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Long-term Air Pollution Exposure and Pneumonia-related Mortality in a Large Pooled European Cohort

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  • Shuo Liu, University of Copenhagen
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  • Youn Hee Lim, University of Copenhagen
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  • Jie Chen, Utrecht University
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  • Maciek Strak, Utrecht University, National Institute for Public Health and the Environment (RIVM)
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  • Kathrin Wolf, Helmholtz Zentrum München - German Research Center for Environmental Health
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  • Gudrun Weinmayr, Ulm University
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  • Sophia Rodopolou, University of Athens
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  • Kees de Hoogh, Swiss Tropical and Public Health Institute, University of Basel
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  • Tom Bellander, Karolinska Institutet, Region Stockholm
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  • Jørgen Brandt
  • Hans Concin, Agency for Preventive and Social Medicine, Bregenz, Austria.
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  • Emanuel Zitt, LKH Feldkirch, Agency for Preventive and Social Medicine, Bregenz, Austria.
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  • Daniela Fecht, Imperial College London
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  • Francesco Forastiere, Department of Epidemiology Lazio Regional Health Service, King's College London
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  • John Gulliver, Imperial College London, University of Leicester
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  • Ole Hertel
  • Barbara Hoffmann, Heinrich Heine University Düsseldorf
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  • Ulla A. Hvidtfeldt, Danish Cancer Society
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  • W. M. Monique Verschuren, Utrecht University, National Institute for Public Health and the Environment (RIVM)
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  • Karl Heinz Jockel
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  • Jeanette T. Jørgensen, University of Copenhagen
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  • Rina So, University of Copenhagen
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  • Heresh Amini, University of Copenhagen
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  • Thomas Cole-Hunter, University of Copenhagen
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  • Amar J. Mehta, University of Copenhagen, Statistics Denmark
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  • Laust H. Mortensen, University of Copenhagen, Statistics Denmark
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  • Matthias Ketzel
  • Anton Lager, Karolinska Institutet
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  • Karin Leander, Karolinska Institutet
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  • Petter Ljungman, Karolinska Institutet
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  • Gianluca Severi, Universite Paris-Saclay, University of Florence
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  • Marie Christine Boutron-Ruault, Universite Paris-Saclay
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  • Patrik K.E. Magnusson, Karolinska Institutet
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  • Gabriele Nagel, Ulm University
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  • Goran Pershagen, Karolinska Institutet, Region Stockholm
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  • Annette Peters, Ludwig Maximilian University of Munich
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  • Ole Raaschou-Nielsen
  • Debora Rizzuto, Karolinska Institutet, Karolinska Institutet and Stockholm University and The Stockholm Gerontology Research Center
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  • Yvonne T. van der Schouw, Utrecht University
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  • Sara Schramm, University of Duisburg-Essen
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  • Mette Sørensen, Danish Cancer Society, Roskilde University
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  • Massimo Stafoggia, Karolinska Institutet, Department of Epidemiology Lazio Regional Health Service
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  • Anne Tjønneland, Danish Cancer Society, Diet, Genes and Environment (DGE)
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  • Klea Katsouyanni, University of Athens, King's College London
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  • Wei Huang, Peking University
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  • Evangelia Samoli, University of Athens
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  • Bert Brunekreef, Utrecht University
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  • Gerard Hoek, Utrecht University
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  • Zorana J. Andersen, University of Copenhagen

Rationale: Ambient air pollution exposure has been linked to mortality from chronic cardiorespiratory diseases, while evidence on respiratory infections remains more limited. Objectives: We examined the association between long-term exposure to air pollution and pneumonia-related mortality in adults in a pool of eight European cohorts. Methods: Within the multicenter project ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO2), black carbon (BC), and ozone were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and pneumonia, influenza, and acute lower respiratory infections (ALRI) mortality. Measurements and Main Results: Of 325,367 participants, 712 died from pneumonia and influenza combined, 682 from pneumonia, and 695 from ALRI during a mean follow-up of 19.5 years. NO2 and BC were associated with 10–12% increases in pneumonia and influenza combined mortality, but 95% confidence intervals included unity (hazard ratios, 1.12 [0.99–1.26] per 10 μg/m3 for NO2; 1.10 [0.97–1.24] per 0.5 1025m21 for BC). Associations with pneumonia and ALRI mortality were almost identical. We detected effect modification suggesting stronger associations with NO2 or BC in overweight, employed, or currently smoking participants compared with normal weight, unemployed, or nonsmoking participants. Conclusions: Long-term exposure to combustion-related air pollutants NO2 and BC may be associated with mortality from lower respiratory infections, but larger studies are needed to estimate these associations more precisely.

Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume205
Issue12
Pages (from-to)1429-1439
Number of pages11
ISSN1073-449X
DOIs
Publication statusPublished - 15 Jun 2022

Bibliographical note

Publisher Copyright:
Copyright © 2022 by the American Thoracic Society

    Research areas

  • adults, air pollution, long-term exposure, respiratory infections

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