TY - JOUR
T1 - Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project
T2 - pooled analysis
AU - Strak, Maciej
AU - Weinmayr, Gudrun
AU - Rodopoulou, Sophia
AU - Chen, Jie
AU - de Hoogh, Kees
AU - Andersen, Zorana J
AU - Atkinson, Richard
AU - Bauwelinck, Mariska
AU - Bekkevold, Terese
AU - Bellander, Tom
AU - Boutron-Ruault, Marie-Christine
AU - Brandt, Jørgen
AU - Cesaroni, Giulia
AU - Concin, Hans
AU - Fecht, Daniela
AU - Forastiere, Francesco
AU - Gulliver, John
AU - Hertel, Ole
AU - Hoffmann, Barbara
AU - Hvidtfeldt, Ulla Arthur
AU - Janssen, Nicole A H
AU - Jöckel, Karl-Heinz
AU - Jørgensen, Jeanette T
AU - Ketzel, Matthias
AU - Klompmaker, Jochem O
AU - Lager, Anton
AU - Leander, Karin
AU - Liu, Shuo
AU - Ljungman, Petter
AU - Magnusson, Patrik K E
AU - Mehta, Amar J
AU - Nagel, Gabriele
AU - Oftedal, Bente
AU - Pershagen, Göran
AU - Peters, Annette
AU - Raaschou-Nielsen, Ole
AU - Renzi, Matteo
AU - Rizzuto, Debora
AU - van der Schouw, Yvonne T
AU - Schramm, Sara
AU - Severi, Gianluca
AU - Sigsgaard, Torben
AU - Sørensen, Mette
AU - Stafoggia, Massimo
AU - Tjønneland, Anne
AU - Verschuren, W M Monique
AU - Vienneau, Danielle
AU - Wolf, Kathrin
AU - Katsouyanni, Klea
AU - Brunekreef, Bert
AU - Hoek, Gerard
AU - Samoli, Evangelia
N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - OBJECTIVE: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.DESIGN: Pooled analysis of eight cohorts.SETTING: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.PARTICIPANTS: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon.MAIN OUTCOME MEASURES: Deaths due to natural causes and cause specific mortality.RESULTS: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths.CONCLUSIONS: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
AB - OBJECTIVE: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.DESIGN: Pooled analysis of eight cohorts.SETTING: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.PARTICIPANTS: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon.MAIN OUTCOME MEASURES: Deaths due to natural causes and cause specific mortality.RESULTS: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths.CONCLUSIONS: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
KW - Air Pollutants/adverse effects
KW - Air Pollution/adverse effects
KW - Cardiovascular Diseases/mortality
KW - Environmental Exposure/adverse effects
KW - Europe
KW - Humans
KW - Noncommunicable Diseases/mortality
UR - http://www.scopus.com/inward/record.url?scp=85114298591&partnerID=8YFLogxK
U2 - 10.1136/bmj.n1904
DO - 10.1136/bmj.n1904
M3 - Article
C2 - 34470785
SN - 0959-8138
VL - 374
JO - BMJ (Clinical Research ed.)
JF - BMJ (Clinical Research ed.)
M1 - n1904
ER -