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Nagel G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland A, Vermeulen RCH, Wolf K, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O, Weinmayr G. Long-term exposure to air pollution and incidence of gastric and the upper aerodigestive tract cancers in a pooled European cohort: The ELAPSE project. Int J Cancer 2024; 154:1900-1910. [PMID: 38339851 DOI: 10.1002/ijc.34864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
Air pollution has been shown to significantly impact human health including cancer. Gastric and upper aerodigestive tract (UADT) cancers are common and increased risk has been associated with smoking and occupational exposures. However, the association with air pollution remains unclear. We pooled European subcohorts (N = 287,576 participants for gastric and N = 297,406 for UADT analyses) and investigated the association between residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone in the warm season (O3w) with gastric and UADT cancer. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. During 5,305,133 and 5,434,843 person-years, 872 gastric and 1139 UADT incident cancer cases were observed, respectively. For gastric cancer, we found no association with PM2.5, NO2 and BC while for UADT the hazard ratios (95% confidence interval) were 1.15 (95% CI: 1.00-1.33) per 5 μg/m3 increase in PM2.5, 1.19 (1.08-1.30) per 10 μg/m3 increase in NO2, 1.14 (1.04-1.26) per 0.5 × 10-5 m-1 increase in BC and 0.81 (0.72-0.92) per 10 μg/m3 increase in O3w. We found no association between long-term ambient air pollution exposure and incidence of gastric cancer, while for long-term exposure to PM2.5, NO2 and BC increased incidence of UADT cancer was observed.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lea Skodda
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate - Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Institute, Copenhagen, Denmark
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- The Danish Cancer Institute, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Ohlander J, Kromhout H, Vermeulen R, Portengen L, Kendzia B, Savary B, Cavallo D, Cattaneo A, Migliori E, Richiardi L, Plato N, Wichmann HE, Karrasch S, Consonni D, Landi MT, Caporaso NE, Siemiatycki J, Gustavsson P, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, Jolanta Lissowska JL, Beata Swiatkowska BS, John K Field JKF, McLaughlin JR, Demers PA, Pandics T, Forastiere F, Fabianova E, Schejbalova M, Foretova L, Janout V, Mates D, Barul C, Brüning T, Behrens T, Straif K, Schüz J, Olsson A, Peters S. Respirable crystalline silica and lung cancer in community-based studies: impact of job-exposure matrix specifications on exposure-response relationships. Scand J Work Environ Health 2024; 50:178-186. [PMID: 38264956 DOI: 10.5271/sjweh.4140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES The quantitative job-exposure matrix SYN-JEM consists of various dimensions: job-specific estimates, region-specific estimates, and prior expert ratings of jobs by the semi-quantitative DOM-JEM. We analyzed the effect of different JEM dimensions on the exposure-response relationships between occupational silica exposure and lung cancer risk to investigate how these variations influence estimates of exposure by a quantitative JEM and associated health endpoints. METHODS Using SYN-JEM, and alternative SYN-JEM specifications with varying dimensions included, cumulative silica exposure estimates were assigned to 16 901 lung cancer cases and 20 965 controls pooled from 14 international community-based case-control studies. Exposure-response relationships based on SYN-JEM and alternative SYN-JEM specifications were analyzed using regression analyses (by quartiles and log-transformed continuous silica exposure) and generalized additive models (GAM), adjusted for age, sex, study, cigarette pack-years, time since quitting smoking, and ever employment in occupations with established lung cancer risk. RESULTS SYN-JEM and alternative specifications generated overall elevated and similar lung cancer odds ratios ranging from 1.13 (1st quartile) to 1.50 (4th quartile). In the categorical and log-linear analyses SYN-JEM with all dimensions included yielded the best model fit, and exclusion of job-specific estimates from SYN-JEM yielded the poorest model fit. Additionally, GAM showed the poorest model fit when excluding job-specific estimates. CONCLUSION The established exposure-response relationship between occupational silica exposure and lung cancer was marginally influenced by varying the dimensions of SYN-JEM. Optimized modelling of exposure-response relationships will be obtained when incorporating all relevant dimensions, namely prior rating, job, time, and region. Quantitative job-specific estimates appeared to be the most prominent dimension for this general population JEM.
