Mortality and Morbidity in a Population Exposed to Emission from a Municipal Waste Incinerator. A Retrospective Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. The Incinerator (MWI) and the Area of Investigation
2.2. Study Design
2.3. Exposure Assessment
2.4. Definition of Health Indicators
2.5. Socio-Economic Status
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Mortality and Hospitalization Causes | ICD-9 Codes |
---|---|
All mortality causes | 001–999 |
Mortality due to natural causes | 001–799 |
Cancers | |
Stomach | 151 |
Colorectal | 153–154 |
Liver cancer | 155 |
Lung cancer | 162 |
Connective and other soft tissues | 171 |
Central nervous system | 191–192, 225 |
Lymphatic and haematopoietic tissues | 200–208 |
Leukemia | 204–208 |
Non-Hodgkin Lymphoma | 200, 202 |
Cardiovascular diseases | 390–459 |
Acute myocardial infarction | 410 |
Ischemic heart diseases | 410–414 |
Cerebrovascular diseases | 430–438 |
Respiratory diseases | 460–519 |
Acute respiratory diseases | 460–466, 480–487 |
Chronic pulmonary diseases | 491–492, 494–496 |
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Classes of NOχ-MWI (µg/m3) | Total | p | ||||
---|---|---|---|---|---|---|
Cohort | NOχ-MWI ≤ 0.013 | 0.013 < NOχ-MWI ≤ 0.019 | 0.019 < NOχ-MWI ≤ 0.031 | NOχ-MWI > 0.031 | ||
Female (PY) | 102,130 | 135,534 | 161,875 | 175,633 | 575,172 | <0.001 |
Females in the exposure classes (%) | 17.76 | 23.56 | 28.14 | 30.54 | 100 | |
Females in single exposure class (%) | 52.18 | 53.10 | 52.89 | 52.31 | 52.63 | |
Male (PY) | 93,613 | 119,694 | 144,211 | 160,127 | 517,645 | |
Males in the exposure classes (%) | 18.08 | 23.12 | 27.86 | 30.93 | 100 | |
Males in single exposure class (%) | 47.82 | 46.90 | 47.11 | 47.69 | 47.37 | |
Total (PY) | 195,743 | 255,228 | 306,086 | 335,760 | 1,092,817 | |
Subjects in the exposure classes (%) | 17.91 | 23.36 | 28.01 | 30.72 | 100 | |
Subjects in single exposure class (%) | 100 | 100 | 100 | 100 | 100 | |
Age (mean) | 47.74 | 46.48 | 46.97 | 45.58 | 46.57 | <0.001 |
SD | 23.01 | 23.06 | 23.03 | 22.27 | 22.82 | <0.001 |
NOχ-IND (mean) | 0.86 | 1.50 | 1.27 | 0.76 | 1.10 | <0.001 |
SD | 0.62 | 0.95 | 0.35 | 0.31 | 0.66 | <0.001 |
NOχ-LUR (mean) | 26.56 | 31.01 | 35.14 | 32.14 | 31.72 | <0.001 |
SD | 10.35 | 10.79 | 12.13 | 12.32 | 11.94 | <0.001 |
DI class (mean) | 2.51 | 2.42 | 2.29 | 2.76 | 2.50 | <0.001 |
SD | 1.14 | 1.11 | 1.06 | 1.09 | 1.11 | <0.001 |
Mortality Causes | Sex | Exp Class * | N | Hazard Ratio ** | p | IC95% | HR Trend | p | IC95% | ||
---|---|---|---|---|---|---|---|---|---|---|---|
All causes | M | low | 1114 | ||||||||
high | 1662 | 1.09 | 0.04 | 1.00 | 1.19 | 1.02 | 0.06 | 1.00 | 1.05 | ||
F | low | 1252 | |||||||||
high | 1728 | 1.03 | 0.42 | 0.95 | 1.12 | 1.01 | 0.26 | 0.99 | 1.04 | ||
