18-yr cumulative incidence of respiratory/allergic symptoms/diseases and risk factors in the Pisa epidemiological study

Abstract

Background: Few population-based studies on the effects of environmental exposure variation exist. Aim: Assessing respiratory symptom/disease incidence related to risk factor exposure changes. Methods: A longitudinal general population sample from two surveys (PISA2:1991(PISA2: -1993 PISA3:2009 PISA3: -2011; no. ¼ 970), aged �20 years at baseline, completed a questionnaire on respiratory symptoms/diseases, risk factor exposure and performed spirometry. 18-year follow-up cumulative incidence of respiratory symptoms/diseases and longitudinal changes (persistence, incidence, remittance) in risk factor exposure were computed. Results: Cumulative incidence values were: 3.2% (corresponding to a 1.8‰/year incidence rate), asthma; 6.6% (3.8‰/year), asthma attacks; 4.5% (2.6‰/year), wheeze; 31.7% (21.0‰/year), allergic rhinitis-AR; 7.6% (4.4‰/year), chronic obstructive pulmonary disease-COPD; 16.1% (9.7‰/year), usual cough; 18.5% (11.3‰/ year), usual phlegm; 30.7% (20.1‰/year), dyspnoea 1þ; 13.9% (8.3‰/year), airway obstruction. The following associations emerged among respiratory symptom/disease cumulative incidence and risk factor exposure changes: a two-to-five fold higher risk for COPD, phlegm, cough, dyspnoea, asthma attacks, airway obstruction in persistent smokers; a two-to-three fold higher risk for COPD in remittent smokers; a two-fold higher risk for AR, phlegm and a four-fold higher risk for asthma in subjects with persistent occupational exposure; a two-fold higher risk for cough, phlegm, dyspnoea, AR in subjects with incident occupational exposure; a two-fold higher risk for AR, asthma attacks, COPD in subjects with incident traffic exposure. Conclusions: Our study showed noteworthy respiratory symptom/disease incidence values and indicated that lifestyle and environmental exposure changes can differently influence onset. This information could be useful for primary prevention strategies in order to reduce the chronic disease burden in the general population.

Effects of Particulate Matter on the Incidence of Respiratory Diseases in the Pisan Longitudinal Study

“…Indeed, in our study, an increase of 1 µg/m 3 in PM 2.5 annual mean was associated with a higher risk of developing rhinitis (OR 2.25). This result is in line with our previous data showing a strong relationship between incident rhinitis and incident exposure to a proxy of outdoor pollution, i.e., vehicular traffic near home (OR 1.8) [20].…”

“…Since 1990, the prevalence of rhinitis has been increasing worldwide [33]. This increase was previously shown in the Pisa sample with prevalence values ranging from 16% in 1985-1988 to 37% in 2009-2011 [19] and with a cumulative incidence value of 32% from 1991-1993 to 2009-2011 [20]. Possible determinants of this upward trend are: increasing air pollution, poor indoor air quality, improved hygiene practices and climatic changes [34][35][36][37].…”

“…A sample of subjects living in the urban/suburban area of Pisa (Tuscany, Italy) was selected using a multistage stratified family-cluster design. Detailed information on population characteristics and methods are available elsewhere [17,[20][21][22][23]. Briefly, we considered the subjects participating in two surveys, performed in 1991-1993 (first survey) and in 2009-2011 (second survey).…”

“…Information about symptoms/diseases and risk factors was collected through standardized interviewer-administered questionnaires developed by CNR [19][20][21]24], based on the National Heart Blood and Lung Institute questionnaire [25], for the first survey and by the EU-funded Project "Indicators for Monitoring COPD and Asthma in the EU" (IMCA II) for the second survey [26,27].…”

“…BEEP has given us the unique opportunity to evaluate the long-term air pollution effects on the longitudinal analytical epidemiological survey in Pisa, Italy [17][18][19][20], by linking PM levels estimated at the residential address to the individual respiratory health data, and adjusting for individual potential confounders. Indeed, this approach overcomes some limitations of the studies based on routinely collected health and environmental data.…”