AbstractObjectiveTo investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and ...guidelines.DesignPooled analysis of eight cohorts.SettingMulticentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.Participants325 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 (PM2.5), nitrogen dioxide, ozone, and black carbon.Main outcome measuresDeaths due to natural causes and cause specific mortality.ResultsOf 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths.ConclusionsOur 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.
The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, the Health Effects Institute (HEI) ...appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected adverse health outcomes. Health outcomes were selected based on evidence of causality for general air pollution (broader than TRAP) cited in authoritative reviews, relevance for public health and policy, and resources available.
The Panel used a systematic approach to search the literature, select studies for inclusion in the review, assess study quality, summarize results, and reach conclusions about the confidence in the evidence. An extensive search was conducted of literature published between January 1980 and July 2019 on selected health outcomes. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP.
In total, 353 studies were included in the review. Respiratory effects in children (118 studies) and birth outcomes (86 studies) were the most commonly studied outcomes. Fewer studies investigated cardiometabolic effects (57 studies), respiratory effects in adults (50 studies), and mortality (48 studies).
The findings from the systematic review, meta-analyses, and evaluation of the quality of the studies and potential biases provided an overall high or moderate-to-high level of confidence in an association between long-term exposure to TRAP and the adverse health outcomes all-cause, circulatory, ischemic heart disease and lung cancer mortality, asthma onsetin chilldren and adults, and acute lower respiratory infections in children. The evidence was considered moderate, low or very low for the other selected outcomes.
In light of the large number of people exposed to TRAP – both in and beyond the near-road environment - the Panel concluded that the overall high or moderate-to-high confidence in the evidence for an association between long-term exposure to TRAP and several adverse health outcomes indicates that exposures to TRAP remain an important public health concern and deserve greater attention from the public and from policymakers.
Particulate matter (PM) air pollution is a human lung carcinogen; however, the components responsible have not been identified. We assessed the associations between PM components and lung cancer ...incidence.
We used data from 14 cohort studies in eight European countries. We geocoded baseline addresses and assessed air pollution with land-use regression models for eight elements (Cu, Fe, K, Ni, S, Si, V and Zn) in size fractions of PM2.5 and PM10. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effect models for meta-analysis.
The 245,782 cohort members contributed 3,229,220person–years at risk. During follow-up (mean, 13.1years), 1878 incident cases of lung cancer were diagnosed. In the meta-analyses, elevated hazard ratios (HRs) for lung cancer were associated with all elements except V; none was statistically significant. In analyses restricted to participants who did not change residence during follow-up, statistically significant associations were found for PM2.5 Cu (HR, 1.25; 95% CI, 1.01–1.53 per 5ng/m3), PM10 Zn (1.28; 1.02–1.59 per 20ng/m3), PM10 S (1.58; 1.03–2.44 per 200ng/m3), PM10 Ni (1.59; 1.12–2.26 per 2ng/m3) and PM10 K (1.17; 1.02–1.33 per 100ng/m3). In two-pollutant models, associations between PM10 and PM2.5 and lung cancer were largely explained by PM2.5 S.
This study indicates that the association between PM in air pollution and lung cancer can be attributed to various PM components and sources. PM containing S and Ni might be particularly important.
•Particulate matter air pollution is a human lung carcinogen.•The particulate matter components being responsible have not been identified.•This study indicates that various components are responsible.•The sulfur and nickel containing particles might be particularly important.
We investigated the short-term effects of particulate matter with aerodynamic diameter <10
μg/m
3 (PM
10), sulfur dioxide (SO
2), nitrogen dioxide (NO
2) and ozone (O
3) on pediatric asthma emergency ...admissions in Athens, Greece over the period 2001–2004. We explored effect modification patterns by season, sex, age and by the presence of desert dust transported mainly from the Sahara area.
We used daily time-series data provided by the children's hospitals and the fixed monitoring stations. The associations were investigated using Poisson regression models controlling for seasonality, weather, influenza episodes, day of the week and holiday effects.
A 10
μg/m
3 increase in PM
10 was associated with a 2.54% increase (95% confidence interval (CI): 0.06%, 5.08%) in the number of pediatric asthma hospital admissions, while the same increase in SO
2 was associated with a 5.98% (95% CI: 0.88%, 11.33%) increase. O
3 was associated with a statistically significant increase in asthma admissions among older children in the summer. Our findings provide limited evidence of an association between NO
2 exposure and asthma exacerbation. Statistically significant PM
10 effects were higher during winter and during desert dust days, while SO
2 effects occurred mainly during spring.
Our study confirms previously reported PM
10 effects on emergency hospital admissions for pediatric asthma and further provides evidence of stronger effects during desert dust days. We additionally report severe effects of SO
2, even at today's low concentration levels.
► We found adverse effects of exposure to pollutants on pediatric asthma admissions. ► PM
10 effects were higher during winter and during desert dust days. ►O
3 was associated with asthma admissions among older children in the summer. ►We report severe effects of SO
2, even at today's low concentration levels.
A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data ...collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO2), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO2 respectively.
The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.
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•We investigated NO2 associations with socioeconomic indicators in 9 European cities.•Higher NO2 was observed in areas with higher population density.•Higher NO2 was observed in areas with higher population born outside EU.•Higher NO2 was observed in areas with higher crime or unemployment rates.•Worse air quality is typically encountered in deprived European urban areas.
Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed ...associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE).
In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000–11; follow-up until 2011–17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and tropospheric warm-season ozone (O3) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis.
