{
  "abstract": "Background: Assessing the health impact of environmental exposures such as airport activity is challenging due to strong confounding and non-random exposure. The collapse in air traffic during the COVID-19 pandemic provides a natural experiment to evaluate causal effects in a real-world setting.\n\nMethods: We analyzed age-standardized hospitalizations (total, respiratory, cardiovascular) in people directly exposed to Treviso airport-related environmental factors. Bayesian changepoint detection (BEAST) and counterfactual modeling (CausalImpact) were used to assess structural changes and deviations from a counterfactual trajectory. The pre-period was 2002–2019; post-periods was 2020–2024. Two alternative post-periods (2021-2024 and 2022-2024) were used for temporal falsification. Covariates included hospitalizations in residents in a control area and a placebo outcome (appendicitis and cholelithiasis admissions) to account for systemic healthcare dynamics.\n\nResults: Air traffic showed a clear structural break in 2020. No corresponding changepoint was observed in hospital admissions. Only respiratory hospitalizations showed a statistically significant reduction −14% [95%CI −22% −6%], whereas total −3.7% [−14% +8%], circulatory −12% [−25% +3%] and placebo outcomes −8% [−23% +12%] showed no evidence of change. However, the respiratory effect was not temporally consistent: it attenuated and became non-significant in 2021–2024 −12% [−22% +6%], but re-emerged in 2022–2024 −17% [−27% to + 2%] despite the recovery of air traffic.\n\nConclusions: Findings do not support a robust causal relationship between airport activity and hospital admissions. Observed patterns are more consistent with post-pandemic healthcare dynamics, including possible “immunity debt”. These results highlight the importance of combining counterfactual methods with temporal consistency checks when informing environmental health policies and interpreting observational data.\n\nKey messages: • The 2020 collapse in air traffic provided a natural experiment, but no temporally coherent effect on hospital admissions was observed.\n\n• Combining counterfactual models with temporal falsification improves causal inference in environmental epidemiology.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "name": "M Ramigni"
    },
    {
      "name": "V Gobbetto"
    },
    {
      "name": "C Piovesan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a0anyde2q8zf4.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.1054",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13699299/",
  "id": "a0anyde2q8zf4",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.1054",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "6. Poster Displays"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "openalex",
      "2307|Air Quality and Health Impacts"
    ]
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  "openalex": "W7223664711",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13699299/pdf/?tool=EBI",
  "pmcid": "PMC13699299",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/a0anyde2q8zf4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:56Z",
      "native_id": "PMC13699299",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.1054"
    },
    {
      "first_seen": "2026-10-30T12:21:25Z",
      "native_id": "PMC:PMC13699299",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13699299"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Air Quality and Health Impacts",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Natural experiment on airport activity and hospital admissions in Northern Italy",
  "title_text": "Natural experiment on airport activity and hospital admissions in Northern Italy",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:35:54Z",
  "url": "https://research.draconitic.com/paper/a0anyde2q8zf4",
  "venue": "The European Journal of Public Health",
  "versions": []
}