Long-term exposure to low-level air pollution and incidence of chronic obstructive pulmonary disease: The ELAPSE project

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Shuo Liu, Københavns Universitet, Institut for Folkesundhedsvidenskab, Denmark
  • Jeanette T Jørgensen, Københavns Universitet, Institut for Folkesundhedsvidenskab, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Denmark
  • Petter Ljungman, Department of Cardiology, Danderyd University Hospital, Stockholm, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  • Göran Pershagen, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital
  • ,
  • Tom Bellander, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital, Center for Occupational and Environmental Medicine, Region Stockholm, Sweden
  • Karin Leander, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital, Sweden
  • Patrik K E Magnusson, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital, Sweden
  • Debora Rizzuto, Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, The Stockholm Gerontology Research Center, Sweden
  • Ulla A Hvidtfeldt, Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, Denmark
  • Ole Raaschou-Nielsen
  • Kathrin Wolf, Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, D-85764 Neuherberg, Germany., Germany
  • Barbara Hoffmann, Institute of Occupational, Social and Environmental Medicine, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
  • Bert Brunekreef, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Netherlands
  • Maciej Strak, Institute for Risk Assessment Sciences (IRAS), Utrecht University, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • Jie Chen, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Netherlands
  • Amar Mehta, Københavns Universitet, Institut for Folkesundhedsvidenskab, Denmark
  • Richard W Atkinson, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St George’s, University of London, London, UK, United Kingdom
  • Mariska Bauwelinck, Interface Demography – Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium, Belgium
  • Raphaëlle Varraso, CESP INSERM UMRS 1018, Villejuif Cedex, France., France
  • Marie-Christine Boutron-Ruault, CESP INSERM UMRS 1018, Villejuif Cedex, France., France
  • Jørgen Brandt
  • Giulia Cesaroni, Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Italy
  • Francesco Forastiere, Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Italy
  • Daniela Fecht, MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK., United Kingdom
  • John Gulliver, UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, Imperial College London, Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, United Kingdom
  • Ole Hertel
  • Kees de Hoogh, Swiss Tropical and Public Health Institute (Swiss TPH), Switzerland
  • Nicole A H Janssen, National Institute for Public Health and the Environment (RIVM), Netherlands
  • Klea Katsouyanni, National and Kapodistrian University of Athens, Greece
  • Matthias Ketzel
  • Jochem O Klompmaker, Institute for Risk Assessment Sciences (IRAS), Utrecht University, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
  • Gabriele Nagel, Ulm Univ, Ulm University, Germany
  • Bente Oftedal, Norwegian Institute of Public Health, Norway
  • Annette Peters, Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany., Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
  • Anne Tjønneland, Department of Public Health, University of Copenhagen, 1123, Copenhagen, Denmark., Danish Cancer Society, Research Center, Copenhagen, Denmark., Denmark
  • Sophia P Rodopoulou, National and Kapodistrian University of Athens, Greece
  • Evangelia Samoli, National and Kapodistrian University of Athens, Greece
  • Terese Bekkevold, Norwegian Institute of Public Health, Norway
  • Torben Sigsgaard
  • Massimo Stafoggia, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital, Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Sweden
  • Danielle Vienneau, Swiss Tropical and Public Health Institute (Swiss TPH), Switzerland
  • Gudrun Weinmayr, Ulm Univ, Ulm University, Germany
  • Gerard Hoek, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Netherlands
  • Zorana J Andersen, Department of Public Health, University of Copenhagen, 1123, Copenhagen, Denmark., Nykøbing Falster Hospital, Center for Epidemiological Research, Ejegodvej 63, DK-4800 Nykøbing, Denmark, Denmark

BACKGROUND: Air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD), but evidence is sparse and inconsistent.

OBJECTIVES: We examined the association between long-term exposure to low-level air pollution and COPD incidence.

METHODS: Within the 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE) study, we pooled data from three cohorts, from Denmark and Sweden, with information on COPD hospital discharge diagnoses. Hybrid land use regression models were used to estimate annual mean concentrations of particulate matter with a diameter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) in 2010 at participants' baseline residential addresses, which were analysed in relation to COPD incidence using Cox proportional hazards models.

RESULTS: Of 98,058 participants, 4,928 developed COPD during 16.6 years mean follow-up. The adjusted hazard ratios (HRs) and 95% confidence intervals for associations with COPD incidence were 1.17 (1.06, 1.29) per 5 µg/m3 for PM2.5, 1.11 (1.06, 1.16) per 10 µg/m3 for NO2, and 1.11 (1.06, 1.15) per 0.5 10-5m-1 for BC. Associations persisted in subset participants with PM2.5 or NO2 levels below current EU and US limit values and WHO guidelines, with no evidence for a threshold. HRs for NO2 and BC remained unchanged in two-pollutant models with PM2.5, whereas the HR for PM2.5 was attenuated to unity with NO2 or BC.

CONCLUSIONS: Long-term exposure to low-level air pollution is associated with the development of COPD, even below current EU and US limit values and possibly WHO guidelines. Traffic-related pollutants NO2 and BC may be the most relevant.

Original languageEnglish
Article number106267
JournalEnvironment International
Volume146
Number of pages8
ISSN0160-4120
DOIs
Publication statusPublished - Jan 2021

    Research areas

  • air pollution, COPD incidence, low-level exposure

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