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Affiliation(s)
- Johan Ohlander
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
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Ancona C, Forastiere F, Fateh-Moghadam P. The universal right to health requires peace and rejects war. Lancet 2024; 403:1140. [PMID: 38458221 DOI: 10.1016/s0140-6736(24)00403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Carla Ancona
- Italian Epidemiological Association, Rome, Italy
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Ranzani O, Alari A, Olmos S, Milà C, Rico A, Basagaña X, Dadvand P, Duarte-Salles T, Forastiere F, Nieuwenhuijsen M, Vivanco-Hidalgo RM, Tonne C. Who is more vulnerable to effects of long-term exposure to air pollution on COVID-19 hospitalisation? Environ Int 2024; 185:108530. [PMID: 38422877 DOI: 10.1016/j.envint.2024.108530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Factors that shape individuals' vulnerability to the effects of air pollution on COVID-19 severity remain poorly understood. We evaluated whether the association between long-term exposure to ambient NO2, PM2.5, and PM10 and COVID-19 hospitalisation differs by age, sex, individual income, area-level socioeconomic status, arterial hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. METHODS We analysed a population-based cohort of 4,639,184 adults in Catalonia, Spain, during 2020. We fitted Cox proportional hazard models adjusted for several potential confounding factors and evaluated the interaction effect between vulnerability indicators and the 2019 annual average of NO2, PM2.5, and PM10. We evaluated interaction on both additive and multiplicative scales. RESULTS Overall, the association was additive between air pollution and the vulnerable groups. Air pollution and vulnerability indicators had a synergistic (greater than additive) effect for males and individuals with low income or living in the most deprived neighbourhoods. The Relative Excess Risk due to Interaction (RERI) was 0.21, 95 % CI, 0.15 to 0.27 for NO2 and 0.16, 95 % CI, 0.11 to 0.22 for PM2.5 for males; 0.13, 95 % CI, 0.09 to 0.18 for NO2 and 0.10, 95 % CI, 0.05 to 0.14 for PM2.5 for lower individual income and 0.17, 95 % CI, 0.12 to 0.22 for NO2 and 0.09, 95 % CI, 0.05 to 0.14 for PM2.5 for lower area-level socioeconomic status. Results for PM10 were similar to PM2.5. Results on multiplicative scale were inconsistent. CONCLUSIONS Long-term exposure to air pollution had a larger synergistic effect on COVID-19 hospitalisation for males and those with lower individual- and area-level socioeconomic status.
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Affiliation(s)
- Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Alari
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sergio Olmos
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carles Milà
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alex Rico
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Francesco Forastiere
- National Research Council, IFT, Palermo, Italy; Environmental Research Group, Imperial College London, London, UK
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Cathryn Tonne
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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5
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Weinmayr G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland A, Vermeulen R, Wolf K, Zitt E, Brunekreef B, Thurston G, Hoek G, Raaschou-Nielsen O, Nagel G. Long-term exposure to several constituents and sources of PM 2.5 is associated with incidence of upper aerodigestive tract cancers but not gastric cancer: Results from the large pooled European cohort of the ELAPSE project. Sci Total Environ 2024; 912:168789. [PMID: 37996018 DOI: 10.1016/j.scitotenv.2023.168789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
It is unclear whether cancers of the upper aerodigestive tract (UADT) and gastric cancer are related to air pollution, due to few studies with inconsistent results. The effects of particulate matter (PM) may vary across locations due to different source contributions and related PM compositions, and it is not clear which PM constituents/sources are most relevant from a consideration of overall mass concentration alone. We therefore investigated the association of UADT and gastric cancers with PM2.5 elemental constituents and sources components indicative of different sources within a large multicentre population based epidemiological study. Cohorts with at least 10 cases per cohort led to ten and eight cohorts from five countries contributing to UADT- and gastric cancer analysis, respectively. Outcome ascertainment was based on cancer registry data or data of comparable quality. We assigned home address exposure to eight elemental constituents (Cu, Fe, K, Ni, S, Si, V and Zn) estimated from Europe-wide exposure models, and five source components identified by absolute principal component analysis (APCA). Cox regression models were run with age as time scale, stratified for sex and cohort and adjusted for relevant individual and neighbourhood level confounders. We observed 1139 UADT and 872 gastric cancer cases during a mean follow-up of 18.3 and 18.5 years, respectively. UADT cancer incidence was associated with all constituents except K in single element analyses. After adjustment for NO2, only Ni and V remained associated with UADT. Residual oil combustion and traffic source components were associated with UADT cancer persisting in the multiple source model. No associations were found for any of the elements or source components and gastric cancer incidence. Our results indicate an association of several PM constituents indicative of different sources with UADT but not gastric cancer incidence with the most robust evidence for traffic and residual oil combustion.
