Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: Pooled analysis

MacIej Strak, Gudrun Weinmayr, Sophia Rodopoulou, Jie Chen, Kees De Hoogh, Zorana J. Andersen, Richard Atkinson, Mariska Bauwelinck, Terese Bekkevold, Tom Bellander, Marie Christine Boutron-Ruault, Jørgen Brandt, Giulia Cesaroni, Hans Concin, Daniela Fecht, Francesco Forastiere, John Gulliver, Ole Hertel, Barbara Hoffmann, Ulla Arthur HvidtfeldtNicole A.H. Janssen, Karl Heinz Jöckel, Jeanette T. Jørgensen, Matthias Ketzel, Jochem O. Klompmaker, Anton Lager, Karin Leander, Shuo Liu, Petter Ljungman, Patrik K.E. Magnusson, Amar J. Mehta, Gabriele Nagel, Bente Oftedal, Göran Pershagen, Annette Peters, Ole Raaschou-Nielsen, Matteo Renzi, Debora Rizzuto, Yvonne T. Van Der Schouw, Sara Schramm, Gianluca Severi, Torben Sigsgaard, Mette Sørensen, Massimo Stafoggia, Anne Tjønneland, W. Monique Verschuren, Danielle Vienneau, Kathrin Wolf, Klea Katsouyanni, Bert Brunekreef, Gerard Hoek*, Evangelia Samoli

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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 (PM 2.5), 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 PM 2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 μg/m 3 in PM 2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 μg/m 3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM 2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 μg/m 3 an increase of 5 μg/m 3 in PM 2.5 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.

Original languageEnglish
Article numbern1904
JournalThe BMJ
Volume374
ISSN0959-8146
DOIs
Publication statusPublished - 1 Sep 2021

Bibliographical note

Funding: This work was supported by Health Effects Institute (HEI) research agreement (grant No 4954-RFA14-3/16-5-3).

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