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

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

doi:10.1016/s0140-6736(13)62158-3

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

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

Center of Epidemiology and Screening

748 Citations (Scopus)

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 (PM_2.5), less than 10 μm (PM ₁₀), and between 10 μm and 2.5 μm (PM_coarse), PM_2.5 absorbance, and annual average concentrations of nitrogen oxides (NO₂ and NO_x) 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 metaanalysis. 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 PM_2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m³ was recorded. No heterogeneity was noted between individual cohort effect estimates (I² p value=0.95). HRs for PM_2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m³ (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m³ (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.

Original language	English
Journal	Lancet
Volume	383
Issue number	9919
Pages (from-to)	785–795
ISSN	0140-6736
DOIs	https://doi.org/10.1016/s0140-6736(13)62158-3
Publication status	Published - 2014

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10.1016/s0140-6736(13)62158-3

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Beelen, R., Raaschou-Nielsen, O., Stafoggia, M., Andersen, Z. J., Weinmayr, G., Hoffmann, B., Wolf, K., Samoli, E., Fischer, P., Nieuwenhuijsen, M., Vineis, P., Xun, W. W., Katsouyanni, K., Dimakopoulou, K., Oudin, A., Forsberg, B., Modig, L., Havulinna, A. S., Lanki, T., ... Hoek, G. (2014). Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet, 383(9919), 785–795. https://doi.org/10.1016/s0140-6736(13)62158-3

Beelen, R, Raaschou-Nielsen, O, Stafoggia, M, Andersen, ZJ, Weinmayr, G, Hoffmann, B, Wolf, K, Samoli, E, Fischer, P, Nieuwenhuijsen, M, Vineis, P, Xun, WW, Katsouyanni, K, Dimakopoulou, K, Oudin, A, Forsberg, B, Modig, L, Havulinna, AS, Lanki, T, Turunen, A, Oftedal, B, Nystad, W, Nafstad, P, De Faire, U, Pedersen, NL, Ostenson, C-G, Fratiglioni, L, Penell, J, Korek, M, Pershagen, G, Eriksen, KT, Overvad, K, Ellermann, T, Eeftens, M, Peeters, PH, Meliefste, K, Wang, M, Bueno-de-Mesquita, B, Sugiri, D, Krämer, U, Heinrich, J, de Hoogh, K, Key, T, Peters, A, Hampel, R, Concin, H, Nagel, G, Ineichen, A, Schaffner, E, Probst-Hensch, N, Künzli, N, Schindler, C, Schikowski, T, Adam, M, Phuleria, H, Vilier, A, Clavel-Chapelon, F, Declercq, C, Grioni, S, Krogh, V, Tsai, M-Y, Ricceri, F, Sacerdote, C, Galassi, C, Migliore, E, Ranzi, A, Cesaroni, G, Badaloni, C, Forastiere, F, Tamayo, I, Amiano, P, Dorronsoro, M, Katsoulis, M, Trichopoulou, A, Brunekreef, B & Hoek, G 2014, 'Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project', Lancet, vol. 383, no. 9919, pp. 785–795. https://doi.org/10.1016/s0140-6736(13)62158-3

@article{38662219d5674edea6430bc5366ab25c,

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

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 (PM 10), 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 metaanalysis. 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/m3 was recorded. No heterogeneity was noted between individual cohort effect estimates (I2 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/m3 (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m3 (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.",

author = "Rob Beelen and Ole Raaschou-Nielsen and Massimo Stafoggia and Andersen, {Zorana Jovanovic} and Gudrun Weinmayr and Barbara Hoffmann and Kathrin Wolf and Evangelia Samoli and Paul Fischer and Mark Nieuwenhuijsen and Paolo Vineis and Xun, {Wei W} and Klea Katsouyanni and Konstantina Dimakopoulou and Anna Oudin and Bertil Forsberg and Lars Modig and Havulinna, {Aki S} and Timo Lanki and Anu Turunen and Bente Oftedal and Wenche Nystad and Per Nafstad and {De Faire}, Ulf and Pedersen, {Nancy L} and Claes-G{\"o}ran Ostenson and Laura Fratiglioni and Johanna Penell and Michal Korek and G{\"o}ran Pershagen and Eriksen, {Kirsten Thorup} and Kim Overvad and Thomas Ellermann and Marloes Eeftens and Peeters, {Petra H} and Kees Meliefste and Meng Wang and Bas Bueno-de-Mesquita and Dorothea Sugiri and Ursula Kr{\"a}mer and Joachim Heinrich and {de Hoogh}, Kees and Timothy Key and Annette Peters and Regina Hampel and Hans Concin and Gabriele Nagel and Alex Ineichen and Emmanuel Schaffner and Nicole Probst-Hensch and Nino K{\"u}nzli and Christian Schindler and Tamara Schikowski and Martin Adam and Harish Phuleria and Alice Vilier and Fran{\c c}oise Clavel-Chapelon and Christophe Declercq and Sara Grioni and Vittorio Krogh and Ming-Yi Tsai and Fulvio Ricceri and Carlotta Sacerdote and Claudia Galassi and Enrica Migliore and Andrea Ranzi and Giulia Cesaroni and Chiara Badaloni and Francesco Forastiere and Ibon Tamayo and Pilar Amiano and Miren Dorronsoro and Michail Katsoulis and Antonia Trichopoulou and Bert Brunekreef and Gerard Hoek",