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Affiliation(s)
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lea Skodda
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; The Danish Cancer Institute, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - George Thurston
- Division of Environmental Medicine, Depts of Medicine and Population Health, New York University Grossman School of Medicine, New York, USA
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; The Danish Cancer Institute, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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6
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Taj T, Chen J, Rodopoulou S, Strak M, de Hoogh K, Poulsen AH, Andersen ZJ, Bellander T, Brandt J, Zitt E, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Jørgensen JT, Katsouyanni K, Ketzel M, Lager A, Leander K, Liu S, Ljungman P, Severi G, Besson C, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Samoli E, Sørensen M, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-term exposure to ambient air pollution and risk of leukemia and lymphoma in a pooled European cohort. Environ Pollut 2024; 343:123097. [PMID: 38065336 DOI: 10.1016/j.envpol.2023.123097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Leukemia and lymphoma are the two most common forms of hematologic malignancy, and their etiology is largely unknown. Pathophysiological mechanisms suggest a possible association with air pollution, but little empirical evidence is available. We aimed to investigate the association between long-term residential exposure to outdoor air pollution and risk of leukemia and lymphoma. We pooled data from four cohorts from three European countries as part of the "Effects of Low-level Air Pollution: a Study in Europe" (ELAPSE) collaboration. We used Europe-wide land use regression models to assess annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) at residences. We also estimated concentrations of PM2.5 elemental components: copper (Cu), iron (Fe), zinc (Zn); sulfur (S); nickel (Ni), vanadium (V), silicon (Si) and potassium (K). We applied Cox proportional hazards models to investigate the associations. Among the study population of 247,436 individuals, 760 leukemia and 1122 lymphoma cases were diagnosed during 4,656,140 person-years of follow-up. The results showed a leukemia hazard ratio (HR) of 1.13 (95% confidence intervals [CI]: 1.01-1.26) per 10 μg/m3 NO2, which was robust in two-pollutant models and consistent across the four cohorts and according to smoking status. Sex-specific analyses suggested that this association was confined to the male population. Further, the results showed increased lymphoma HRs for PM2.5 (HR = 1.16; 95% CI: 1.02-1.34) and potassium content of PM2.5, which were consistent in two-pollutant models and according to sex. Our results suggest that air pollution at the residence may be associated with adult leukemia and lymphoma.
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Affiliation(s)
- Tahir Taj
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | | | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805, Villejuif, France; Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Caroline Besson
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805, Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Mette Sørensen
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy.
| | - Anne Tjønneland
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Ole Raaschou-Nielsen
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
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7
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Ancona C, Forastiere F. Post-earthquake demolition in Türkiye: health implications. Lancet 2024; 403:527-528. [PMID: 38341246 DOI: 10.1016/s0140-6736(23)02460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/31/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Carla Ancona
- Italian Association of Epidemiology, Rome 00147, Italy.
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8
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Malmqvist E, Andersen ZJ, Spadaro J, Nieuwenhuijsen M, Katsouyanni K, Forsberg B, Forastiere F, Hoffmann B. Urgent Call to Ensure Clean Air For All in Europe, Fight Health Inequalities and Oppose Delays in Action. Int J Public Health 2024; 69:1606958. [PMID: 38362306 PMCID: PMC10868403 DOI: 10.3389/ijph.2024.1606958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Zorana Jovanovic Andersen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Spadaro
- Spadaro Environment Research Consultants (SERC), Philadelphia, PA, United States
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
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9
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Wan W, Peters S, Portengen L, Olsson A, Schüz J, Ahrens W, Schejbalova M, Boffetta P, Behrens T, Brüning T, Kendzia B, Consonni D, Demers PA, Fabiánová E, Fernández-Tardón G, Field JK, Forastiere F, Foretova L, Guénel P, Gustavsson P, Jöckel KH, Karrasch S, Landi MT, Lissowska J, Barul C, Mates D, McLaughlin JR, Merletti F, Migliore E, Richiardi L, Pándics T, Pohlabeln H, Siemiatycki J, Świątkowska B, Wichmann HE, Zaridze D, Ge C, Straif K, Kromhout H, Vermeulen R. Occupational Benzene Exposure and Lung Cancer Risk: A Pooled Analysis of 14 Case-Control Studies. Am J Respir Crit Care Med 2024; 209:185-196. [PMID: 37812782 PMCID: PMC10806413 DOI: 10.1164/rccm.202306-0942oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
Rationale: Benzene has been classified as carcinogenic to humans, but there is limited evidence linking benzene exposure to lung cancer. Objectives: We aimed to examine the relationship between occupational benzene exposure and lung cancer. Methods: Subjects from 14 case-control studies across Europe and Canada were pooled. We used a quantitative job-exposure matrix to estimate benzene exposure. Logistic regression models assessed lung cancer risk across different exposure indices. We adjusted for smoking and five main occupational lung carcinogens and stratified analyses by smoking status and lung cancer subtypes. Measurements and Main Results: Analyses included 28,048 subjects (12,329 cases, 15,719 control subjects). Lung cancer odds ratios ranged from 1.12 (95% confidence interval, 1.03-1.22) to 1.32 (95% confidence interval, 1.18-1.48) (Ptrend = 0.002) for groups with the lowest and highest cumulative occupational exposures, respectively, compared with unexposed subjects. We observed an increasing trend of lung cancer with longer duration of exposure (Ptrend < 0.001) and a decreasing trend with longer time since last exposure (Ptrend = 0.02). These effects were seen for all lung cancer subtypes, regardless of smoking status, and were not influenced by specific occupational groups, exposures, or studies. Conclusions: We found consistent and robust associations between different dimensions of occupational benzene exposure and lung cancer after adjusting for smoking and main occupational lung carcinogens. These associations were observed across different subgroups, including nonsmokers. Our findings support the hypothesis that occupational benzene exposure increases the risk of developing lung cancer. Consequently, there is a need to revisit published epidemiological and molecular data on the pulmonary carcinogenicity of benzene.
