Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis

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DOI

  • Maciej Strak, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands., National Institute for Public Health and the Environment, Bilthoven, Netherlands., Holland
  • Gudrun Weinmayr, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Tyskland
  • Sophia Rodopoulou, National and Kapodistrian University of Athens, Grækenland
  • Jie Chen, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands., Holland
  • Kees de Hoogh, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland, Schweiz
  • Zorana J Andersen, Department of Public Health, Section of Environment and Health, University of Copenhagen, Danmark
  • Richard Atkinson, Population Health Research Institute, St George's, University of London, Storbritannien
  • Mariska Bauwelinck, Interface Demography – Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium, Belgien
  • Terese Bekkevold, Norwegian Institute of Public Health, Norge
  • Tom Bellander, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Centre for Occupational and Environmental Medicine, Sverige
  • Marie-Christine Boutron-Ruault, University Paris-Saclay, University Paris-Sud, Villejuif, Frankrig
  • Jørgen Brandt
  • Giulia Cesaroni, Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italien
  • Hans Concin, Agency for Preventive and Social Medicine (AKS), Østrig
  • Daniela Fecht, MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK., Storbritannien
  • Francesco Forastiere, Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Science Policy and Epidemiology Environmental Research Group King's College London, Italien
  • John Gulliver, MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK., Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Storbritannien
  • Ole Hertel
  • Barbara Hoffmann, Institute for Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Tyskland
  • Ulla Arthur Hvidtfeldt, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Danmark
  • Nicole A H Janssen, National Institute for Public Health and the Environment (RIVM), Bilthoven, Holland
  • Karl-Heinz Jöckel, Institute for Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University of Duisburg-Essen, Tyskland
  • Jeanette T Jørgensen, Department of Public Health, Section of Environment and Health, University of Copenhagen, Danmark
  • Matthias Ketzel
  • Jochem O Klompmaker, National Institute for Public Health and the Environment (RIVM), Bilthoven, Harvard TH Chan Sch Publ Hlth, Harvard T.H. Chan School of Public Health, Holland
  • Anton Lager, Department of Global Public Health, Karolinska Institutet, Stockholm, Sverige
  • Karin Leander, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sverige
  • Shuo Liu, Department of Public Health, Section of Environment and Health, University of Copenhagen, Danmark
  • Petter Ljungman, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Department of Cardiology, Danderyd University Hospital, Stockholm, Sverige
  • Patrik K E Magnusson, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Sverige
  • Amar J Mehta, Section of Epidemiology, Department of Public Health, The University of Copenhagen, Copenhagen, Denmark, Danmark
  • Gabriele Nagel, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Tyskland
  • Bente Oftedal, Norwegian Institute of Public Health, Norge
  • Göran Pershagen, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Center for Occupational and Environmental Medicine, Region Stockholm, Sverige
  • Annette Peters, Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, D-85764 Neuherberg, Germany., Ludwig-Maximilians-Universität München, Tyskland
  • Ole Raaschou-Nielsen
  • Matteo Renzi, Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Italien
  • Debora Rizzuto, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden., The Stockholm Gerontology Research Center, Sverige
  • Yvonne T van der Schouw, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Holland
  • Sara Schramm, Institute for Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University of Duisburg-Essen, Tyskland
  • Gianluca Severi, University Paris-Saclay, University Paris-Sud, Villejuif, Department of Statistics, Computer Science and Applications "G Parenti" (DISIA), University of Florence, Frankrig
  • Torben Sigsgaard
  • Mette Sørensen, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Department of Natural Science and Environment, Danmark
  • Massimo Stafoggia, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Sverige
  • Anne Tjønneland, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Danmark
  • W M Monique Verschuren, National Institute for Public Health and the Environment (RIVM), Bilthoven, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Holland
  • Danielle Vienneau, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland, Schweiz
  • Kathrin Wolf, Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, D-85764 Neuherberg, Germany., Tyskland
  • Klea Katsouyanni, National and Kapodistrian University of Athens, Science Policy and Epidemiology Environmental Research Group King's College London, Grækenland
  • Bert Brunekreef, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands., Holland
  • Gerard Hoek, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands., Holland
  • Evangelia Samoli, National and Kapodistrian University of Athens, Grækenland

OBJECTIVE: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.

DESIGN: Pooled analysis of eight cohorts.

SETTING: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.

PARTICIPANTS: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon.

MAIN OUTCOME MEASURES: Deaths due to natural causes and cause specific mortality.

RESULTS: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths.

CONCLUSIONS: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.

OriginalsprogEngelsk
Artikelnummern1904
TidsskriftBMJ (Clinical research ed.)
Vol/bind374
Antal sider11
ISSN0959-8146
DOI
StatusUdgivet - sep. 2021

Bibliografisk note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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