The Po River Delta epidemiological study of obstructive lung disease: sampling methods, environmental and population characteristics

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Abstract
A longitudinal study on chronic obstructive lung disease (AOD) has been started in the Po River Delta in northern Italy. The first cross-sectional study was conducted in this previously unpolluted rural area before the start of operation of a large thermoelectric power plant (2,649 megawatt). A significant output of air pollutants is expected. This will permit us to carry out a “natural experiment” to study the effects of air pollutants (SO2 and suspended particulates). A multistage stratified cluster design was chosen. Stratification was based on age and socio-economic characteristics (SES) of households, and was performed in two steps, using the different indices computed from the census data. Geographic zones represented four areas of different predicted pollution exposure, once the plant started operating. There were 3,289 subjects in the selected age group (8–64) who agreed to participate (78%); only 11% refused to participate. The participants were representative of the clusters and SES. Participants had slightly fewer employed males, who did not participate due to work. The stratification and staging method allowed us to keep an acceptable level of precision and efficiency in the sample. In fact age-related differences were not found among the SES strata and geographic zones; various socio-economic characteristics, verified from the questionnaire information, were consistent with the SES stratification. Differences between geographic zones were related to the number of households of different SES within clusters; however this reflects the characteristics of the general population in the area.