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Affiliation(s)
- Wenxin Wan
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ann Olsson
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Miriam Schejbalova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University, Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University, Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University, Bochum, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Eleonóra Fabiánová
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Guillermo Fernández-Tardón
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
- Health Research Institute of Asturias, University Institute of Oncology of Asturias – Cajastur Social Program, University of Oviedo, Oviedo, Spain
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Pascal Guénel
- Center for Research in Epidemiology and Population Health, Team Exposome and Heredity, U1018 Institut national de la santé et de la recherche médicale, University of Paris-Saclay, Villejuif, France
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, and
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Christine Barul
- Université Rennes, Institut national de la santé et de la recherche médicale, École des hautes études en santé publique, Institut de recherche en santé, environnement et travail, UMR_S 1085, Pointe-à-Pitre, France
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - John R. McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Heinz-Erich Wichmann
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig-Maximilians-Universität München, Munich, Germany
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - David Zaridze
- Department of Cancer Epidemiology and Prevention, N.N. Blokhin National Research Center of Oncology, Moscow, Russia
| | - Calvin Ge
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek, Utrecht, the Netherlands
| | - Kurt Straif
- ISGlobal, Barcelona, Spain; and
- Boston College, Boston, Massachusetts
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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10
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Olsson A, Bouaoun L, Schüz J, Vermeulen R, Behrens T, Ge C, Kromhout H, Siemiatycki J, Gustavsson P, Boffetta P, Kendzia B, Radoi L, Barul C, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Merletti F, Migliore E, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, Field JK, Lissowska J, Świątkowska B, McLaughlin JR, Demers PA, Schejbalova M, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Straif K, Brüning T, Vlaanderen J, Peters S. Lung Cancer Risks Associated with Occupational Exposure to Pairs of Five Lung Carcinogens: Results from a Pooled Analysis of Case-Control Studies (SYNERGY). Environ Health Perspect 2024; 132:17005. [PMID: 38236172 PMCID: PMC10795675 DOI: 10.1289/ehp13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND While much research has been done to identify individual workplace lung carcinogens, little is known about joint effects on risk when workers are exposed to multiple agents. OBJECTIVES We investigated the pairwise joint effects of occupational exposures to asbestos, respirable crystalline silica, metals (i.e., nickel, chromium-VI), and polycyclic aromatic hydrocarbons (PAH) on lung cancer risk, overall and by major histologic subtype, while accounting for cigarette smoking. METHODS In the international 14-center SYNERGY project, occupational exposures were assigned to 16,901 lung cancer cases and 20,965 control subjects using a quantitative job-exposure matrix (SYN-JEM). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for ever vs. never exposure using logistic regression models stratified by sex and adjusted for study center, age, and smoking habits. Joint effects among pairs of agents were assessed on multiplicative and additive scales, the latter by calculating the relative excess risk due to interaction (RERI). RESULTS All pairwise joint effects of lung carcinogens in men were associated with an increased risk of lung cancer. However, asbestos/metals and metals/PAH resulted in less than additive effects; while the chromium-VI/silica pair showed marginally synergistic effect in relation to adenocarcinoma (RERI: 0.24; CI: 0.02, 0.46; p = 0.05). In women, several pairwise joint effects were observed for small cell lung cancer including exposure to PAH/silica (OR = 5.12; CI: 1.77, 8.48), and to asbestos/silica (OR = 4.32; CI: 1.35, 7.29), where exposure to PAH/silica resulted in a synergistic effect (RERI: 3.45; CI: 0.10, 6.8). DISCUSSION Small or no deviation from additive or multiplicative effects was observed, but co-exposure to the selected lung carcinogens resulted generally in higher risk than exposure to individual agents, highlighting the importance to reduce and control exposure to carcinogens in workplaces and the general environment. https://doi.org/10.1289/EHP13380.
