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, Jorgen

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 - Jockel, Karl-Heinz

AU - Jorgensen, Jeanette

AU - Ketzel, Matthias

AU - Klompmaker, Jochem

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, Goran

AU - Peters, Annette

AU - Raaschou-Nielsen, Ole

AU - Renzi, Matteo

AU - Rizzuto, Debora

AU - Schouw, Yvonne T. van der

AU - Schramm, Sara

AU - Severi, Gianluca

AU - Sigsgaard, Torben

AU - Sørensen, Mette

AU - Stafoggia, Massimo

AU - Tjonneland, Anne

AU - Verschuren, W. M. Monique

AU - Vienneau, Danielle

AU - Wolf, Kathrin

AU - Katsouyanni, Klea

AU - Brunekreef, Bert

AU - Hoek, Gerard

AU - Samoli, Evangelia

PY - 2021

Y1 - 2021

N2 - OBJECTIVETo investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.DESIGNPooled analysis of eight cohorts.SETTINGMulticentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.PARTICIPANTS325 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 MEASURESDeaths due to natural causes and cause specific mortality.RESULTSOf 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 mu g/m(3) 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 mu g/m(3) 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 mu g/m(3) an increase of 5 mu g/m(3) in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths.CONCLUSIONSOur 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 - OBJECTIVETo investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.DESIGNPooled analysis of eight cohorts.SETTINGMulticentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.PARTICIPANTS325 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 MEASURESDeaths due to natural causes and cause specific mortality.RESULTSOf 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 mu g/m(3) 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 mu g/m(3) 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 mu g/m(3) an increase of 5 mu g/m(3) in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths.CONCLUSIONSOur 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 - FINE PARTICULATE MATTER

KW - CANADIAN CENSUS HEALTH

KW - GLOBAL BURDEN

KW - MODELS

KW - PM2.5

KW - NO2

KW - ASSOCIATIONS

KW - STABILITY

KW - RISK

KW - O-3

U2 - 10.1136/bmj.n1904

DO - 10.1136/bmj.n1904

M3 - Journal article

C2 - 34470785

VL - 374

JO - The BMJ

JF - The BMJ

SN - 0959-8146

M1 - 1904

ER -