The Lancet:Effects of long-term exposure to air pollution on natural-cause mortality

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Copyright © 2013 Elsevier Ltd All rights reserved. BRON
Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project.
Dr Rob Beelen PhD a

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, Ole Raaschou-Nielsen PhD b, Massimo Stafoggia MSc c, Zorana Jovanovic Andersen PhD b d, Gudrun Weinmayr PhD e f, Prof Barbara Hoffmann MD f, Kathrin Wolf PhD g, Evangelia Samoli PhD h, Paul Fischer MSc i, Mark Nieuwenhuijsen PhD j k, Prof Paolo Vineis MD l, Wei W Xun MSc l m, Prof Klea Katsouyanni PhD h, Konstantina Dimakopoulou MSc h, Anna Oudin PhD n, Prof Bertil Forsberg PhD n, Lars Modig PhD n, Aki S Havulinna DSc [tech] o, Timo Lanki PhD p, Anu Turunen PhD p, Bente Oftedal PhD q, Prof Wenche Nystad PhD q, Prof Per Nafstad MD q r, Prof Ulf De Faire PhD s, Prof Nancy L Pedersen PhD t, Prof Claes-Göran Östenson PhD u, Laura Fratiglioni PhD v, Johanna Penell PhD s, Michal Korek MSc s, Prof Göran Pershagen MD s, Kirsten Thorup Eriksen PhD b, Kim Overvad PhD w, Thomas Ellermann PhD x, Marloes Eeftens MSc a, Prof Petra H Peeters PhD y z, Kees Meliefste BSc a, Meng Wang MSc a, Prof Bas Bueno-de-Mesquita PhD i, Dorothea Sugiri MSc f, Prof Ursula Krämer PhD f, Joachim Heinrich PhD aa, Kees de Hoogh PhD l, Prof Timothy Key DPhil ab, Prof Annette Peters PhD g, Regina Hampel PhD g, Hans Concin MD ac, Prof Gabriele Nagel PhD e ac, Alex Ineichen BSc ad ae, Emmanuel Schaffner MSc ad ae, Prof Nicole Probst-Hensch PhD ad ae, Prof Nino Künzli PhD ad ae, Christian Schindler PhD ad ae, Tamara Schikowski PhD ad ae, Martin Adam PhD ad ae, Harish Phuleria PhD ad ae, Alice Vilier MSc af ag ah, Françoise Clavel-Chapelon PhD af ag ah, Christophe Declercq MD ai, Sara Grioni BSc aj, Vittorio Krogh MD aj, Ming-Yi Tsai PhD ad ae ak, Fulvio Ricceri PhD al, Carlotta Sacerdote PhD am, Claudia Galassi MD am, Enrica Migliore MSc am, Andrea Ranzi PhD an, Giulia Cesaroni MSc c, Chiara Badaloni MSc c, Francesco Forastiere MD c, Ibon Tamayo MSc k ao, Pilar Amiano MSc k ao, Miren Dorronsoro MD k ao, Michail Katsoulis MSc ap, Prof Antonia Trichopoulou PhD ap, Prof Bert Brunekreef PhD a y, Gerard Hoek PhD a 

Summary 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/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.
Funding
European Community’s Seventh Framework Program (FP7/2007—2011).