Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project

Massimo Stafoggia; Giulia Cesaroni; Annette Peters; Zorana Jovanovic Andersen; Chiara Badaloni; Rob Beelen; Barbara Caracciolo; Josef Cyrys; Ulf de Faire; Kees de Hoogh; Kirsten T Eriksen; Laura Fratiglioni; Claudia Galassi; Bruna Gigante; Aki S Havulinna; Frauke Hennig; Agneta Hilding; Gerard Hoek; Barbara Hoffmann; Danny Houthuijs; Michal Korek; Timo Lanki; Karin Leander; Patrik K Magnusson; Christa Meisinger; Enrica Migliore; Kim Overvad; Claes-Göran Ostenson; Nancy L Pedersen; Juha Pekkanen; Johanna Penell; Göran Pershagen; Noreen Pundt; Andrei Pyko; Ole Raaschou-Nielsen; Andrea Ranzi; Fulvio Ricceri; Carlotta Sacerdote; Wim J Swart; Anu W Turunen; Paolo Vineis; Christian Weimar; Gudrun Weinmayr; Kathrin Wolf; Bert Brunekreef; Francesco Forastiere

doi:10.1289/ehp.1307301

Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project

Massimo Stafoggia, Giulia Cesaroni, Annette Peters, Zorana Jovanovic Andersen, Chiara Badaloni, Rob Beelen, Barbara Caracciolo, Josef Cyrys, Ulf de Faire, Kees de Hoogh, Kirsten T Eriksen, Laura Fratiglioni, Claudia Galassi, Bruna Gigante, Aki S Havulinna, Frauke Hennig, Agneta Hilding, Gerard Hoek, Barbara Hoffmann, Danny HouthuijsMichal Korek, Timo Lanki, Karin Leander, Patrik K Magnusson, Christa Meisinger, Enrica Migliore, Kim Overvad, Claes-Göran Ostenson, Nancy L Pedersen, Juha Pekkanen, Johanna Penell, Göran Pershagen, Noreen Pundt, Andrei Pyko, Ole Raaschou-Nielsen, Andrea Ranzi, Fulvio Ricceri, Carlotta Sacerdote, Wim J Swart, Anu W Turunen, Paolo Vineis, Christian Weimar, Gudrun Weinmayr, Kathrin Wolf, Bert Brunekreef, Francesco Forastiere

181 Citations (Scopus)

Abstract

Background: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events. Objectives: We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts. Methods: Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM_2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM₁₀ (PM ≤ 10 μm), PM_2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation. Results: A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m³ increase in annual PM_2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM₁₀. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM_2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among neversmokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM_2.5 exposure < 25 μg/m³ (HR = 1.33, 95% CI: 1.01, 1.77). Conclusions: We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.

Original language	English
Journal	Environmental Health Perspectives
Volume	122
Issue number	9
Pages (from-to)	919-925
Number of pages	7
ISSN	0091-6765
DOIs	https://doi.org/10.1289/ehp.1307301
Publication status	Published - Sept 2014

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10.1289/ehp.1307301

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Stafoggia, M., Cesaroni, G., Peters, A., Andersen, Z. J., Badaloni, C., Beelen, R., Caracciolo, B., Cyrys, J., de Faire, U., de Hoogh, K., Eriksen, K. T., Fratiglioni, L., Galassi, C., Gigante, B., Havulinna, A. S., Hennig, F., Hilding, A., Hoek, G., Hoffmann, B., ... Forastiere, F. (2014). Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project. Environmental Health Perspectives, 122(9), 919-925. https://doi.org/10.1289/ehp.1307301

Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events : Results from 11 European Cohorts within the ESCAPE Project. / Stafoggia, Massimo; Cesaroni, Giulia; Peters, Annette et al.

In: Environmental Health Perspectives, Vol. 122, No. 9, 09.2014, p. 919-925.

Research output: Contribution to journal › Journal article › Research › peer-review

Stafoggia, M, Cesaroni, G, Peters, A, Andersen, ZJ, Badaloni, C, Beelen, R, Caracciolo, B, Cyrys, J, de Faire, U, de Hoogh, K, Eriksen, KT, Fratiglioni, L, Galassi, C, Gigante, B, Havulinna, AS, Hennig, F, Hilding, A, Hoek, G, Hoffmann, B, Houthuijs, D, Korek, M, Lanki, T, Leander, K, Magnusson, PK, Meisinger, C, Migliore, E, Overvad, K, Ostenson, C-G, Pedersen, NL, Pekkanen, J, Penell, J, Pershagen, G, Pundt, N, Pyko, A, Raaschou-Nielsen, O, Ranzi, A, Ricceri, F, Sacerdote, C, Swart, WJ, Turunen, AW, Vineis, P, Weimar, C, Weinmayr, G, Wolf, K, Brunekreef, B & Forastiere, F 2014, 'Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project', Environmental Health Perspectives, vol. 122, no. 9, pp. 919-925. https://doi.org/10.1289/ehp.1307301

