Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Lancet Planet Health. 2021 Sep;5(9):e620-e632. doi: 10.1016/S2542-5196(21)00195-9.
Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM), nitrogen dioxide (NO), black carbon, and warm-season ozone (O) with the incidence of stroke and acute coronary heart disease.
We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.
From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8-19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM (hazard ratio 1·10 [95% CI 1·01-1·21] per 5 μg/m increase), NO (1·08 [1·04-1·12] per 10 μg/m increase), and black carbon (1·06 [1·02-1·10] per 0·5 10/m increase), whereas coronary heart disease incidence was only associated with NO (1·04 [1·01-1·07]). Warm-season O was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM and NO remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m for PM and 40 μg/m for NO.
Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values.
Health Effects Institute.
长期暴露在户外空气污染中会增加患心血管疾病的风险，但目前仍不清楚暴露于低于当前欧盟和美国标准以及世界卫生组织指导限值的污染物浓度对健康的影响。在多中心研究“低水平空气污染的影响：欧洲的一项研究（ELAPSE）”中，我们调查了长期暴露于细颗粒物（PM）、二氧化氮（NO）、黑碳和暖季臭氧（O）与中风和急性冠心病发病率的关系。
我们对来自瑞典、丹麦、荷兰和德国的六个基于人群的队列研究（1992-2004 年招募）中的个体数据进行了 pooled 分析，并在队列之间对个体和区域水平变量进行了协调。参与者（均为成年人）随访至从研究区域迁移、死亡、或发生中风或冠心病，或随访结束（2011-15 年）。从集中开发的欧洲范围土地利用回归模型中获得的 2010 年平均空气污染物浓度被分配给参与者的基线居住地址。我们使用 Cox 比例风险模型，随着协变量调整水平的增加，调查了空气污染暴露与中风和冠心病发病率的关系。我们评估了浓度-反应函数的形状，并对生活在低于预定义值的污染物浓度下的参与者进行了亚组分析。
在经过充分调整的模型中，我们对来自 pooled ELAPSE 队列的 137148 名参与者的数据进行了分析。在中位随访 17.2 年（IQR 13.8-19.5）期间，我们观察到 6950 例中风事件和 10071 例冠心病事件。中风的发病率与 PM（每增加 5μg/m，风险比 1.10 [95%CI 1.01-1.21]）、NO（每增加 10μg/m，1.08 [1.04-1.12]）和黑碳（每增加 0.510/m，1.06 [1.02-1.10]）有关，而冠心病发病率仅与 NO 有关（每增加 10μg/m，1.04 [1.01-1.07]）。暖季 O 与这两种结果的增加均无关。浓度-反应曲线表明，在心血管健康不受损害的污染物浓度阈值以下，没有证据表明存在危害。即使将分析仅限于暴露于低于欧盟 PM 25μg/m 和 NO 40μg/m 限值的参与者，PM 和 NO 的效应估计仍保持升高。
长期暴露于空气污染与中风和冠心病的发病率有关，即使在低于当前限值的污染物浓度下也是如此。
健康影响研究所。
