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Lancet. 2014 Mar 1;383(9919):785-95. doi: 10.1016/S0140-6736(13)62158-3. Epub 2013 Dec 9.

Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project.

Author information

1
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands. Electronic address: r.m.j.beelen@uu.nl.
2
Danish Cancer Society Research Center, Copenhagen, Denmark.
3
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
4
Danish Cancer Society Research Center, Copenhagen, Denmark; Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
5
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; IUF - Leibniz Research Institute for Environmental Medicine, Germany and Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
6
IUF - Leibniz Research Institute for Environmental Medicine, Germany and Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
7
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
8
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece.
9
National Institute for Public Health and the Environment, Bilthoven, Netherlands.
10
Centre for Research in Environmental Epidemiology (CREAL), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
11
MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, UK.
12
MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, UK; CeLSIUS, University College London, London, UK.
13
Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
14
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
15
Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
16
Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway.
17
Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway.
18
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
19
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
20
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
21
Ageing Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
22
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Aarhus, Denmark.
23
Department of Environmental Science, Aarhus University, Roskilde, Denmark.
24
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
25
Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, UK.
26
Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.
27
Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
28
Agency for Preventive and Social Medicine, Bregenz, Austria.
29
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for Preventive and Social Medicine, Bregenz, Austria.
30
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
31
Inserm, Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France; University Paris Sud, UMRS 1018, F-94805, Villejuif, France; Institut Gustave Roussy, F-94805, Villejuif, France.
32
French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
33
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
34
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
35
Human Genetics Foundation - HuGeF, Turin, Italy.
36
Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Centre for Cancer Prevention, Turin, Italy.
37
Environmental Health Reference Centre-Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy.
38
Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain; Public Health Division of Gipuzkoa, Basque Government, Gipuzkoa, Spain.
39
Hellenic Health Foundation, Athens, Greece.
40
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.

Abstract

BACKGROUND:

Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants.

METHODS:

We used data from 22 European cohort studies, which created a total study population of 367,251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and between 10 μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis.

FINDINGS:

The total study population consisted of 367,251 participants who contributed 5,118,039 person-years at risk (average follow-up 13.9 years), of whom 29,076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m(3) (1.07, 1.01-1.13).

INTERPRETATION:

Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.

FUNDING:

European Community's Seventh Framework Program (FP7/2007-2011).

PMID:
24332274
DOI:
10.1016/S0140-6736(13)62158-3
[Indexed for MEDLINE]

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