Shuo Liu1, Jeanette T Jørgensen2, Petter Ljungman3, Göran Pershagen4, Tom Bellander4, Karin Leander5, Patrik K E Magnusson6, Debora Rizzuto7, Ulla A Hvidtfeldt8, Ole Raaschou-Nielsen9, Kathrin Wolf10, Barbara Hoffmann11, Bert Brunekreef12, Maciej Strak13, Jie Chen12, Amar Mehta1, Richard W Atkinson14, Mariska Bauwelinck15, Raphaëlle Varraso16, Marie-Christine Boutron-Ruault17, Jørgen Brandt18, Giulia Cesaroni19, Francesco Forastiere19, Daniela Fecht20, John Gulliver21, Ole Hertel22, Kees de Hoogh23, Nicole A H Janssen24, Klea Katsouyanni25, Matthias Ketzel26, Jochem O Klompmaker13, Gabriele Nagel27, Bente Oftedal28, Annette Peters29, Anne Tjønneland30, Sophia P Rodopoulou25, Evangelia Samoli25, Terese Bekkevold31, Torben Sigsgaard32, Massimo Stafoggia33, Danielle Vienneau23, Gudrun Weinmayr27, Gerard Hoek12, Zorana J Andersen34. 1. Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 2. Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 3. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden. 4. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden. 5. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 6. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 7. Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; The Stockholm Gerontology Research Center, Stockholm, Sweden. 8. Danish Cancer Society Research Center, Copenhagen, Denmark. 9. Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark. 10. Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany. 11. Institute of Occupational, Social and Environmental Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. 12. Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands. 13. Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. 14. Population Health Research Institute, St George's, University of London, London, United Kingdom. 15. Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium. 16. CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, Inserm UMR 1018, Villejuif, France. 17. CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, Inserm UMR 1018, Villejuif, France; Gustave Roussy, Villejuif, France. 18. Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Aarhus University Interdisciplinary Center for Climate Change, Roskilde, Denmark. 19. Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy. 20. MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom. 21. UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom. 22. Department of Environmental Science, Aarhus University, Roskilde, Denmark. 23. Swiss Tropical and Public Health Institute, Basel, Switzerland. 24. National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. 25. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 26. Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research, University of Surrey, Guildford, United Kingdom. 27. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. 28. Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. 29. Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany. 30. Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark. 31. Department of Infectious Diseases Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway. 32. Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark. 33. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy. 34. Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark. Electronic address: zorana.andersen@sund.ku.dk.
Abstract
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.
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.
Authors: Jie Chen; Gerard Hoek; Kees de Hoogh; Sophia Rodopoulou; Zorana J Andersen; Tom Bellander; Jørgen Brandt; Daniela Fecht; Francesco Forastiere; John Gulliver; Ole Hertel; Barbara Hoffmann; Ulla Arthur Hvidtfeldt; W M Monique Verschuren; Karl-Heinz Jöckel; Jeanette T Jørgensen; Klea Katsouyanni; Matthias Ketzel; Diego Yacamán Méndez; Karin Leander; Shuo Liu; Petter Ljungman; Elodie Faure; Patrik K E Magnusson; Gabriele Nagel; Göran Pershagen; Annette Peters; Ole Raaschou-Nielsen; Debora Rizzuto; Evangelia Samoli; Yvonne T van der Schouw; Sara Schramm; Gianluca Severi; Massimo Stafoggia; Maciej Strak; Mette Sørensen; Anne Tjønneland; Gudrun Weinmayr; Kathrin Wolf; Emanuel Zitt; Bert Brunekreef; George D Thurston Journal: Environ Sci Technol Date: 2022-06-23 Impact factor: 11.357
Authors: Amelia K Wesselink; Tanran R Wang; Matthias Ketzel; Ellen M Mikkelsen; Jørgen Brandt; Jibran Khan; Ole Hertel; Anne Sofie D Laursen; Benjamin R Johannesen; Mary D Willis; Jonathan I Levy; Kenneth J Rothman; Henrik T Sørensen; Lauren A Wise; Elizabeth E Hatch Journal: Paediatr Perinat Epidemiol Date: 2021-12-10 Impact factor: 3.103
Authors: Jie Chen; Sophia Rodopoulou; Kees de Hoogh; Maciej Strak; Zorana J Andersen; Richard Atkinson; Mariska Bauwelinck; Tom Bellander; Jørgen Brandt; Giulia Cesaroni; Hans Concin; Daniela Fecht; Francesco Forastiere; John Gulliver; Ole Hertel; Barbara Hoffmann; Ulla Arthur Hvidtfeldt; Nicole A H Janssen; Karl-Heinz Jöckel; Jeanette Jørgensen; Klea Katsouyanni; Matthias Ketzel; Jochem O Klompmaker; Anton Lager; Karin Leander; Shuo Liu; Petter Ljungman; Conor J MacDonald; Patrik K E Magnusson; Amar Mehta; Gabriele Nagel; Bente Oftedal; Göran Pershagen; Annette Peters; Ole Raaschou-Nielsen; Matteo Renzi; Debora Rizzuto; Evangelia Samoli; Yvonne T van der Schouw; Sara Schramm; Per Schwarze; Torben Sigsgaard; Mette Sørensen; Massimo Stafoggia; Anne Tjønneland; Danielle Vienneau; Gudrun Weinmayr; Kathrin Wolf; Bert Brunekreef; Gerard Hoek Journal: Environ Health Perspect Date: 2021-04-12 Impact factor: 9.031