Risk Associations between Air Pollution Exposure and Cardiovascular Diseases: A Residential Retrospective Cohort Study

Abstract

The population of the Venafro Valley (Southern Italy) faces various type of air pollution problems (industrial facilities, traffic, and biomass combustion). To estimate exposure to various pollution sources, a multi-stage random forest model was used, integrating particulate matter (PM) data with satellite observations, land-use patterns, and meteorological information generating maps of PM2.5 concentration. Four distinct PM2.5 exposure categories were established using the quartile method. To assess the association between PM2.5 and cause-specific mortality and morbidity, a time-dependent and sex-specific Cox multiple regression analysis was conducted, adjusting for age classes. In addition, the hazard ratios were accompanied by a probability measure of the strength of the evidence toward a hypothesis of health risk associated with the exposure under study (1−p value). The whole cohort was exposed to PM2.5 annual levels exceeding the 5 µg/m3 limit recommended by the World Health Organization. Mortality excesses were observed in class 3 for both sexes for cardiac heart diseases. Excesses of cardiovascular diseases were observed for both sexes in class 3 and 4. The study highlights significant signals warranting mitigation actions, which regional authorities are currently considering.

Keywords

• air pollution
• cardiovascular diseases
• residential cohort study
• mortality
• morbidity
• hazard ratio