[Global burden of mortality in Italian polluted sites].

SENTIERI Project has assessed the overall mortality profile in all the SINs combined, and performed SIN-specific analyses. The epidemiological evidence of the causal association between cause of death and exposure was classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The procedures and results of the evidence evaluation are presented in a Supplement of Epidemiologia & Prevenzione devoted to SENTIERI. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8% for men (90% CI 114.4–117.2, 2439 extra deaths) and 114.4% for women (90% CI 112.4–116.5, 1,069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403,692 deaths (men and women combined), an excess of 9,969 deaths is observed, with an average of around 1,200 extra deaths per year. Most of these excesses are observed in SINs located in Southern and Central Italy. The distribution of the causes of deaths shows that the excesses are not evenly distributed: cancer mortality accounts for 30% of all deaths, but is 43.2% of the excess deaths (4309 cases of 9969). Conversely, the percentage of excesses in non cancer causes, 19%, is lower than their share of total mortality (42%). Consistently with previous studies, the results suggest that the health status of populations living in the SINs is worse than what regional averages show. Compared to previous studies, the analysis of the causes selected in SENTIERI as the most probable, provides additional information on the environmental exposures’ role, even if some limitations due to methodology and data used should be considered.