Papers by Francesco Forastiere
The European respiratory journal, Mar 1, 2021
Air pollution is responsible for chronic respiratory symptoms and diseases. Efforts to reduce air... more Air pollution is responsible for chronic respiratory symptoms and diseases. Efforts to reduce air pollution exposure to protect public health, especially from emissions from both fossil fuel combustion and biomass combustion, are needed urgently.
Occupational and Environmental Medicine, Apr 6, 2006
Occupational and Environmental Medicine, Jan 8, 2008
Objective: To evaluate the association of different indices of traffic-related air pollution (sel... more Objective: To evaluate the association of different indices of traffic-related air pollution (self-report of traffic intensity, distance from busy roads from geographical information system (GIS), area-based emissions of particulate matter (PM), and estimated concentrations of nitrogen dioxide (NO 2 ) from a land-use regression model) with respiratory health in adults. Methods: A sample of 9488 25-59-year-old Rome residents completed a self-administered questionnaire on respiratory health and various risk factors, including education, occupation, housing conditions, smoking, and traffic intensity in their area of residence. The study used GIS to calculate the distance between their home address and the closest high-traffic road. For each subject, PM emissions in the area of residence as well as estimated NO 2 concentrations as assessed by a land-use regression model (R 2 value = 0.69), were available. Generalised estimating equations (GEE) were used to analyse the association between air pollution measures and prevalence of ''ever'' chronic bronchitis, asthma, and rhinitis taking into account the effects of age, gender, education, smoking habits, socioeconomic position, and the correlation of variables for members of the same family. Results: Three hundred and ninety seven subjects (4% of the study population) reported chronic bronchitis, 472 (5%) asthma, and 1227 (13%) rhinitis. Fifteen per cent of subjects reported living in high traffic areas, 11% lived within 50 m of a high traffic road, and 28% in areas with estimated NO 2 greater than 50 mg/m 3 . Prevalence of asthma was associated only with self-reported traffic intensity whereas no association was found for the other more objective indices. Rhinitis, on the other hand, was strongly associated with all traffic-related indicators (eg, OR = 1.13, 95% CI: 1.04 to 1.22 for 10 mg/m 3 NO 2 ), especially among non-smokers. Conclusions: Indices of exposure to traffic-related air pollution are consistently associated with an increased risk of rhinitis in adults, especially among non-smokers. The results for asthma are weak, possibly due to ascertainment problems.
Environment International, 2020
Background: Uncertainly continues to exist regarding the role of air pollution on pediatric asthm... more Background: Uncertainly continues to exist regarding the role of air pollution on pediatric asthma and allergic conditions, especially as air pollution levels have started to decrease in recent decades. Objective: We examined associations of long-term air pollution levels at the home address with pediatric eczema, rhinoconjunctivitis and asthma prevalences in five birth cohorts (BIB, EDEN, GASPII, RHEA and INMA) from seven areas in five European countries. Methods: Current eczema, rhinoconjunctivitis and asthma were assessed in children aged four (N = 6527) and eight years (N = 2489). A multi-morbidity outcome (≥2 conditions versus none) was also defined. Individual outdoor levels of nitrogen dioxide (NO 2 ), nitrogen oxides, mass of particulate matter with an aerodynamic diameter < 10 μm (PM 10 ), 10-2.5 μm (PM coarse ) and < 2.5 μm (PM 2.5 ), and PM 2.5 absorbance were assigned to the birth, four-and eight-year home addresses using highly defined spatial air pollution exposure models.
Environmental Health Perspectives, 2019
BACKGROUND: Living in areas with higher levels of surrounding greenness and access to urban green... more BACKGROUND: Living in areas with higher levels of surrounding greenness and access to urban green areas have been associated with beneficial health outcomes. Some studies suggested a beneficial influence on mortality, but the evidence is still controversial. OBJECTIVES: We used longitudinal data from a large cohort to estimate associations of two measures of residential greenness exposure with causespecific mortality and stroke incidence. METHODS: We studied a population-based cohort of 1,263,721 residents in Rome aged ≥30 y, followed from 2001 to 2013. As greenness exposure, we utilized the leaf area index (LAI), which expresses the tree canopy as the leaf area per unit ground surface area, and the normalized difference vegetation index (NDVI) within 300-and 1,000-m buffers around home addresses. We estimated the association between the two measures of residential greenness and the outcomes using Cox models, after controlling for relevant individual covariates and contextual characteristics, and explored potential mediation by air pollution [fine particulate matter with aerodynamic diameter ≤2:5 lm ðPM 2:5 Þ and NO 2 ] and road traffic noise. RESULTS: We observed 198,704 deaths from nonaccidental causes, 81,269 from cardiovascular diseases [CVDs; 29,654 from ischemic heart disease (IHD)], 18,090 from cerebrovascular diseases, and 29,033 incident cases of stroke. Residential greenness, expressed as interquartile range (IQR) increase in LAI within 300 m, was inversely associated with stroke incidence {hazard ratio (HR) 0.977 [95% confidence interval (CI): 0.961, 0.994]} and mortality for nonaccidental [HR 0.988 (95% CI: 0.981, 0.994)], cardiovascular [HR 0.984 (95% CI: 0.974, 0.994)] and cerebrovascular diseases [HR 0.964 (95% CI: 0.943, 0.985)]. Similar results were obtained using NDVI with 300-or 1,000-m buffers. CONCLUSIONS: Living in greener areas was associated with better health outcomes in our study, which could be partly due to reduced exposure to environmental hazards. Further research is required to understand the underlying mechanisms.