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Affiliation(s)
- Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Liacine Bouaoun
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Loredana Radoi
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, University Paris-Saclay, University Paris Cité, Villejuif, France
| | - Christine Barul
- University Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, Pointe-à-Pitre, France
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Neil E. Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - David Zaridze
- Department of Cancer Epidemiology and Prevention, N.N. Blokhin National Research Centre of Oncology, Moscow, Russia
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - John R. McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Miriam Schejbalova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | | | - Eleonora Fabianova
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Jelle Vlaanderen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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11
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Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Forastiere F, Brynedal B, Hertel O, Hoffmann B, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Multiple myeloma risk in relation to long-term air pollution exposure - A pooled analysis of four European cohorts. Environ Res 2023; 239:117230. [PMID: 37806476 DOI: 10.1016/j.envres.2023.117230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Air pollution is a growing concern worldwide, with significant impacts on human health. Multiple myeloma is a type of blood cancer with increasing incidence. Studies have linked air pollution exposure to various types of cancer, including leukemia and lymphoma, however, the relationship with multiple myeloma incidence has not been extensively investigated. METHODS We pooled four European cohorts (N = 234,803) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone (O3) and multiple myeloma. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 4,415,817 person-years of follow-up (average 18.8 years), we observed 404 cases of multiple myeloma. The results of the fully adjusted linear analyses showed hazard ratios (95% confidence interval) of 0.99 (0.84, 1.16) per 10 μg/m³ NO2, 1.04 (0.82, 1.33) per 5 μg/m³ PM2.5, 0.99 (0.84, 1.18) per 0.5 10-5 m-1 BCE, and 1.11 (0.87, 1.41) per 10 μg/m³ O3. CONCLUSIONS We did not observe an association between long-term ambient air pollution exposure and incidence of multiple myeloma.
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Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, And Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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12
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Nobile F, Forastiere A, Michelozzi P, Forastiere F, Stafoggia M. Long-term exposure to air pollution and incidence of mental disorders. A large longitudinal cohort study of adults within an urban area. Environ Int 2023; 181:108302. [PMID: 37944432 DOI: 10.1016/j.envint.2023.108302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Recent epidemiological evidence suggests associations between air pollution exposure and major depressive disorders, but the literature is inconsistent for other mental illnesses. We investigated the associations of several air pollutants and road traffic noise with the incidence of different categories of mental disorders in a large population-based cohort. METHODS We enrolled 1,739,277 individuals 30 + years from the 2011 census in Rome, Italy, and followed them up until 2019. In detail, we analyzed 1,733,331 participants (mean age 56.43 +/- 15.85 years; 54.96 % female) with complete information on covariates of interest. We excluded subjects with prevalent mental disorders at baseline to evaluate the incidence (first hospitalization or co-pay exemption) of schizophrenia spectrum disorders, bipolar, anxiety, personality, or substance use disorders. In addition, we studied subjects with first prescriptions of antipsychotics, antidepressants, and mood stabilizers. Annual average concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO₂), Black Carbon (BC), ultrafine particles (UFP), and road traffic noise were assigned to baseline residential addresses. We applied Cox regression models adjusted for individual and area-level covariates. RESULTS Each interquartile range (1.13 µg/m3) increase in PM2.5 was associated with a hazard ratio (HR) of 1.070 (95 % confidence interval [CI]: 1.017, 1.127) for schizophrenia spectrum disorder, 1.135 (CI: 1.086, 1.186) for depression, 1.097 (CI: 1.030, 1.168) for anxiety disorders. Positive associations were also detected for BC and UFP, and with the three categories of drug prescriptions. Bipolar, personality, and substance use disorders did not show clear associations. The effects were highest in the age group 30-64 years, except for depression. CONCLUSIONS Long-term exposure to ambient air pollution, especially fine and ultrafine particles, was associated with increased risks of schizophrenia spectrum disorder, depression, and anxiety disorders. The association of the pollutants with the prescriptions of specific drugs increases the credibility of the results.