Natural causes | M | low | 1050 | ||||||||
high | 1571 | 1.10 | 0.03 | 1.01 | 1.20 | 1.03 | 0.05 | 1.00 | 1.05 | ||
F | low | 1213 | |||||||||
high | 1651 | 1.02 | 0.59 | 0.94 | 1.11 | 1.01 | 0.38 | 0.99 | 1.04 | ||
Stomach cancer | M | low | 18 | ||||||||
high | 28 | 0.80 | 0.52 | 0.41 | 1.57 | 0.95 | 0.63 | 0.77 | 1.17 | ||
F | low | 9 | |||||||||
high | 18 | 1.18 | 0.72 | 0.49 | 2.80 | 1.08 | 0.51 | 0.85 | 1.38 | ||
Colorectal cancer | M | low | 33 | ||||||||
high | 54 | 0.92 | 0.74 | 0.57 | 1.48 | 1.00 | 0.97 | 0.87 | 1.15 | ||
F | low | 42 | |||||||||
high | 62 | 1.02 | 0.92 | 0.66 | 1.59 | 1.00 | 0.95 | 0.88 | 1.15 | ||
Liver cancer | M | low | 24 | ||||||||
high | 37 | 1.15 | 0.62 | 0.65 | 2.05 | 0.99 | 0.90 | 0.84 | 1.17 | ||
F | low | 24 | |||||||||
high | 29 | 0.90 | 0.74 | 0.48 | 1.67 | 0.91 | 0.37 | 0.74 | 1.12 | ||
Lung cancer | M | low | 130 | ||||||||
high | 172 | 0.92 | 0.53 | 0.71 | 1.19 | 0.96 | 0.35 | 0.89 | 1.04 | ||
F | low | 36 | |||||||||
high | 57 | 1.22 | 0.39 | 0.77 | 1.94 | 1.05 | 0.51 | 0.91 | 1.21 | ||
Connective and other soft tissues | M | low | 2 | ||||||||
high | 2 | 0.97 | 0.98 | 0.11 | 8.36 | 0.95 | 0.87 | 0.50 | 1.79 | ||
F | low | 2 | |||||||||
high | 1 | 0.27 | 0.36 | 0.02 | 4.58 | 0.85 | 0.68 | 0.39 | 1.86 | ||
Lymphatic and hematopoietic tissues | M | low | 21 | ||||||||
high | 59 | 1.79 | 0.04 | 1.03 | 3.12 | 1.23 | 0.01 | 1.05 | 1.43 | ||
F | low | 23 | |||||||||
high | 38 | 1.26 | 0.43 | 0.71 | 2.21 | 1.09 | 0.34 | 0.92 | 1.29 | ||
Leukemia | M | low | 10 | ||||||||
high | 26 | 1.64 | 0.23 | 0.73 | 3.70 | 1.26 | 0.06 | 0.99 | 1.61 | ||
F | low | 3 | |||||||||
high | 14 | 3.29 | 0.08 | 0.87 | 12.50 | 1.39 | 0.06 | 0.99 | 1.93 | ||
Non-Hodgkin lymphoma | M | low | 5 | ||||||||
high | 20 | 2.31 | 0.12 | 0.80 | 6.68 | 1.29 | 0.08 | 0.97 | 1.70 | ||
F | low | 9 | |||||||||
high | 13 | 1.37 | 0.50 | 0.55 | 3.41 | 1.07 | 0.61 | 0.82 | 1.41 | ||
Central nervous system | M | low | 4 | ||||||||
high | 13 | 1.87 | 0.32 | 0.54 | 6.44 | 1.22 | 0.20 | 0.90 | 1.65 | ||
F | low | 13 | |||||||||
high | 8 | 0.38 | 0.06 | 0.14 | 1.05 | 0.81 | 0.16 | 0.60 | 1.09 | ||
Cardiovascular diseases | M | low | 372 | ||||||||
high | 592 | 1.21 | 0.01 | 1.05 | 1.39 | 1.06 | 0.01 | 1.02 | 1.11 | ||
F | low | 538 | |||||||||
high | 740 | 1.02 | 0.82 | 0.90 | 1.15 | 1.02 | 0.23 | 0.99 | 1.06 | ||
Acute myocardial infarction | M | low | 58 | ||||||||
high | 104 | 1.38 | 0.07 | 0.97 | 1.98 | 1.17 | 0.01 | 1.05 | 1.31 | ||
F | low | 56 | |||||||||
high | 73 | 1.13 | 0.54 | 0.76 | 1.69 | 1.02 | 0.75 | 0.91 | 1.15 | ||
Ischemic heart diseases | M | low | 153 | ||||||||
high | 244 | 1.24 | 0.06 | 0.99 | 1.55 | 1.09 | 0.01 | 1.02 | 1.17 | ||
F | low | 163 | |||||||||
