Stafoggia Massimo, Oftedal Bente, Chen Jie, Rodopoulou Sophia, Renzi Matteo, Atkinson Richard W, Bauwelinck Mariska, Klompmaker Jochem O, Mehta Amar, Vienneau Danielle, Andersen Zorana J, Bellander Tom, Brandt Jørgen, Cesaroni Giulia, de Hoogh Kees, Fecht Daniela, Gulliver John, Hertel Ole, Hoffmann Barbara, Hvidtfeldt Ulla A, Jöckel Karl-Heinz, Jørgensen Jeanette T, Katsouyanni Klea, Ketzel Matthias, Kristoffersen Doris Tove, Lager Anton, Leander Karin, Liu Shuo, Ljungman Petter L S, Nagel Gabriele, Pershagen Göran, Peters Annette, Raaschou-Nielsen Ole, Rizzuto Debora, Schramm Sara, Schwarze Per E, Severi Gianluca, Sigsgaard Torben, Strak Maciek, van der Schouw Yvonne T, Verschuren Monique, Weinmayr Gudrun, Wolf Kathrin, Zitt Emanuel, Samoli Evangelia, Forastiere Francesco, Brunekreef Bert, Hoek Gerard, Janssen Nicole A H
Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
Lancet Planet Health. 2022 Jan;6(1):e9-e18. doi: 10.1016/S2542-5196(21)00277-1.
Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE).
In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000-11; follow-up until 2011-17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM), nitrogen dioxide (NO), black carbon, and tropospheric warm-season ozone (O) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis.
We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM, NO, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m increment in PM, 1·044 (1·019-1·069) per 10 μg/m NO, and 1·039 (1·018-1·059) per 0·5 × 10/m black carbon. Associations with PM, NO, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM (10 μg/m) and NO (40 μg/m) were 1·078 (1·046-1·111) per 5 μg/m PM and 1·049 (1·024-1·075) per 10 μg/m NO. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032-1·092) for exposure lower than 1·5× 10/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10/m.
Long-term exposure to concentrations of PM and NO lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions.
Health Effects Institute.
长期暴露于环境空气污染与过早死亡有关，但低于当前年度限值浓度下的关联尚不确定。我们在多中心研究“低水平空气污染的影响：欧洲的一项研究”（ELAPSE）中分析了低水平空气污染与死亡率之间的关联。
在这项多中心纵向研究中，我们分析了ELAPSE中来自比利时、丹麦、英格兰、荷兰、挪威、罗马（意大利）和瑞士的7个基于人群的成年人队列（年龄≥30岁）（于2000 - 2011年入组；随访至2011 - 2017年）。使用死亡率登记处提取已故个体的潜在死因。将来自欧洲范围空间分辨率为100米的土地利用回归模型的细颗粒物（PM）、二氧化氮（NO）、黑碳和对流层暖季臭氧（O）的年平均浓度分配到基线居住地址。我们应用特定队列的Cox比例风险模型，并对区域水平和个体水平的协变量进行调整，以评估与非意外死亡率（作为主要结局）以及心血管、非恶性呼吸道和肺癌死亡率的关联。对居住在低污染物浓度（根据预定义值）的参与者进行子集分析，并使用自然样条来研究浓度 - 反应函数。特定队列的效应估计值在随机效应荟萃分析中进行合并。
我们分析了28153138名参与者，共257859621人年的观察期，在此期间发生了3593741例非意外死亡。我们发现非意外死亡率与PM、NO和黑碳之间存在显著正相关，PM每增加5μg/m³，风险比（HR）为1.053（95%CI 1.021 - 1.085）；NO每增加10μg/m³，HR为1.044（1.019 - 1.069）；黑碳每增加0.5×10⁻⁵/m³，HR为1.039（1.018 - 1.059）。与PM、NO和黑碳的关联在心血管死亡率方面稍弱，在非恶性呼吸道死亡率方面相似，在肺癌死亡率方面更强。暖季O与非意外和特定病因死亡率均呈负相关。在低浓度时关联更强：低于世界卫生组织2（005年空气质量指南值（PM为10μg/m³，NO为40μg/m³）的浓度下，非意外死亡率的HR分别为PM每增加5μg/m³时1.078（1.046 - 1.111），NO每增加10μg/m³时1.049（1.024 - 1.075）。同样，黑碳与非意外死亡率之间的关联在低浓度时最高。暴露低于1.5×10⁻⁵/m³时HR为1.061（1.032 - 1.092），暴露低于1.0×10⁻⁵/m³时HR为1.081（0.9（66 - 1.210）。
长期暴露于低于当前年度限值浓度的PM和NO与7个大型欧洲队列中的非意外、心血管、非恶性呼吸道和肺癌死亡率相关。对低浓度空气污染物影响的持续研究有望为欧洲和其他全球区域制定空气质量标准的过程提供进一步信息。
健康影响研究所。
