Objectives and results


MED HISS project aimed at contributing to the updating and development of European Union environmental policy and legislation, in order to mitigate adverse health effects of air pollution.
For many years the understanding of the association between long-term exposure to air pollution and adverse health effects was based on cohort studies from USA, Canada, Japan, China.
In recent years, new studies have been conducted in Europe, but often with restrictions on age of cohort recruited, on pollutant studied, and with poor geographical variability (mainly on urban areas). Health Impact Assessment (HIA) previously done on European population could have been biased due to the use of risks estimated from northern American cohorts to European population, exposed to different particulate chemical composition as well as with different population characteristics.

MED HISS aimed at contributing to consolidate the knowledge base for the development, assessment, monitoring and evaluation of environmental policy and legislation, by setting up a low-cost European surveillance system of long term effects of air pollution based on cohorts recruited using National Health Interview Survey (NHIS) data already available. Ideally, the cohorts could be followed-up for mortality and morbidity (and other health outcomes), each subject has information on individual life style factors as well as previous notable pathologies and to each subject it is possible to assign the exposure to air pollution (PM10, PM2.5, Nox, NO2, O3), derived from national dispersion models and opportunely post processed.

MED HISS cohorts are indeed representative of all populations and areas of residence (urban, rural, metropolitan) and long term effect have been evaluated for a wide range of diseases.

MED HISS was a demonstration project and involved four European countries (Spain, France, Italy, Slovenia), in order to guarantee to the EU a source of information for HIA based on direct measurements.

MED HISS aim has been to assess the feasibility of the adopted approach in other European countries, to create a European cohort database of individual characteristic and air pollution data exposure useful also for future studies on other environmental issues, with a specific attention to exposure assessment methods.


Life Med Hiss approach is potentially exportable to other environmental issues where a cohort representative of the country population is needed and is applicable in all European countries.

The cohort is derived from the National Health Interview Survey, compulsory in European countries, which has information on individual lifestyle factors. In this approach, subjects recruited have been linked at individual level with health data and have been then followed-up for mortality and hospital admissions outcomes.

The principal project results have been published in the following papers:

  1. LIFE Med Hiss: An innovative cohort design for public health.
    Gandini M, Scarinzi C, Bande S, Berti G, Ciancarella L, Costa G, Demaria M, Ghigo S, Marinacci C, Piersanti A, Sebastiani G, Cadum E.

    MethodsX. 2018 Dec 18;6:82-91. doi: 10.1016/j.mex.2018.12.007. eCollection 2019.

  2. Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project.
    Gandini M, Scarinzi C, Bande S, Berti G, Carnà P, Ciancarella L, Costa G, Demaria M, Ghigo S, Piersanti A, Rowinski M, Spadea T, Stroscia M, Cadum E; LIFE MEDHISS collaborative Group.

    Environ Int. 2018 Dec;121(Pt 2):1087-1097. doi: 10.1016/j.envint.2018.10.020. Epub 2018 Oct 23.

  3. Mapping air pollutants at municipality level in Italy and Spain in support to health impact evaluations
    Stefania Ghigo, Stefano Bande, Luisella Ciancarella, Mihaela Mircea, Antonio Piersanti, Gaia Righini, José María Baldasano, Xavier Basagaña, Ennio Cadum & on behalf of the MED HISS Study group

    Air Quality, Atmosphere & Health volume 11, pages69–82(2018) - Cite this article

  4. The association of air pollution and greenness with mortality and life expectancy in Spain: A small-area study.
    de Keijzer C, Agis D, Ambrós A, Arévalo G, Baldasano JM, Bande S, Barrera-Gómez J, Benach J, Cirach M, Dadvand P, Ghigo S, Martinez-Solanas È, Nieuwenhuijsen M, Cadum E, Basagaña X; MED-HISS Study group.

    Environ Int. 2017 Feb;99:170-176. doi: 10.1016/j.envint.2016.11.009. Epub 2016 Nov 18.

  5. Health impact of air pollution on Italy: main findings of VIIAS and MED HISS projects
    Antonio Piersanti, Carla Ancona, Giovanna Berti, Ennio Cadum, Luisella Ciancarella, Ilaria D’Elia, Francesco Forastiere, Gaia Righini

    International Environmental Modelling and Software Society (iEMSs) 8th International Congress on Environmental Modelling and Software Toulouse, France, Sabine Sauvage, José-Miguel Sánchez-Pérez, Andrea Rizzoli (Eds.)