title: Mortality and morbidity in a population exposed to multiple sources of air pollution: A retrospective cohort study using air dispersion models.
abstract: OBJECTIVE
  A landfill, an incinerator, and a refinery plant have been operating since the early 1960s in a contaminated site located in the suburb of Rome (Italy). To evaluate their potential health effects, a population-based retrospective cohort study was conducted using dispersion modeling for exposure assessment.
  
  
  METHODS
  A fixed cohort was enrolled in the Rome Longitudinal Study in 2001, mortality and hospitalizations were followed-up until 2010. Exposure assessments to the landfill (H2S), the incinerator (PM10), and the refinery plant (SOX) were performed for each subject using a Lagrangian dispersion model. Individual and small-area variables were available (including exposures levels to NO2 from traffic and diesel trucks). Cox regression analysis was performed (hazard ratios, HRs, 95% CI) using linear terms for the exposures (5th-95th percentiles difference). Single and bi-pollutant models were run.
  
  
  RESULTS
  The cohort included 85,559 individuals. The estimated annual average exposures levels were correlated. H2S from the landfill was associated with cardiovascular hospital admissions in both genders (HR 1.04 95% CI 1.00-1.09 in women); PM10 from the incinerator was associated with pancreatic cancer mortality in both genders (HR 1.40 95% CI 1.03-1.90 in men, HR 1.47 95% CI 1.12-1.93 in women) and with breast morbidity in women (HR 1.13 95% CI 1.00-1.27). SOx from the refinery was associated with laryngeal cancer mortality in women (HR 4.99 95% CI 1.64-15.9) and respiratory hospital admissions (HR 1.13 95% CI 1.01-1.27).
  
  
  CONCLUSIONS
  We found an association of the pollution sources with some cancer forms and cardio-respiratory diseases. Although there was a high correlation between the estimated exposures, an indication of specific effects from the different sources emerged.
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy. Electronic address: c.ancona@deplazio.it.
authors.forename: Carla
authors.initials: C
authors.lastname: Ancona
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Badaloni
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mataloni
authors.affiliation: Lazio Environmental Protection Agency, Via Boncompagni 101, 00187 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bolignano
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Bucci
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Cesaroni
authors.affiliation: Lazio Environmental Protection Agency, Via Boncompagni 101, 00187 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sozzi
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000392:Air Movements; D000397:Air Pollution / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D012189:Retrospective Studies; D064091:Waste Disposal Facilities; D055815:Young Adult
keywords: Cancer; Dispersion model; Industrial sites; Residential cohort; Waste