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Affiliation(s)
- Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Rome 1, Rome, Italy.
| | | | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service/ASL Rome 1, Rome, Italy
| | - Francesco Forastiere
- Environmental Research Group, Imperial College, London, UK; National Research Council, IFT, Palermo, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Rome 1, Rome, Italy
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13
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Forastiere F. [Air pollution: epidemiological studies, guidelines and decision making]. Epidemiol Prev 2023; 47:319-320. [PMID: 38314539 DOI: 10.19191/ep23.6.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
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14
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Boogaard H, Atkinson RW, Brook JR, Chang HH, Hoek G, Hoffmann B, Sagiv SK, Samoli E, Smargiassi A, Szpiro AA, Vienneau D, Weuve J, Lurmann FW, Forastiere F. Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution. Environ Health Perspect 2023; 131:115002. [PMID: 37991444 PMCID: PMC10664749 DOI: 10.1289/ehp11532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/12/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND There is a long tradition in environmental health of using frameworks for evidence synthesis, such as those of the U.S. Environmental Protection Agency for its Integrated Science Assessments and the International Agency for Research on Cancer Monographs. The framework, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), was developed for evidence synthesis in clinical medicine. The U.S. Office of Health Assessment and Translation (OHAT) elaborated an approach for evidence synthesis in environmental health building on GRADE. METHODS We applied a modified OHAT approach and a broader "narrative" assessment to assess the level of confidence in a large systematic review on traffic-related air pollution and health outcomes. DISCUSSION We discuss several challenges with the OHAT approach and its implementation and suggest improvements for synthesizing evidence from observational studies in environmental health. We consider the determination of confidence using a formal rating scheme of up- and downgrading of certain factors, the treatment of every factor as equally important, and the lower initial confidence rating of observational studies to be fundamental issues in the OHAT approach. We argue that some observational studies can offer high-confidence evidence in environmental health. We note that heterogeneity in magnitude of effect estimates should generally not weaken the confidence in the evidence, and consistency of associations across study designs, populations, and exposure assessment methods may strengthen confidence in the evidence. We mention that publication bias should be explored beyond statistical methods and is likely limited when large and collaborative studies comprise most of the evidence and when accrued over several decades. We propose to identify possible key biases, their most likely direction, and their potential impacts on the results. We think that the OHAT approach and other GRADE-type frameworks require substantial modification to align better with features of environmental health questions and the studies that address them. We emphasize that a broader, "narrative" evidence assessment based on the systematic review may complement a formal GRADE-type evaluation. https://doi.org/10.1289/EHP11532.
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Affiliation(s)
| | - Richard W. Atkinson
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Jeffrey R. Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Sharon K. Sagiv
- Center for Environmental Research and Children’s Health, Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Francesco Forastiere
- Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
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15
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Mei F, Renzi M, Bonifazi M, Bonifazi F, Pepe N, D'Allura A, Brusasca G, Viegi G, Forastiere F. Long-term effects of air pollutants on respiratory and cardiovascular mortality in a port city along the Adriatic sea. BMC Pulm Med 2023; 23:395. [PMID: 37853365 PMCID: PMC10585890 DOI: 10.1186/s12890-023-02629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Shipping and port-related air pollution has a significant health impact on a global scale. The present study aimed to assess the mortality burden attributable to long-term exposure to ambient particulate matter (PM2.5, PM10) and nitrogen dioxide (NO2) in the city of Ancona (Italy), with one of the leading national commercial harbours. METHODS Exposure to air pollutants was derived by dispersion models. The relationship between the long-term exposure of air pollution exposure and cause-specific mortality was evaluated by Poisson regression models, after adjustment for gender, age and socioeconomic status. Results are expressed as percent change of risk (and relative 95% confidence intervals) per 5 unit increases in the exposures. The health impact on the annual number of premature cause-specific deaths was also assessed. RESULTS PM2.5 and NO2 annual concentrations were higher in the area close to the harbour than in the rest of the city. Positive associations between each pollutant and most of the mortality outcomes were observed, with estimates of up to 7.6% (95%CI 0.1, 15.6%) for 10 µg/m3 increase in NO2 and cardiovascular mortality and 15.3% (95%CI-1.1, 37.2%) for 10 µg/m3 increase PM2.5 and lung cancer. In the subpopulation living close to the harbour, there were excess risks of up to 13.5%, 24.1% and 37.9% for natural, cardiovascular and respiratory mortality. The number of annual premature deaths due to the excess of PM2.5 and NO2 exposure (having as a reference the 2021 World Health Organization Air Quality Guidelines) was 82 and 25, respectively. CONCLUSIONS Our study confirms the long-term health effects of PM and NO2 on mortality and reveals a higher mortality burden in areas close to shipping and port-related emissions. Estimating the source-specific health burdens is key to achieve a deeper understanding of the role of different emission sources, as well as to support effective and targeted mitigation strategies.
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Affiliation(s)
- Federico Mei
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
| | - Matteo Renzi
- Department of Epidemiology of Lazio Region, ASL Roma 1, Rome, Italy.
