Aya Jandoubi (University of Milano-Bicocca)
Elena Cottini, Gilberto Turati and Luca Salmasi
We study the causal effect of PM2.5 exposure on respiratory morbidity by combining municipality-level administrative data on hospital admissions and in-hospital mortality in Italy (20132019) with high-resolution pollution measures. Focusing on municipalities hosting industrial plants, we use local wind direction as an instrumental variable to address endogeneity in pollution levels. Higher PM2.5 concentrations significantly increase emergency hospitalisations for COPD, pneumonia, and respiratory failure, as well as associated mortality. Effects are stronger among mild and moderate cases, indicating that pollution primarily triggers acute exacerbations rather than driving severe chronic deterioration. The causal effects are robust to alternative spatial specificationscomparing hospitals within 15 km of industrial facilities (Ring 1) with those located 1530 km away (Ring 2)and to the use of inverse-distance-weighted pollution measures. Heterogeneity analysis shows that effects are concentrated among older and less-educated patients, and in northern regions with higher industrial density. Overall, the findings underscore the persistent health burden of industrial emissions and the value of stringent air quality monitoring in industrial municipalities.