Mila Dirgawati1,2, Andrea Hinwood3, Lee Nedkoff1, Graeme J Hankey4, Bu B Yeap4,5, Leon Flicker4,6, Mark Nieuwenhuijsen7, Bert Brunekreef8, Jane Heyworth1,9. 1. From the School of Population and Global Health, The University of Western Australia, Crawley, Australia. 2. Institut Teknologi Nasional, Department of Environmental Engineering, PH.H Mustafa, Bandung, Indonesia. 3. Edith Cowan University, Joondalup, Australia. 4. School of Medicine, The University of Western Australia, Crawley, Australia. 5. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, Australia. 6. WA Centre for Health & Ageing, The University of Western Australia (M577), Royal Perth Hospital MRF Building, Perth, Australia. 7. ISGlobal, Barcelona Institute for Global Health Campus MAR, Barcelona Biomedical Research Park, Barcelona, Spain. 8. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands. 9. Centre for Air Pollution, Energy and Health, Glebe, New South Wales, Australia.
Abstract
BACKGROUND: Long-term air pollution exposure has been associated with increased risk of mortality and stroke. Less is known about the risk at lower concentrations. The association of long-term exposure to PM2.5, PM2.5 absorbance, NO2, and NOx with all-cause mortality and stroke was investigated in a cohort of men aged ≥ 65 years who lived in metropolitan Perth, Western Australia. METHODS: Land use regression models were used to estimate long-term exposure to air pollutants at participant's home address (n = 11,627) over 16 years. Different metrics of exposure were assigned: baseline; year before the outcome event; and average exposure across follow-up period. The Mortality Register and Hospital Morbidity Data from the Western Australia Data Linkage System were used to ascertain mortality and stroke cases. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models, adjusting for age, smoking, education, and body mass index for all-cause mortality. For fatal and hospitalized stroke, the models included variables controlled for all-cause mortality plus hypertension. RESULTS: Fifty-four percent of all-participants died, 3% suffered a fatal stroke, and 14% were hospitalized stroke cases. PM2.5 absorbance increased the risk of all-cause mortality with adjusted HR of 1.12 (1.02-1.23) for baseline and average exposures, and 1.14 (1.02-1.24) for past-year exposure. There were no associations between PM2.5 absorbance, NO2, and NOx and stroke outcomes. However, PM2.5 was associated with reduced risks of fatal stroke. CONCLUSION: Long-term exposure to PM2.5 absorbance was associated with all-cause mortality among older men exposed to low concentrations; and exposure to PM2.5 was associated with reduced risk of fatal stroke.
BACKGROUND: Long-term air pollution exposure has been associated with increased risk of mortality and stroke. Less is known about the risk at lower concentrations. The association of long-term exposure to PM2.5, PM2.5 absorbance, NO2, and NOx with all-cause mortality and stroke was investigated in a cohort of men aged ≥ 65 years who lived in metropolitan Perth, Western Australia. METHODS: Land use regression models were used to estimate long-term exposure to air pollutants at participant's home address (n = 11,627) over 16 years. Different metrics of exposure were assigned: baseline; year before the outcome event; and average exposure across follow-up period. The Mortality Register and Hospital Morbidity Data from the Western Australia Data Linkage System were used to ascertain mortality and stroke cases. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models, adjusting for age, smoking, education, and body mass index for all-cause mortality. For fatal and hospitalized stroke, the models included variables controlled for all-cause mortality plus hypertension. RESULTS: Fifty-four percent of all-participants died, 3% suffered a fatal stroke, and 14% were hospitalized stroke cases. PM2.5 absorbance increased the risk of all-cause mortality with adjusted HR of 1.12 (1.02-1.23) for baseline and average exposures, and 1.14 (1.02-1.24) for past-year exposure. There were no associations between PM2.5 absorbance, NO2, and NOx and stroke outcomes. However, PM2.5 was associated with reduced risks of fatal stroke. CONCLUSION: Long-term exposure to PM2.5 absorbance was associated with all-cause mortality among older men exposed to low concentrations; and exposure to PM2.5 was associated with reduced risk of fatal stroke.
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