posted on 2021-10-04, 16:10authored byMaciej Strak, Gudrun Weinmayr, Sophia Rodopoulou, Jie Chen, Kees de Hoogh, Zorana J Andersen, Richard Atkinson, Mariska Bauwelinck, Terese Bekkevold, Tom Bellander, Marie-Christine Boutron-Ruault, Jorgen Brandt, Giulia Cesaroni, Hans Concin, Daniela Fecht, Francesco Forastiere, John Gulliver, Ole Hertel, Barbara Hoffmann, Ulla Arthur Hvidtfeldt, Nicole AH Janssen, Karl-Heinz Jockel, Jeanette Jorgensen, Matthias Ketzel, Jochem Klompmaker, Anton Lager, Karin Leander, Shuo Liu, Petter Ljungman, Patrik KE Magnusson, Amar J Mehta, Gabriele Nagel, Bente Oftedal, Goran Pershagen, Annette Peters, Ole Raaschou-Nielsen, Matteo Renzi, Debora Rizzuto, Yvonne T van der Schouw, Sara Schramm, Gianluca Severi, Torben Sigsgaard, Mette Sorensen, Massimo Stafoggia, Anne Tjonneland, WM Monique Verschuren, Danielle Vienneau, Kathrin Wolf, Klea Katsouyanni, Bert Brunekreef, Gerard Hoek, Evangelia Samoli
Objective: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines.
Design: Pooled analysis of eight cohorts.
Setting: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries.
Participants: 325 367 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 measures: Deaths due to natural causes and cause specific mortality.
Results: Of 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.
Conclusions: Our 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.
Funding
This work was supported by Health Effects Institute (HEI) research agreement (grant No 4954-RFA14-3/16-5-3). Research described in this article was conducted under contract to the HEI, an organisation jointly funded by the US Environmental Protection Agency (EPA) (assistance award No R-82811201) and certain motor vehicle and engine manufacturers. The contents of this article do not necessarily reflect the views of HEI, or its sponsors, nor do they necessarily reflect the views and policies of the EPA or motor vehicle and engine manufacturers.
History
Citation
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1904 (Published 02 September 2021)
Cite this as: BMJ 2021;374:n1904
Author affiliation
Centre for Environmental Health and Sustainability, School of Geography, Geology and the Environment