[Progetto PNC "Atlante Aria e Salute": revisione web esplorativa e valutazione della qualità degli atlanti open access disponibili sul web sugli effetti dell'inquinamento atmosferico sulla salute].

OBJECTIVES

to identify, retrieve, and analyse publicly available websites providing interactive maps or infographics which show the impact of outdoor air pollution on human health in order to inform the development of the Air and Health Atlas.

DESIGN

explorative web-based review conducted according to a predefined protocol. The review was guided by an adapted Population-Exposure-Comparator-Outcome (PECO) framework to define scope of the search, eligibility criteria, and data extraction strategy. Websites were identified through structured keyword searches, screened for eligibility, and independently assessed by multiple reviewers using extraction forms and predefined technical and qualitative evaluation criteria.

SETTING AND

PARTICIPANTS

websites freely accessible on the Internet and regularly updated were searched for the period September and December 2024 using major international and national search engines. Platforms presenting empirical data or estimates on air pollution exposure and related health outcomes were included in the analysis.

MAIN OUTCOME MEASURES: websites were assessed for structural and informational characteristics type of pollutants and health outcomes reported, and technical and qualitative variables: interactivity with a qualitative ad hoc defined scale, readability, using the validated Flesch Reading Ease (FRE), accessibility using the Web Content Accessibility Guidelines, completeness/transparency using an ad hoc developed scale based on 6 topics, and speed/efficiency using quantitative parameters.

RESULTS

out of 1,000 screened websites, 15 were potentially relevant. The in-depth analysis led to the exclusion of 7 of these, because they do not fulfil inclusion criteria, mostly the absence of any measure of the impact on health; 8 were included in the review. Three sites are operated by governmental agencies, three by academic institutions with public funding, and two by private foundations. All platforms reported exposure to particulate matter (PM2.5 and/or PM10), while information on nitrogen dioxide and ozone was less frequently available. Except for one website providing real-time air quality data, exposure levels were generally based on annual averages. Six websites included quantitative dose-response estimates for health outcomes, mainly focusing on long-term effects and all-cause mortality; only two reported cause-specific mortality, including respiratory, cardiovascular, and cancer-related mortality, and none provided data on hospitalizations, even if the Global Burden of Disease includes data on morbidity. On the other hand, the analysis of the technical and qualitative variables showed a marked variability in the level of interactivity, ranging from highly configurable platforms allowing extensive data manipulation to static interfaces. Readability was generally low, with most websites requiring a high educational level and extensive familiarity with technical terminology. Accessibility scores were overall satisfactory, although uneven across platforms. The assessment of completeness and transparency showed higher scores for websites presenting only outcomes with high certainty of the causal association with exposure, offering detailed methodological information, multiple exposure-outcome metrics, and horizon time. Finally, website speed analysis showed heterogeneous performances among platforms.

CONCLUSIONS

existing online platforms on air pollution and health show marked heterogeneity in content, quality, and communicative approach, reflecting differences in intended aims and target audiences. Designing a multi-target interactive atlas requires balancing scientific rigour with clarity and accessibility. The findings suggest that focusing on a limited set of well-established exposures and outcomes, combined with clear and transparent visual communication, may enhance usability for policymakers, professionals, and the general public.