Long-term exposure to low-level air pollution and incidence of chronic obstructive pulmonary disease: The ELAPSE project

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  • Petter Ljungman
  • Göran Pershagen
  • Tom Bellander
  • Karin Leander
  • Patrik K.E. Magnusson
  • Debora Rizzuto
  • Ulla A. Hvidtfeldt
  • Ole Raaschou-Nielsen
  • Kathrin Wolf
  • Barbara Hoffmann
  • Bert Brunekreef
  • Maciej Strak
  • Jie Chen
  • Richard W. Atkinson
  • Mariska Bauwelinck
  • Raphaëlle Varraso
  • Marie Christine Boutron-Ruault
  • Jørgen Brandt
  • Giulia Cesaroni
  • Francesco Forastiere
  • Daniela Fecht
  • John Gulliver
  • Ole Hertel
  • Kees de Hoogh
  • Nicole A.H. Janssen
  • Klea Katsouyanni
  • Matthias Ketzel
  • Jochem O. Klompmaker
  • Gabriele Nagel
  • Bente Oftedal
  • Annette Peters
  • Sophia P. Rodopoulou
  • Evangelia Samoli
  • Terese Bekkevold
  • Torben Sigsgaard
  • Massimo Stafoggia
  • Danielle Vienneau
  • Gudrun Weinmayr
  • Gerard Hoek

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.

Original languageEnglish
Article number106267
JournalEnvironment International
Publication statusPublished - 2021

    Research areas

  • Air pollution, COPD incidence, Low-level exposure

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