Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Environ Int. 2021 Jan;146:106267. doi: 10.1016/j.envint.2020.106267. Epub 2020 Dec 1.
Air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD), but evidence is sparse and inconsistent.
We examined the association between long-term exposure to low-level air pollution and COPD incidence.
Within the 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE) study, we pooled data from three cohorts, from Denmark and Sweden, with information on COPD hospital discharge diagnoses. Hybrid land use regression models were used to estimate annual mean concentrations of particulate matter with a diameter < 2.5 µm (PM), nitrogen dioxide (NO), and black carbon (BC) in 2010 at participants' baseline residential addresses, which were analysed in relation to COPD incidence using Cox proportional hazards models.
Of 98,058 participants, 4,928 developed COPD during 16.6 years mean follow-up. The adjusted hazard ratios (HRs) and 95% confidence intervals for associations with COPD incidence were 1.17 (1.06, 1.29) per 5 µg/m for PM, 1.11 (1.06, 1.16) per 10 µg/m for NO, and 1.11 (1.06, 1.15) per 0.5 10m for BC. Associations persisted in subset participants with PM or NO levels below current EU and US limit values and WHO guidelines, with no evidence for a threshold. HRs for NO and BC remained unchanged in two-pollutant models with PM, whereas the HR for PM was attenuated to unity with NO or BC.
Long-term exposure to low-level air pollution is associated with the development of COPD, even below current EU and US limit values and possibly WHO guidelines. Traffic-related pollutants NO and BC may be the most relevant.
空气污染被认为是慢性阻塞性肺疾病（COPD）的一个风险因素，但证据有限且不一致。
我们研究了长期暴露于低水平空气污染与 COPD 发病之间的关系。
在“低水平空气污染的影响：欧洲研究”（ELAPSE）研究中，我们汇总了来自丹麦和瑞典三个队列的数据，这些队列均有 COPD 住院诊断信息。混合用地回归模型用于估计 2010 年参与者基线居住地址的细颗粒物（PM2.5）、二氧化氮（NO2）和黑碳（BC）的年平均浓度，并使用 Cox 比例风险模型分析它们与 COPD 发病的关系。
在 98058 名参与者中，有 4928 人在 16.6 年的平均随访期间发生了 COPD。调整后的 COPD 发病风险比（HR）及其 95%置信区间分别为 PM2.5 每增加 5μg/m 为 1.17（1.06，1.29）、NO2 每增加 10μg/m 为 1.11（1.06，1.16）、BC 每增加 0.5 10m 为 1.11（1.06，1.15）。在 PM 或 NO 水平低于当前欧盟和美国限值以及世卫组织指南的亚组参与者中，这些关联仍然存在，且不存在阈值。在包含 PM 的双污染物模型中，NO 和 BC 的 HR 没有变化，而 PM 的 HR 在包含 NO 或 BC 时减弱到 1。
即使低于当前欧盟和美国限值以及世卫组织指南，长期暴露于低水平空气污染也与 COPD 的发生有关。交通相关污染物 NO 和 BC 可能是最相关的。
