Abstract
Spatio-temporal Bayesian disease mapping is the branch of spatial epidemiology interested in providing valuable risk estimates in certain geographical regions using administrative areas as statistical units. The aim of the present paper is to describe spatio-temporal distribution of cardiovascular mortality in the Province of Pavia in 2010 through 2015 and assess its association with environmental pollution exposure. To produce reliable risk estimates, eight different models (hierarchical log-linear model) have been assessed: temporal parametric trend components were included together with some random effects that allowed the accounting of spatial structure of the region. The Bayesian approach allowed the borrowing information effect, including simpler model results in the more complex setting. To compare these models, Watanabe–Akaike Information Criteria (WAIC) and Leave One Out Information Criteria (LOOIC) were applied. In the modelling phase, the relationship between the disease risk and pollutants exposure (PM2.5) accounting for the urbanisation level of each geographical unit showed a strong significant effect of the pollutant exposure (OR = 1.075 and posterior probability, or PP, >0.999, equivalent to p < 0.001). A high-risk cluster of Cardiovascular mortality in the Lomellina subareas in the studied window was identified.
Highlights
Health effects of air pollution have continued to be investigated for a long time
Clusters for cardiovascular mortality in Lomellina overlap the municipalities with highest PM2.5 annual concentrations, but this is not true for municipalities with elevated relative risk (RR) placed in Oltrepo’, typically with the lowest air pollution levels
The mortality for cardiovascular diseases in one of the most polluted Italian areas is spatially related with particulate matter adjusted by degree of urbanisation
Summary
Health effects of air pollution have continued to be investigated for a long time. The environmental exposure can affect different systems, but according to the majority of epidemiological studies, those primarily affected are the cardiovascular and the respiratory systems [1,2,3,4,5,6,7,8,9,10,11,12]. Particulate matter with aerodynamic diameter less than 2.5 μm (the so-called fine particles or PM2.5) evidenced an association with mortality for cardiovascular diseases in different epidemiological studies, as recently summarised by Franklin and co-workers [13]. As indicated in the special report 23/2018 by the European court of auditors [15], in Europe, almost the totality of people living in urban areas were exposed to levels of air pollutants dangerous to their health, according to the World Health Organisation (WHO) [16]. Some studies suggested that living in the most polluted areas could be connected with an increased risk of mortality in general and in particular for cardiovascular diseases [17,18,19].
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