high | 225 | 1.04 | 0.75 | 0.82 | 1.31 | 1.04 | 0.26 | 0.97 | 1.11 | ||
Cerebrovascular diseases | M | low | 110 | ||||||||
high | 158 | 1.10 | 0.50 | 0.84 | 1.43 | 1.04 | 0.40 | 0.95 | 1.12 | ||
F | low | 172 | |||||||||
high | 248 | 1.11 | 0.35 | 0.89 | 1.38 | 1.03 | 0.34 | 0.97 | 1.10 | ||
Respiratory diseases | M | low | 102 | ||||||||
high | 130 | 0.95 | 0.74 | 0.71 | 1.27 | 0.99 | 0.82 | 0.91 | 1.08 | ||
F | low | 86 | |||||||||
high | 111 | 1.14 | 0.43 | 0.82 | 1.58 | 0.99 | 0.90 | 0.90 | 1.09 | ||
Acute respiratory diseases | M | low | 25 | ||||||||
high | 18 | 0.53 | 0.07 | 0.26 | 1.04 | 0.81 | 0.05 | 0.66 | 1.00 | ||
F | low | 18 | |||||||||
high | 39 | 2.52 | 0.01 | 1.31 | 4.83 | 1.19 | 0.04 | 1.00 | 1.41 | ||
Chronic pulmonary diseases | M | low | 49 | ||||||||
high | 73 | 1.18 | 0.42 | 0.79 | 1.76 | 1.05 | 0.42 | 0.93 | 1.18 | ||
F | low | 47 | |||||||||
high | 48 | 0.87 | 0.56 | 0.55 | 1.39 | 0.94 | 0.36 | 0.82 | 1.08 |
Causes | Sex | Exp Class * | N | HR ** | p | IC95% | HR Trend | p | IC95% | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Cardiovascular diseases | M | low | 1367 | ||||||||
high | 2080 | 1.00 | 0.96 | 0.93 | 1.08 | 1.00 | 0.70 | 0.98 | 1.03 | ||
F | low | 1187 | |||||||||
high | 1744 | 1.01 | 0.88 | 0.93 | 1.09 | 1.01 | 0.51 | 0.98 | 1.03 | ||
Ischemic heart diseases | M | low | 484 | ||||||||
high | 728 | 0.98 | 0.77 | 0.86 | 1.12 | 1.01 | 0.67 | 0.97 | 1.05 | ||
F | low | 258 | |||||||||
high | 383 | 1.01 | 0.90 | 0.85 | 1.21 | 1.02 | 0.45 | 0.97 | 1.08 | ||
Acute myocardial infarction | M | low | 231 | ||||||||
high | 373 | 1.08 | 0.42 | 0.90 | 1.30 | 1.03 | 0.27 | 0.98 | 1.09 | ||
F | low | 138 | |||||||||
high | 193 | 0.96 | 0.75 | 0.75 | 1.23 | 1.01 | 0.88 | 0.93 | 1.08 | ||
Cerebrovascular diseases | M | low | 414 | ||||||||
high | 607 | 0.98 | 0.74 | 0.85 | 1.12 | 1.00 | 0.91 | 0.96 | 1.04 | ||
F | low | 413 | |||||||||
high | 611 | 1.00 | 0.95 | 0.87 | 1.15 | 1.01 | 0.54 | 0.97 | 1.06 | ||
Respiratory diseases | M | low | 779 | ||||||||
high | 1200 | 0.95 | 0.35 | 0.86 | 1.05 | 0.99 | 0.35 | 0.96 | 1.02 | ||
F | low | 652 | |||||||||
high | 984 | 0.94 | 0.25 | 0.84 | 1.05 | 0.98 | 0.14 | 0.94 | 1.01 | ||
Chronic pulmonary diseases | M | low | 97 | ||||||||
high | 148 | 1.12 | 0.42 | 0.84 | 1.50 | 1.00 | 0.99 | 0.92 | 1.09 | ||
F | low | 88 | |||||||||
high | 115 | 0.86 | 0.35 | 0.63 | 1.18 | 0.97 | 0.55 | 0.89 | 1.07 | ||
Acute respiratory diseases | M | low | 276 | ||||||||
high | 408 | 0.91 | 0.28 | 0.77 | 1.08 | 0.95 | 0.07 | 0.91 | 1.00 | ||
F | low | 207 | |||||||||
high | 355 | 1.08 | 0.45 | 0.89 | 1.30 | 1.00 | 0.97 | 0.95 | 1.06 | ||
Stomach cancer | M | low | 37 | ||||||||
high | 46 | 0.77 | 0.30 | 0.48 | 1.26 | 0.92 | 0.26 | 0.79 | 1.07 | ||
F | low | 15 | |||||||||