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Floriano Bonifazi
- Honorary President Associazione Allergologi Immunologi Italiani Territoriali E Ospedalieri, , Firenze, Italy
| | | | | | | | - Giovanni Viegi
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Francesco Forastiere
- Institute of Translational Pharmacology, National Research Council (CNR), Palermo, Italy
- Environmental Research Group, Imperial College, London, UK
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16
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Turner MC, Andersen ZJ, Neira M, Krzyzanowski M, Malmqvist E, González Ortiz A, Kiesewetter G, Katsouyanni K, Brunekreef B, Melén E, Ljungman P, Tolotto M, Forastiere F, Dendale P, Price R, Bakke O, Reichert S, Hoek G, Pershagen G, Peters A, Querol X, Gerometta A, Samoli E, Markevych I, Basthiste R, Khreis H, Pant P, Nieuwenhuijsen M, Sacks JD, Hansen K, Lymes T, Stauffer A, Fuller GW, Boogaard H, Hoffmann B. Clean air in Europe for all! Taking stock of the proposed revision to the ambient air quality directives: a joint ERS, HEI and ISEE workshop report. Eur Respir J 2023; 62:2301380. [PMID: 37827574 PMCID: PMC10894647 DOI: 10.1183/13993003.01380-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
Ambient air pollution is a major public health concern and comprehensive new legislation is currently being considered to improve air quality in Europe. The European Respiratory Society (ERS), Health Effects Institute (HEI), and International Society for Environmental Epidemiology (ISEE) organised a joint meeting on May 24, 2023 in Brussels, Belgium, to review and critically evaluate the latest evidence on the health effects of air pollution and discuss ongoing revisions of the European Ambient Air Quality Directives (AAQDs). A multi-disciplinary expert group of air pollution and health researchers, patient and medical societies, and policy representatives participated. This report summarises key discussions at the meeting.
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Affiliation(s)
- Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Maria Neira
- World Health Organization (WHO), Geneva, Switzerland
| | | | | | | | - Gregor Kiesewetter
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria
| | | | | | - Erik Melén
- Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Paul Dendale
- European Society of Cardiology (ESC), Sophia Antipolis, France
| | - Richard Price
- European Cancer Organisation (ECO), Brussels, Belgium
| | - Ole Bakke
- Standing Committee of European Doctors (CPME), Brussels, Belgium
| | - Sibylle Reichert
- International Association of Mutual Benefit Societies (AIM), Brussels, Belgium
| | - Gerard Hoek
- Utrecht University, Utrecht, The Netherlands
| | | | - Annette Peters
- Helmholtz München - German Center for Environmental Health, Neuherberg, Germany
- IBE, Medical Faculty, Ludwig Maximilians Universität, Munich, Germany
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xavier Querol
- Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona, Spain
| | | | - Evangelia Samoli
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
- Health and Quality of Life in a Green and Sustainable Environment, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Haneen Khreis
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jason D Sacks
- Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency (EPA), Research Triangle Park, NC, USA
| | - Kjeld Hansen
- European Lung Foundation, Sheffield, UK
- Kristiania University College, Oslo, Norway
| | | | | | - Gary W Fuller
- MRC Centre for Environment and Health, Imperial College London, London, UK
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17
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Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-term air pollution exposure and malignant intracranial tumours of the central nervous system: a pooled analysis of six European cohorts. Br J Cancer 2023; 129:656-664. [PMID: 37420001 PMCID: PMC10421949 DOI: 10.1038/s41416-023-02348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/06/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Risk factors for malignant tumours of the central nervous system (CNS) are largely unknown. METHODS We pooled six European cohorts (N = 302,493) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), ozone (O3) and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) and malignant intracranial CNS tumours defined according to the International Classification of Diseases ICD-9/ICD-10 codes 192.1/C70.0, 191.0-191.9/C71.0-C71.9, 192.0/C72.2-C72.5. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 5,497,514 person-years of follow-up (average 18.2 years), we observed 623 malignant CNS tumours. The results of the fully adjusted linear analyses showed a hazard ratio (95% confidence interval) of 1.07 (0.95, 1.21) per 10 μg/m³ NO2, 1.17 (0.96, 1.41) per 5 μg/m³ PM2.5, 1.10 (0.97, 1.25) per 0.5 10-5m-1 BC, and 0.99 (0.84, 1.17) per 10 μg/m³ O3. CONCLUSIONS We observed indications of an association between exposure to NO2, PM2.5, and BC and tumours of the CNS. The PM elements were not consistently associated with CNS tumour incidence.
