Carugno Michele, Consonni Dario, Bertazzi Pier Alberto, Biggeri Annibale, Baccini Michela
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Environ Pollut. 2017 Aug;227:280-286. doi: 10.1016/j.envpol.2017.04.077. Epub 2017 May 3.
Exposure to particulate matter with diameter ≤10 μm (PM) entails well documented adverse effects on human health. In the last decade, concentration of PM in Lombardy (10 million inhabitants), Italy, has been gradually decreasing. We evaluated how the mortality burden due to PM varied in that same period.
We focused on 13 areas of the Region in 2003-2014: 11 cities with more than 50,000 inhabitants, 1 smaller alpine town and 1 agricultural province. For each area, we collected PM annual average concentrations and natural mortality data, and we used the posterior area-specific effects from a previous Bayesian meta-analysis to estimate the short-term impact of PM on mortality, in terms of deaths attributable (AD) to annual average exposures exceeding the WHO threshold of 20 μg/m.
PM annual average values showed a non-homogenous decreasing trend in the investigated time period in most of the areas. Overall, the population-weighted exposure levels decreased, except for a peak in 2011, but never met the WHO threshold. In 2003-2006, PM levels were responsible, on average, for 343.0 annual AD from natural causes that decreased to 253.5 in 2007-2010 and to 208.3 in 2011-2014. Overall we estimated that PM was responsible for about 1% of all natural deaths (min-max range: 0.86%-1.42%); the impact was heterogeneous among areas.
By collecting routinely available data for the most populated areas in Lombardy, we returned a picture of air pollution and health trends in the last decade. Notwithstanding the observed reduction in PM between 2003 and 2014 and the resulting decline in the number of AD, the impact is still relevant. Hence, appropriate policies for emission reduction could have a further beneficial effect on population health. Studies based on routine data and local effect estimates are recommended to properly inform the policy-making process.
接触直径≤10微米的颗粒物（PM）对人类健康会产生诸多已被充分记录的不利影响。在过去十年中，意大利伦巴第大区（1000万居民）的PM浓度一直在逐渐下降。我们评估了同一时期因PM导致的死亡负担是如何变化的。
我们关注了2003年至2014年该地区的13个区域：11个居民超过5万的城市、1个较小的阿尔卑斯山镇和1个农业省份。对于每个区域，我们收集了PM年平均浓度和自然死亡率数据，并使用先前贝叶斯荟萃分析得出的特定区域后验效应，来估计PM对死亡率的短期影响，即归因于年平均暴露量超过世界卫生组织20微克/立方米阈值的死亡数（AD）。
在调查期间，大多数区域的PM年平均值呈现出非均匀下降趋势。总体而言，除2011年出现峰值外，人口加权暴露水平有所下降，但从未达到世界卫生组织的阈值。在2003 - 2006年，PM水平平均每年导致343.0例自然原因的AD，在2007 - 2010年降至253.5例，在2011 - 2014年降至208.3例。总体而言，我们估计PM约占所有自然死亡的1%（最小 - 最大范围：0.86% - 1.42%）；各区域的影响存在差异。
通过收集伦巴第人口最多地区的常规可用数据，我们呈现了过去十年空气污染和健康趋势的情况。尽管在2003年至2014年期间观察到PM有所减少，且由此导致AD数量下降，但影响仍然显著。因此，适当的减排政策可能会对人群健康产生进一步的有益影响。建议开展基于常规数据和局部效应估计的研究，以便为决策过程提供恰当信息。