high | 31 | 1.30 | 0.45 | 0.66 | 2.56 | 1.06 | 0.56 | 0.87 | 1.29 | ||
Colorectal cancer | M | low | 122 | ||||||||
high | 189 | 0.95 | 0.71 | 0.74 | 1.22 | 1.00 | 0.96 | 0.92 | 1.08 | ||
F | low | 131 | |||||||||
high | 163 | 0.83 | 0.16 | 0.64 | 1.08 | 0.99 | 0.80 | 0.92 | 1.07 | ||
Connective and other soft tissues | M | low | 7 | ||||||||
high | 7 | 0.76 | 0.64 | 0.23 | 2.46 | 0.90 | 0.54 | 0.64 | 1.27 | ||
F | low | 6 | |||||||||
high | 5 | 0.72 | 0.63 | 0.19 | 2.71 | 0.72 | 0.11 | 0.48 | 1.08 | ||
Liver cancer | M | low | 38 | ||||||||
high | 57 | 1.11 | 0.67 | 0.69 | 1.76 | 0.95 | 0.50 | 0.83 | 1.10 | ||
F | low | 32 | |||||||||
high | 40 | 0.94 | 0.82 | 0.55 | 1.60 | 0.94 | 0.49 | 0.79 | 1.12 | ||
Lung cancer | M | low | 136 | ||||||||
high | 173 | 0.87 | 0.27 | 0.67 | 1.12 | 0.96 | 0.32 | 0.89 | 1.04 | ||
F | low | 40 | |||||||||
high | 78 | 1.34 | 0.17 | 0.88 | 2.05 | 1.11 | 0.11 | 0.98 | 1.26 | ||
Lymphatic and hematopoietic tissue | M | low | 39 | ||||||||
high | 86 | 1.41 | 0.12 | 0.92 | 2.15 | 1.14 | 0.04 | 1.01 | 1.29 | ||
F | low | 38 | |||||||||
high | 71 | 1.21 | 0.39 | 0.78 | 1.88 | 1.05 | 0.42 | 0.93 | 1.19 | ||
Non-Hodgkin lymphoma | M | low | 11 | ||||||||
high | 35 | 1.85 | 0.11 | 0.88 | 3.89 | 1.21 | 0.06 | 0.99 | 1.49 | ||
F | low | 14 | |||||||||
high | 28 | 1.54 | 0.24 | 0.76 | 3.12 | 1.12 | 0.25 | 0.92 | 1.37 | ||
Leukemia | M | low | 13 | ||||||||
high | 34 | 1.75 | 0.13 | 0.86 | 3.57 | 1.21 | 0.07 | 0.98 | 1.49 | ||
F | low | 10 | |||||||||
high | 27 | 1.35 | 0.46 | 0.61 | 3.00 | 1.04 | 0.70 | 0.84 | 1.30 | ||
Central nervous system | M | low | 26 | ||||||||
high | 44 | 0.99 | 0.98 | 0.58 | 1.72 | 1.02 | 0.85 | 0.86 | 1.19 | ||
F | low | 39 | |||||||||
high | 46 | 0.81 | 0.38 | 0.51 | 1.30 | 0.91 | 0.19 | 0.79 | 1.05 |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Romanelli, A.M.; Bianchi, F.; Curzio, O.; Minichilli, F. Mortality and Morbidity in a Population Exposed to Emission from a Municipal Waste Incinerator. A Retrospective Cohort Study. Int. J. Environ. Res. Public Health 2019, 16, 2863. https://doi.org/10.3390/ijerph16162863
Romanelli AM, Bianchi F, Curzio O, Minichilli F. Mortality and Morbidity in a Population Exposed to Emission from a Municipal Waste Incinerator. A Retrospective Cohort Study. International Journal of Environmental Research and Public Health. 2019; 16(16):2863. https://doi.org/10.3390/ijerph16162863
Chicago/Turabian StyleRomanelli, Anna Maria, Fabrizio Bianchi, Olivia Curzio, and Fabrizio Minichilli. 2019. "Mortality and Morbidity in a Population Exposed to Emission from a Municipal Waste Incinerator. A Retrospective Cohort Study" International Journal of Environmental Research and Public Health 16, no. 16: 2863. https://doi.org/10.3390/ijerph16162863