Abstract
BackgroundIn the winter of 2016–2017, the number of deaths recorded in the north-west Europe was significantly higher than that in previous years. This spike in mortality was attributed principally to an influenza epidemic, but the contribution of air pollution and cold temperature has not been investigated. Information on the combined effect of low temperatures, influenza epidemic, and air pollution on mortality is inadequate. The objective of this study was to estimate the excess mortality in the winter of 2016–2017 in the metropolitan area of Milan, and to evaluate the independent short-term effect of 3 risk factors: low temperatures, the influenza epidemic, and air pollution.MethodsWe used a case-crossover, time-stratified study design. Mortality data were collected on all people aged > 65 years who died of natural causes, due to respiratory diseases or cardiovascular diseases, between December 1, 2016 and February 15, 2017. Environmental data were extracted from the Regional Environmental Protection Agency. The National Surveillance Network provided data on influenza epidemic.ResultsAmong the 7590 natural deaths in people aged > 65 years, 965 (13%) were caused by respiratory conditions, and 2688 (35%) were caused by cardiovascular conditions. There were statistically significant associations between the minimum recorded temperature and deaths due to natural causes (OR = 0.966, 95% CI: 0.944–0.989), and cardiovascular conditions (OR = 0.961, 95% CI: 0.925–0.999). There were also statistically significant association between the influenza epidemic and deaths due to natural causes (OR = 1.198, 95% CI: 1.156–1.241), cardiovascular conditions (OR = 1.153, 95% CI: 1.088–1.223), and respiratory conditions (OR = 1.303, 95% CI: 1.166–1.456). High levels of PM10 (60 and 70 μg/m3) were associated with a statistically significant increase in natural and cause-specific mortality. There were statistically significant interactions between PM10 and influenza for cardiovascular-related mortality, and between influenza and temperature for deaths due to natural causes.ConclusionsExcess of mortality in Milan during winter 2016–2017 was associated with influenza epidemic and concomitant environmental exposures, specifically, the combined effect of air pollution and low temperatures. Policies mitigating the effects of environmental risk factors should be implemented to prevent future excess mortality.
Highlights
In the winter of 2016–2017, the number of deaths recorded in the north-west Europe was significantly higher than that in previous years
We have found an increase of 15.3% (OR = 1.153, 95% confidence intervals (CI): 1.088–1.223) associated with an increase of 1 influenza case per 103 persons, and a decrease of 3.9% (OR = 0.961, 95% CI: 0.925–0.999) associated with 1 °C increase in minimum temperature
This study confirmed influenza as contributed to the excess mortality that occurred in the winter of 2016–2017 in the metropolitan area of Milan
Summary
In the winter of 2016–2017, the number of deaths recorded in the north-west Europe was significantly higher than that in previous years This spike in mortality was attributed principally to an influenza epidemic, but the contribution of air pollution and cold temperature has not been investigated. Information on the combined effect of low temperatures, influenza epidemic, and air pollution on mortality is inadequate. The objective of this study was to estimate the excess mortality in the winter of 2016–2017 in the metropolitan area of Milan, and to evaluate the independent short-term effect of 3 risk factors: low temperatures, the influenza epidemic, and air pollution. Multi-city studies in Europe, USA, and other parts of the world, have shown that ambient air pollution has adverse effects on total and cause-specific morbidity and mortality [3,4,5]. The authors’ findings confirmed the relationship between mortality and long-term exposure to particulate matter, fine particles, and nitrogen compounds; the authors reported an association between these risk factors and invasive lung neoplasms [8]
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