Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project.
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Beelen Rob, Raaschou-Nielsen Ole, Stafoggia Massimo, Andersen Zorana Jovanovic, Weinmayr Gudrun, Hoffmann Barbara, Wolf Kathrin, Samoli Evangelia, Fischer Paul, Nieuwenhuijsen Mark, Vineis Paolo, Xun Wei W, Katsouyanni Klea, Dimakopoulou Konstantina, Oudin Anna, Forsberg Bertil, Modig Lars, Havulinna Aki S, Lanki Timo, Turunen Anu, Oftedal Bente, Nystad Wenche, Nafstad Per, De Faire Ulf, Pedersen Nancy L, Östenson Claes-Göran, Fratiglioni Laura, Penell Johanna, Korek Michal, Pershagen Göran, Eriksen Kirsten Thorup, Overvad Kim, Ellermann Thomas, Eeftens Marloes, Peeters Petra H, Meliefste Kees, Wang Meng, Bueno-de-Mesquita Bas, Sugiri Dorothea, Krämer Ursula, Heinrich Joachim, de Hoogh Kees, Key Timothy, Peters Annette, Hampel Regina, Concin Hans, Nagel Gabriele, Ineichen Alex, Schaffner Emmanuel, Probst-Hensch Nicole, Künzli Nino, Schindler Christian, Schikowski Tamara, Adam Martin, Phuleria Harish, Vilier Alice, Clavel-Chapelon Françoise, Declercq Christophe, Grioni Sara, Krogh Vittorio, Tsai Ming-Yi, Ricceri Fulvio, Sacerdote Carlotta, Galassi Claudia, Migliore Enrica, Ranzi Andrea, Cesaroni Giulia, Badaloni Chiara, Forastiere Francesco, Tamayo Ibon, Amiano Pilar, Dorronsoro Miren, Katsoulis Michail, Trichopoulou Antonia, Brunekreef Bert, Hoek Gerard
Аннотация
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).