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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• 作者：Dr Rob Beelen ; PhD^a ; ^{r.m.j.beelen@uu.nl" class="auth_mail} ; 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 ; MScⁱ ; 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 ; PhDⁿ ; Prof Bertil Forsberg ; PhDⁿ ; Lars Modig ; PhDⁿ ; 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-Gö ; ran Ö ; stenson ; PhD^u ; Laura Fratiglioni ; PhD^v ; Johanna Penell ; PhD^s ; Michal Korek ; MSc^s ; Prof Gö ; ran 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 ; PhDⁱ ; Dorothea Sugiri ; MSc^f ; Prof Ursula Krä ; mer ; 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 Kü ; nzli ; 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 ; Franç ; oise 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
• 刊名：The Lancet
• 出版年：1-7 March, 2014
• 年：2014
• 卷：383
• 期：9919
• 页码：785-795
• 全文大小：351 K

文摘

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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鈥?51 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路5 渭m (PM_2路5), less than 10 渭m (PM₁₀), and between 10 渭m and 2路5 渭m (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鈥攖raffic 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鈥?51 participants who contributed 5鈥?18鈥?39 person-years at risk (average follow-up 13路9 years), of whom 29鈥?76 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM_2路5 of 1路07 (95% CI 1路02-1路13) per 5 渭g/m³ was recorded. No heterogeneity was noted between individual cohort effect estimates (I² p value=0路95). HRs for PM_2路5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 渭g/m³ (HR 1路06, 95% CI 1路00-1路12) or below 20 渭g/m³ (1路07, 1路01-1路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).