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title = "Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project",

abstract = "Background: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events. Objectives: We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts. Methods: Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM10 (PM ≤ 10 μm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation. Results: A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m3 increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among neversmokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM2.5 exposure < 25 μg/m3 (HR = 1.33, 95% CI: 1.01, 1.77). Conclusions: We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.",

author = "Massimo Stafoggia and Giulia Cesaroni and Annette Peters and Andersen, {Zorana Jovanovic} and Chiara Badaloni and Rob Beelen and Barbara Caracciolo and Josef Cyrys and {de Faire}, Ulf and {de Hoogh}, Kees and Eriksen, {Kirsten T} and Laura Fratiglioni and Claudia Galassi and Bruna Gigante and Havulinna, {Aki S} and Frauke Hennig and Agneta Hilding and Gerard Hoek and Barbara Hoffmann and Danny Houthuijs and Michal Korek and Timo Lanki and Karin Leander and Magnusson, {Patrik K} and Christa Meisinger and Enrica Migliore and Kim Overvad and Claes-G{\"o}ran Ostenson and Pedersen, {Nancy L} and Juha Pekkanen and Johanna Penell and G{\"o}ran Pershagen and Noreen Pundt and Andrei Pyko and Ole Raaschou-Nielsen and Andrea Ranzi and Fulvio Ricceri and Carlotta Sacerdote and Swart, {Wim J} and Turunen, {Anu W} and Paolo Vineis and Christian Weimar and Gudrun Weinmayr and Kathrin Wolf and Bert Brunekreef and Francesco Forastiere",

year = "2014",

month = sep,

doi = "10.1289/ehp.1307301",

language = "English",

volume = "122",

pages = "919--925",

journal = "Environmental Health Perspectives",

issn = "0091-6765",

publisher = "National Institute of Environmental Health Sciences",

number = "9",

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TY - JOUR

T1 - Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events

T2 - Results from 11 European Cohorts within the ESCAPE Project

AU - Stafoggia, Massimo

AU - Cesaroni, Giulia

AU - Peters, Annette

AU - Andersen, Zorana Jovanovic

AU - Badaloni, Chiara

AU - Beelen, Rob

AU - Caracciolo, Barbara

AU - Cyrys, Josef

AU - de Faire, Ulf

AU - de Hoogh, Kees

AU - Eriksen, Kirsten T

AU - Fratiglioni, Laura

AU - Galassi, Claudia

AU - Gigante, Bruna

AU - Havulinna, Aki S

AU - Hennig, Frauke

AU - Hilding, Agneta

AU - Hoek, Gerard

AU - Hoffmann, Barbara

AU - Houthuijs, Danny

AU - Korek, Michal

AU - Lanki, Timo

AU - Leander, Karin

AU - Magnusson, Patrik K

AU - Meisinger, Christa

AU - Migliore, Enrica

AU - Overvad, Kim

AU - Ostenson, Claes-Göran

AU - Pedersen, Nancy L

AU - Pekkanen, Juha

AU - Penell, Johanna

AU - Pershagen, Göran

AU - Pundt, Noreen

AU - Pyko, Andrei

AU - Raaschou-Nielsen, Ole

AU - Ranzi, Andrea

AU - Ricceri, Fulvio

AU - Sacerdote, Carlotta

AU - Swart, Wim J

AU - Turunen, Anu W

AU - Vineis, Paolo

AU - Weimar, Christian

AU - Weinmayr, Gudrun

AU - Wolf, Kathrin

AU - Brunekreef, Bert

AU - Forastiere, Francesco

PY - 2014/9

Y1 - 2014/9

N2 - Background: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events. Objectives: We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts. Methods: Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM10 (PM ≤ 10 μm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation. Results: A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m3 increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among neversmokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM2.5 exposure < 25 μg/m3 (HR = 1.33, 95% CI: 1.01, 1.77). Conclusions: We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.

AB - Background: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events. Objectives: We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts. Methods: Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM10 (PM ≤ 10 μm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation. Results: A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m3 increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among neversmokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM2.5 exposure < 25 μg/m3 (HR = 1.33, 95% CI: 1.01, 1.77). Conclusions: We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.

U2 - 10.1289/ehp.1307301

DO - 10.1289/ehp.1307301

M3 - Journal article

C2 - 24835336

SN - 0091-6765

VL - 122

SP - 919

EP - 925

JO - Environmental Health Perspectives

JF - Environmental Health Perspectives

IS - 9

ER -

Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project

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