BACKGROUND: Few European studies have investigated the effects of long-term exposure to both fine particulate matter (/= 30 years of age who had been living in Rome for at least 5 years at baseline. Residential exposures included annual NO2 (from a land use regression model) and annual PM2.5 (from a Eulerian dispersion model), as well as distance to roads with > 10,000 vehicles/day and traffic intensity. We used Cox regression models to estimate associations with cause-specific mortality adjusted for individual (sex, age, place of birth, residential history, marital status, education, occupation) and area (socioeconomic status, clustering) characteristics. RESULTS: Long-term exposures to both NO2 and PM2.5 were associated with an increase in nonaccidental mortality [hazard ratio (HR) = 1.03 (95% CI: 1.02, 1.03) per 10-microg/m3 NO2; HR = 1.04 (95% CI: 1.03, 1.05) per 10-microg/m3 PM2.5]. The strongest association was found for ischemic heart diseases (IHD) [HR = 1.10 (95% CI: 1.06, 1.13) per 10-microg/m3 PM2.5], followed by cardiovascular diseases and lung cancer. The only association showing some deviation from linearity was that between NO2 and IHD. In a bi-pollutant model, the estimated effect of NO2 on mortality was independent of PM2.5. CONCLUSIONS: This large study strongly supports an effect of long-term exposure to NO2 and PM2.5 on mortality, especially from cardiovascular causes. The results are relevant for the next European policy decisions regarding air quality.
Cesaroni, G., Badaloni, C., Gariazzo, C., Stafoggia, M., Sozzi, R., Davoli, M., & Forastiere, F. (2013). Long-term exposure to urban air pollution and mortality in a cohort of more than a million adults in Rome. Environmental Health Perspectives, 121(3), 324–331. https://doi.org/10.1289/ehp.1205862