We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM2·5, NO2, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021–1·085) per 5 μg/m3 increment in PM2·5, 1·044 (1·019–1·069) per 10 μg/m3 NO2, and 1·039 (1·018–1·059) per 0·5 × 10−5/m black carbon. Associations with PM2·5, NO2, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O3 was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM2·5 (10 μg/m3) and NO2 (40 μg/m3) were 1·078 (1·046–1·111) per 5 μg/m3 PM2·5 and 1·049 (1·024–1·075) per 10 μg/m3 NO2. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032–1·092) for exposure lower than 1·5× 10−5/m, and 1·081 (0·966–1·210) for exposure lower than 1·0× 10−5/m.
Long-term exposure to concentrations of PM2·5 and NO2 lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions.
Health Effects Institute.
The evidence linking ambient air pollution to bladder cancer is limited and mixed.
We assessed the associations of bladder cancer incidence with residential exposure to fine particles (PM
), nitrogen ...dioxide (NO
), black carbon (BC), warm season ozone (O
) and eight PM
elemental components (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) in a pooled cohort (N = 302,493). Exposures were primarily assessed based on 2010 measurements and back-extrapolated to the baseline years. We applied Cox proportional hazard models adjusting for individual- and area-level potential confounders.
During an average of 18.2 years follow-up, 967 bladder cancer cases occurred. We observed a positive though statistically non-significant association between PM
and bladder cancer incidence. Hazard Ratios (HR) were 1.09 (95% confidence interval (CI): 0.93-1.27) per 5 µg/m
for 2010 exposure and 1.06 (95% CI: 0.99-1.14) for baseline exposure. Effect estimates for NO
, BC and O
were close to unity. A positive association was observed with PM
zinc (HR 1.08; 95% CI: 1.00-1.16 per 10 ng/m
).
We found suggestive evidence of an association between long-term PM
mass exposure and bladder cancer, strengthening the evidence from the few previous studies. The association with zinc in PM
suggests the importance of industrial emissions.
•A systematic review was conducted on associations between long-term exposure to traffic-related air pollution and non-accidental mortality.•A new exposure framework was developed to determine ...whether a study was sufficiently specific to TRAP, which includes studies beyond the near-roadway environment.•The overall confidence in the evidence for a positive association between long-term exposure to TRAP and non-accidental mortality was high.
The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest across the globe. Following its 2010 review, the Health Effects Institute appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected health outcomes. This paper describes the main findings of the systematic review on non-accidental mortality.
The Panel used a systematic approach to conduct the review. An extensive search was conducted of literature published between 1980 and 2019. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP, which included studies beyond the near-roadway environment. We performed random-effects meta-analysis when at least three estimates were available of an association between a specific exposure and outcome. We evaluated confidence in the evidence using a modified Office of Health Assessment and Translation (OHAT) approach, supplemented with a broader narrative synthesis.
Thirty-six cohort studies were included. Virtually all studies adjusted for a large number of individual and area-level covariates—including smoking, body mass index, and individual and area-level socioeconomic status—and were judged at a low or moderate risk for bias. Most studies were conducted in North America and Europe, and a few were based in Asia and Australia. The meta-analytic summary estimates for nitrogen dioxide, elemental carbon and fine particulate matter—pollutants with more than 10 studies—were 1.04 (95% CI 1.01, 1.06), 1.02 (1.00, 1.04) and 1.03 (1.01, 1.05) per 10, 1 and 5 µg/m3, respectively. Effect estimates are interpreted as the relative risk of mortality when the exposure differs with the selected increment. The confidence in the evidence for these pollutants was judged as high, because of upgrades for monotonic exposure–response and consistency across populations. The consistent findings across geographical regions, exposure assessment methods and confounder adjustment resulted in a high confidence rating using a narrative approach as well.
The overall confidence in the evidence for a positive association between long-term exposure to TRAP and non-accidental mortality was high.
Although the health effects of short-term exposure to ambient particles have been well documented, there is a need to update scientific knowledge due to the continuously changing profile of the air ...pollution mixture. Furthermore the effect of the severe economic crisis in Greece that started in 2008 on previously reported associations has not been studied. We assessed the change in mortality risk associated with short-term exposure to PM10 in Athens, Greece during 2001–12.
Time-series data on the daily concentrations of regulated particles and all cause, cardiovascular and respiratory mortality were analyzed using overdispersed Poisson regression models, controlling for time-varying confounders such as seasonality, meteorology, influenza outbreaks, summer holidays and day of the week. We assessed changes in risk over time by inclusion of an interaction term between particles' levels and time or predefined periods, i.e. 2001–07 and 2008–12.
While the related mortality risks increased over the analyzed period, the difference before and after 2008 was significant only for total mortality (p-value for interaction .03) and driven by the difference observed among those ≥75 years. An interquartile increase in PM10 before 2008 was associated with 1.51% increase in deaths among ≥75 years (95% Confidence interval (CI): 0.62%, 2.40%), while after 2008 with a 2.61% increase (95%CI: 1.72%, 3.51%) (p-value for interaction .01).
Our results indicate that despite the decline in particles' concentration in Athens, Greece during 2001–12 the associated mortality risk has possibly increased, suggesting that the economic crisis initiated in 2008 may have led to changes in the particles' composition due to the ageing of the vehicular fleet and the increase in the use of biomass fuel for heating.
•Mortality risks associated with PM10 exposure increased after 2008.•Increases were significant for total and cardiovascular mortality among ≥75 years.•The economic crisis initiated in 2008 may have changed particles' toxicity.
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