooled estimates have been derived from random effects meta-analysis, evaluating the presence of heterogeneity in the city specific results.
  
  
  METHODS
  it was analysed 422,723 deaths in the 25 cities of the project among people aged 35 years or more, resident in each city during the period 2006-2010.
  
  
  METHODS
  daily counts of natural, cardiac, cerebrovascular, and respiratory mortality, obtained from the registries of each city. Demographic information were obtained by record linkage procedure with the civil registry of each city.
  
  
  RESULTS
  mean number of deaths for natural causes ranged from 513 in Rovigo to 20,959 in Rome. About 25% of deaths are due to cardiac diseases, 10% to cerebrovascular diseases, and 7% to respiratory diseases. It was found an immediate effect of PM10 on natural mortality (0.51%; 95%CI 0.16-0.86; lag 0-1). More relevant and prolonged effects (lag 0-5) have been found for PM2.5 (0.78%; 95%CI 0.12-1.46) and NO2 (1.10%; 95%CI 0.63-1.58). Increases in cardiac mortality are associated with PM10 (0.93%; 95%CI 0.16-1.70) and PM2.5 (1.25%; 95%CI 0.17-2.34), while for respiratory mortality exposure to NO2 has an important role (1.67%; 95%CI 0.23-3.13; lag 2-5), as well as PM10 (1.41%; 95%CI - 0.23;+3.08). Results are strongly homogeneous among cities, except for respiratory mortality. No effect has been found for cerebrovascular mortality and weak evidence of association has been observed between ozone and mortality.
  
  
  CONCLUSIONS
  a clear increase in mortality associated to air pollutants was observed. More important are the effects of NO2 (on natural mortality), mostly associated with traffic emissions, and of PM2.5 (on cardiac and respiratory mortality). Nitrogen dioxide shows an independent effect from the particulate matter, as observed in the bi-pollutant models.
authors.affiliation: Dipartimento di epidemiologia del servizio sanitario regionale, Azienda unità sanitaria locale Roma E, Regione Lazio e.alessandrini@deplazio.it.
authors.forename: Ester Rita
authors.initials: ER
authors.lastname: Alessandrini
authors.forename: Annunziata
authors.initials: A
authors.lastname: Faustini
authors.forename: Monica
authors.initials: M
authors.lastname: Chiusolo
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
authors.forename: Martina
authors.initials: M
authors.lastname: Gandini
authors.forename: Moreno
authors.initials: M
authors.lastname: Demaria
authors.forename: Antonello
authors.initials: A
authors.lastname: Antonelli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Arena
authors.forename: Annibale
authors.initials: A
authors.lastname: Biggeri
authors.forename: Cristina
authors.initials: C
authors.lastname: Canova
authors.forename: Giovanna
authors.initials: G
authors.lastname: Casale
authors.forename: Achille
authors.initials: A
authors.lastname: Cernigliaro
authors.forename: Elsa
authors.initials: E
authors.lastname: Garrone
authors.forename: Bianca
authors.initials: B
authors.lastname: Gherardi
authors.forename: Emilio Antonio Luca
authors.initials: EA
authors.lastname: Gianicolo
authors.forename: Simone
authors.initials: S
authors.lastname: Giannini
authors.forename: Claudia
authors.initials: C
authors.lastname: Iuzzolino
authors.forename: Paolo
authors.initials: P
authors.lastname: Lauriola
authors.forename: Mauro
authors.initials: M
authors.lastname: Mariottini
authors.forename: Paolo
authors.initials: P
authors.lastname: Pasetto
authors.forename: Giorgia
authors.initials: G
authors.lastname: Randi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranzi
authors.forename: Michele
authors.initials: M
authors.lastname: Santoro
authors.forename: Vittorio
authors.initials: V
authors.lastname: Selle
authors.forename: Maria
authors.initials: M
authors.lastname: Serinelli
authors.forename: Elisa
authors.initials: E
authors.lastname: Stivanello
authors.forename: Riccardo
authors.initials: R
authors.lastname: Tominz
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Vigotti
authors.forename: Stefano
authors.initials: S
authors.lastname: Zauli-Sajani
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.forename: Ennio
authors.initials: E
authors.lastname: Cadum
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality*; D002947:Cities; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000401:mortality*; D014504:Urban Health