year = "2014",

doi = "10.1016/s0140-6736(13)62158-3",

language = "English",

volume = "383",

pages = "785–795",

journal = "Lancet",

issn = "0140-6736",

publisher = "TheLancet Publishing Group",

number = "9919",

}

TY - JOUR

T1 - Effects of long-term exposure to air pollution on natural-cause mortality

T2 - an analysis of 22 European cohorts within the multicentre ESCAPE project

AU - Beelen, Rob

AU - Raaschou-Nielsen, Ole

AU - Stafoggia, Massimo

AU - Andersen, Zorana Jovanovic

AU - Weinmayr, Gudrun

AU - Hoffmann, Barbara

AU - Wolf, Kathrin

AU - Samoli, Evangelia

AU - Fischer, Paul

AU - Nieuwenhuijsen, Mark

AU - Vineis, Paolo

AU - Xun, Wei W

AU - Katsouyanni, Klea

AU - Dimakopoulou, Konstantina

AU - Oudin, Anna

AU - Forsberg, Bertil

AU - Modig, Lars

AU - Havulinna, Aki S

AU - Lanki, Timo

AU - Turunen, Anu

AU - Oftedal, Bente

AU - Nystad, Wenche

AU - Nafstad, Per

AU - De Faire, Ulf

AU - Pedersen, Nancy L

AU - Ostenson, Claes-Göran

AU - Fratiglioni, Laura

AU - Penell, Johanna

AU - Korek, Michal

AU - Pershagen, Göran

AU - Eriksen, Kirsten Thorup

AU - Overvad, Kim

AU - Ellermann, Thomas

AU - Eeftens, Marloes

AU - Peeters, Petra H

AU - Meliefste, Kees

AU - Wang, Meng

AU - Bueno-de-Mesquita, Bas

AU - Sugiri, Dorothea

AU - Krämer, Ursula

AU - Heinrich, Joachim

AU - de Hoogh, Kees

AU - Key, Timothy

AU - Peters, Annette

AU - Hampel, Regina

AU - Concin, Hans

AU - Nagel, Gabriele

AU - Ineichen, Alex

AU - Schaffner, Emmanuel

AU - Probst-Hensch, Nicole

AU - Künzli, Nino

AU - Schindler, Christian

AU - Schikowski, Tamara

AU - Adam, Martin

AU - Phuleria, Harish

AU - Vilier, Alice

AU - Clavel-Chapelon, Françoise

AU - Declercq, Christophe

AU - Grioni, Sara

AU - Krogh, Vittorio

AU - Tsai, Ming-Yi

AU - Ricceri, Fulvio

AU - Sacerdote, Carlotta

AU - Galassi, Claudia

AU - Migliore, Enrica

AU - Ranzi, Andrea

AU - Cesaroni, Giulia

AU - Badaloni, Chiara

AU - Forastiere, Francesco

AU - Tamayo, Ibon

AU - Amiano, Pilar

AU - Dorronsoro, Miren

AU - Katsoulis, Michail

AU - Trichopoulou, Antonia

AU - Brunekreef, Bert

AU - Hoek, Gerard

PY - 2014

Y1 - 2014

N2 - 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 (PM 10), 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 metaanalysis. 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/m3 was recorded. No heterogeneity was noted between individual cohort effect estimates (I2 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/m3 (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m3 (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.

AB - 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 (PM 10), 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 metaanalysis. 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/m3 was recorded. No heterogeneity was noted between individual cohort effect estimates (I2 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/m3 (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m3 (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.

U2 - 10.1016/s0140-6736(13)62158-3

DO - 10.1016/s0140-6736(13)62158-3

M3 - Journal article

C2 - 24332274

SN - 0140-6736

VL - 383

SP - 785

EP - 795

JO - Lancet

JF - Lancet

IS - 9919

ER -

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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