Massimo Stafoggia1, Bente Oftedal2, Jie Chen3, Sophia Rodopoulou4, Matteo Renzi5, Richard W Atkinson6, Mariska Bauwelinck7, Jochem O Klompmaker8, Amar Mehta9, Danielle Vienneau10, Zorana J Andersen11, Tom Bellander12, Jørgen Brandt13, Giulia Cesaroni5, Kees de Hoogh10, Daniela Fecht14, John Gulliver15, Ole Hertel16, Barbara Hoffmann17, Ulla A Hvidtfeldt18, Karl-Heinz Jöckel19, Jeanette T Jørgensen11, Klea Katsouyanni20, Matthias Ketzel21, Doris Tove Kristoffersen22, Anton Lager23, Karin Leander24, Shuo Liu11, Petter L S Ljungman25, Gabriele Nagel26, Göran Pershagen12, Annette Peters27, Ole Raaschou-Nielsen28, Debora Rizzuto29, Sara Schramm30, Per E Schwarze31, Gianluca Severi32, Torben Sigsgaard33, Maciek Strak34, Yvonne T van der Schouw35, Monique Verschuren36, Gudrun Weinmayr26, Kathrin Wolf37, Emanuel Zitt38, Evangelia Samoli4, Francesco Forastiere39, Bert Brunekreef3, Gerard Hoek3, Nicole A H Janssen40. 1. Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: m.stafoggia@deplazio.it. 2. Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. 3. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands. 4. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 5. Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy. 6. Population Health Research Institute, St George's, University of London, London, UK. 7. Interface Demography-Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium. 8. National Institute for Public Health and the Environment, Bilthoven, Netherlands; Harvard T H Chan School of Public Health, Boston, MA, USA. 9. Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 10. Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. 11. Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 12. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden. 13. Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate Aarhus University Interdisciplinary Centre for Climate Change, Aarhus, Denmark. 14. School of Public Health, Faculty of Medicine, Imperial College London, London, UK. 15. School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Centre for Environmental Health and Sustainability and School of Geography, Geology and the Environment, University of Leicester, Leicester, UK. 16. Department of Bioscience, Aarhus University, Roskilde, Denmark. 17. Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 18. Danish Cancer Society Research Center, Copenhagen, Denmark. 19. Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany. 20. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; School of Public Health, Faculty of Medicine, Imperial College London, London, UK. 21. Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research, University of Surrey, Guildford, UK. 22. Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway. 23. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. 24. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 25. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden. 26. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. 27. Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, Munich, Germany. 28. Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark. 29. Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden. 30. Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany. 31. Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. 32. Exposome and Heredity Team, University Paris-Saclay, UVSQ, INSERM, Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science and Applications "G Parenti", University of Florence, Italy. 33. Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark. 34. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; National Institute for Public Health and the Environment, Bilthoven, Netherlands. 35. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands. 36. National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands. 37. Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany. 38. Agency for Preventive and Social Medicine, Bregenz, Austria. 39. Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK. 40. National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Abstract
BACKGROUND: Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE). METHODS: In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000-11; follow-up until 2011-17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and tropospheric warm-season ozone (O3) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis. FINDINGS: We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM2·5, NO2, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m3 increment in PM2·5, 1·044 (1·019-1·069) per 10 μg/m3 NO2, and 1·039 (1·018-1·059) per 0·5 × 10-5/m black carbon. Associations with PM2·5, NO2, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O3 was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM2·5 (10 μg/m3) and NO2 (40 μg/m3) were 1·078 (1·046-1·111) per 5 μg/m3 PM2·5 and 1·049 (1·024-1·075) per 10 μg/m3 NO2. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032-1·092) for exposure lower than 1·5× 10-5/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10-5/m. INTERPRETATION: Long-term exposure to concentrations of PM2·5 and NO2 lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions. FUNDING: Health Effects Institute.
BACKGROUND: Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE). METHODS: In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000-11; follow-up until 2011-17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and tropospheric warm-season ozone (O3) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis. FINDINGS: We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM2·5, NO2, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m3 increment in PM2·5, 1·044 (1·019-1·069) per 10 μg/m3 NO2, and 1·039 (1·018-1·059) per 0·5 × 10-5/m black carbon. Associations with PM2·5, NO2, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O3 was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM2·5 (10 μg/m3) and NO2 (40 μg/m3) were 1·078 (1·046-1·111) per 5 μg/m3 PM2·5 and 1·049 (1·024-1·075) per 10 μg/m3 NO2. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032-1·092) for exposure lower than 1·5× 10-5/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10-5/m. INTERPRETATION: Long-term exposure to concentrations of PM2·5 and NO2 lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions. FUNDING: Health Effects Institute.
Authors: Hans Orru; Henrik Olstrup; Jaakko Kukkonen; Susana López-Aparicio; David Segersson; Camilla Geels; Tanel Tamm; Kari Riikonen; Androniki Maragkidou; Torben Sigsgaard; Jørgen Brandt; Henrik Grythe; Bertil Forsberg Journal: BMC Public Health Date: 2022-07-04 Impact factor: 4.135
Authors: Scott Weichenthal; Lauren Pinault; Tanya Christidis; Richard T Burnett; Jeffrey R Brook; Yen Chu; Dan L Crouse; Anders C Erickson; Perry Hystad; Chi Li; Randall V Martin; Jun Meng; Amanda J Pappin; Michael Tjepkema; Aaron van Donkelaar; Crystal L Weagle; Michael Brauer Journal: Sci Adv Date: 2022-09-28 Impact factor: 14.957