Article Publish Status: FREE
Abstract Title:

Long-term exposure to low ambient air pollution concentrations and mortality among 28 million people: results from seven large European cohorts within the ELAPSE project.

Abstract Source:

Lancet Planet Health. 2022 Jan ;6(1):e9-e18. PMID: 34998464

Abstract Author(s):

Massimo Stafoggia, Bente Oftedal, Jie Chen, Sophia Rodopoulou, Matteo Renzi, Richard W Atkinson, Mariska Bauwelinck, Jochem O Klompmaker, Amar Mehta, Danielle Vienneau, Zorana J Andersen, Tom Bellander, Jørgen Brandt, Giulia Cesaroni, Kees de Hoogh, Daniela Fecht, John Gulliver, Ole Hertel, Barbara Hoffmann, Ulla A Hvidtfeldt, Karl-Heinz Jöckel, Jeanette T Jørgensen, Klea Katsouyanni, Matthias Ketzel, Doris Tove Kristoffersen, Anton Lager, Karin Leander, Shuo Liu, Petter L S Ljungman, Gabriele Nagel, Göran Pershagen, Annette Peters, Ole Raaschou-Nielsen, Debora Rizzuto, Sara Schramm, Per E Schwarze, Gianluca Severi, Torben Sigsgaard, Maciek Strak, Yvonne T van der Schouw, Monique Verschuren, Gudrun Weinmayr, Kathrin Wolf, Emanuel Zitt, Evangelia Samoli, Francesco Forastiere, Bert Brunekreef, Gerard Hoek, Nicole A H Janssen

Article Affiliation:

Massimo Stafoggia


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 (PM), nitrogen dioxide (NO), black carbon, and tropospheric warm-season ozone (O) 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 PM, NO, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/mincrement in PM, 1·044 (1·019-1·069) per 10 μg/mNO, and 1·039 (1·018-1·059) per 0·5 × 10/m black carbon. Associations with PM, NO, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season Owas 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 PM(10μg/m) and NO(40μg/m) were 1·078 (1·046-1·111) per 5 μg/mPMand 1·049 (1·024-1·075) per 10 μg/mNO. 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/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10/m.

INTERPRETATION: Long-term exposure to concentrations of PMand NOlower 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.

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