Respiratory Medicine, 2018
Background: Although general practitioners (GPs) are frequently the first healthcare professional... more Background: Although general practitioners (GPs) are frequently the first healthcare professionals whom asthma patients refer to for their symptoms, few studies have explored the extent of adherence to guidelines for asthma management based on data provided directly by GPs. Aims of the present study were to assess drug prescriptions for asthma by GPs and to evaluate prescriptive adherence to GINA guidelines (GL) and its relationship with disease control in real life. Methods: 995 asthmatic patients (45% males, mean age 43.3 ± 17.7 yrs) were enrolled by 107 Italian GPs distributed throughout the country. Data on diagnosis, disease severity, prescribed anti-asthmatic drugs and control were collected through questionnaires filled out by GPs taking into consideration the 2009 GINA Guidelines. Data on drug use and chronic sinusitis, nasal polyposis, chronic bronchitis, emphysema were reported by patients through a self-administered questionnaire.
International journal of cancer, Jan 26, 2018
Air pollution has been classified as carcinogenic to humans. However, to date little is known abo... more Air pollution has been classified as carcinogenic to humans. However, to date little is known about the relevance for cancers of the stomach and upper aerodigestive tract (UADT). We investigated the association of long-term exposure to ambient air pollution with incidence of gastric and UADT cancer in 11 European cohorts. Air pollution exposure was assigned by land-use regression models for particulate matter (PM) below 10 µm (PM ), below 2.5 µm (PM ), between 2.5 and 10 µm (PM ), PM absorbance and nitrogen oxides (NO and NO ) as well as approximated by traffic indicators. Cox regression models with adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined with random effects meta-analyses. During average follow-up of 14.1 years of 305 551 individuals, 744 incident cases of gastric cancer and 933 of UADT cancer occurred. The hazard ratio for an increase of 5 µg/m of PM was 1.38 (95%-CI 0.99;1.92) for gastric and 1.05 (95%-CI 0.62...
European urology focus, Jan 26, 2016
Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of ur... more Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population. To evaluate the association between long-term exposure to ambient air pollution and BC incidence. We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N=303431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO2 and NOx), particulate matter (PM) with diameter <10μm (PM10), <2.5μm (PM2.5), between 2.5 and 10μm (PM2.5-10), PM2.5absorbance (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project. We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estim...
The European respiratory journal, 2017
The American Thoracic Society has previously published statements on what constitutes an adverse ... more The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These consideration...
European Respiratory Journal, 2016
Epidemiological evidence on the associations between exposure to ultrafine particles (UFP), with ... more Epidemiological evidence on the associations between exposure to ultrafine particles (UFP), with aerodynamic electrical mobility diameters <100 nm, and health is limited. We gathered data on UFP from five European cities within 2001–2011 to investigate associations between short-term changes in concentrations and respiratory hospitalisations.We applied city-specific Poisson regression models and combined city-specific estimates to obtain pooled estimates. We evaluated the sensitivity of our findings to co-pollutant adjustment and investigated effect modification patterns by period of the year, age at admission and specific diagnoses.Our results for the whole time period do not support an association between UFP and respiratory hospitalisations, although we found suggestive associations among those 0–14 years old. We nevertheless report consistent adverse effect estimates during the warm period of the year, statistically significant after lag 2 when an increase by 10 000 particles...
International journal of immunopathology and pharmacology, Jan 2, 2016
Allergic diseases are complex identities determined by an interplay of genetic and environmental ... more Allergic diseases are complex identities determined by an interplay of genetic and environmental factors, resulting in the clinical manifestation of the disease. So far in Italy, updated data about the prevalence and risk factors of respiratory and allergic diseases in preschool children are not available. Children aged 3-5 years, attending four different nursery schools in an urban district of the city of Rome. A standardized questionnaire developed under the SIDRIA-2 protocol was administered to the parents of the children for the assessment of the potential risk factors and the outcomes. A total of 494 children were enrolled in the study; 289 of them (60.3%) performed a skin prick test (SPT). In the 12 months preceding the interviews, 15% of children experienced at least one episode of wheezing, 5.5% of allergic rhinitis, 11% of children had a doctor diagnosis of asthma, 12% of children who underwent the SPT were positive to at least one of the tested allergens, being diagnosed a...
Geospatial Health, 2015
The Po Valley (Northern Italy) has elevated levels of air-pollution due to various sources of pol... more The Po Valley (Northern Italy) has elevated levels of air-pollution due to various sources of pollution and adverse weather conditions. This study evaluates the short-term effects of exposure to particulate matter with a diameter of 10 microns or less (PM10) on asthma symptoms in school-aged children. An initial cross-sectional survey was conducted in the area to estimate asthma prevalence in children. Out of a total of 250 asthmatic children identified by the study, 69 agreed to participate in a panel study. The PM10 exposure assessment was based on a combination of geographic and environmental measurements leading to a focus on three different areas, each characterised by its own daily PM10 level. Participants were monitored daily for respiratory symptoms for eight weeks (January-March 2006). We assessed the relationship between daily PM10 exposure and occurrence of asthma symptoms with a generalised linear model based on a total of 3864 person-days of observation. Exposure to PM1...
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Papers by Francesco Forastiere