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Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate-interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
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18
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Vicedo-Cabrera AM, Melén E, Forastiere F, Gehring U, Katsouyanni K, Yorgancioglu A, Ulrik CS, Hansen K, Powell P, Ward B, Hoffmann B, Andersen ZJ. Climate change and respiratory health: a European Respiratory Society position statement. Eur Respir J 2023; 62:2201960. [PMID: 37661094 DOI: 10.1183/13993003.01960-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/05/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Erik Melén
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy
- Science Policy and Epidemiology Environmental Research Group King's College London, London UK
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Klea Katsouyanni
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Arzu Yorgancioglu
- Celal Bayar University Medical Faculty Department of Pulmonology, Manisa, Turkey
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Hansen
- European Lung Foundation, Sheffield, UK
- Kristiania University College, Technology, Oslo, Norway
| | | | - Brian Ward
- European Respiratory Society, Brussels, Belgium
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Zorana Jovanovic Andersen
- Section of Environment and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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19
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Nobile F, Forastiere A, Michelozzi P, Forastiere F, Stafoggia M. [Air pollution and incidence of psychiatric disorders in the Rome longitudinal study.]. Recenti Prog Med 2023; 114:382-384. [PMID: 37229690 DOI: 10.1701/4042.40236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The literature on the impact of long-term exposure to air pollution on the incidence of psychiatric disorders is steadily increasing reflecting a growing interest. In the 2011 Rome longitudinal study, strong associations between long-term exposure to air pollution and the incidence of some psychiatric conditions and medication prescriptions were observed. More studies investigating this relationship in large populations are needed to provide consistent scientific evidence even on the etiology of mental disorders, which are a public health priority.
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Affiliation(s)
- Federica Nobile
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio - Asl Roma 1, Roma
| | | | - Paola Michelozzi
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio - Asl Roma 1, Roma
| | | | - Massimo Stafoggia
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio - Asl Roma 1, Roma
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20
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Kutlar Joss M, Boogaard H, Samoli E, Patton AP, Atkinson R, Brook J, Chang H, Haddad P, Hoek G, Kappeler R, Sagiv S, Smargiassi A, Szpiro A, Vienneau D, Weuve J, Lurmann F, Forastiere F, Hoffmann BH. Long-Term Exposure to Traffic-Related Air Pollution and Diabetes: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1605718. [PMID: 37325174 PMCID: PMC10266340 DOI: 10.3389/ijph.2023.1605718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives: We report results of a systematic review on the health effects of long-term traffic-related air pollution (TRAP) and diabetes in the adult population. Methods: An expert Panel appointed by the Health Effects Institute conducted this systematic review. We searched the PubMed and LUDOK databases for epidemiological studies from 1980 to July 2019. TRAP was defined based on a comprehensive protocol. Random-effects meta-analyses were performed. Confidence assessments were based on a modified Office for Health Assessment and Translation (OHAT) approach, complemented with a broader narrative synthesis. We extended our interpretation to include evidence published up to May 2022. Results: We considered 21 studies on diabetes. All meta-analytic estimates indicated higher diabetes risks with higher exposure. Exposure to NO2 was associated with higher diabetes prevalence (RR 1.09; 95% CI: 1.02; 1.17 per 10 μg/m3), but less pronounced for diabetes incidence (RR 1.04; 95% CI: 0.96; 1.13 per 10 μg/m3). The overall confidence in the evidence was rated moderate, strengthened by the addition of 5 recently published studies. Conclusion: There was moderate evidence for an association of long-term TRAP exposure with diabetes.
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Affiliation(s)
- Meltem Kutlar Joss
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | | | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Richard Atkinson
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Jeff Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pascale Haddad
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Ron Kappeler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sharon Sagiv
- Center for Environmental Research and Children’s Health, Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Adam Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Fred Lurmann
- Sonoma Technology, Inc., Petaluma, CA, United States
| | - Francesco Forastiere
- Faculty of Medicine, School of Public Health, Imperial College, London, United Kingdom
| | - Barbara H. Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
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21
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So R, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Samoli E, Rodopoulou S, Loft S, Lim YH, Westendorp RGJ, Amini H, Cole-Hunter T, Bergmann M, Shahri SMT, Zhang J, Maric M, Mortensen LH, Bauwelinck M, Klompmaker JO, Atkinson RW, Janssen NAH, Oftedal B, Renzi M, Forastiere F, Strak M, Brunekreef B, Hoek G, Andersen ZJ. Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study. Environ Res 2023; 224:115552. [PMID: 36822536 DOI: 10.1016/j.envres.2023.115552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is a well-recognized risk factor for premature death. However, evidence on which PM2.5 components are most relevant is unclear. METHODS We evaluated the associations between mortality and long-term exposure to eight PM2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM2.5 mass. RESULTS Of 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03-1.05), RF-Si (1.01; 1.00-1.02), SLR-K (1.03; 1.02-1.04), and RF-K (1.06; 1.05-1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality. CONCLUSIONS We present novel results of the relevance of different PM2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard W Atkinson
- Population Health Research Institute, St George's University of London, London, UK
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bente Oftedal
- Department of air quality and noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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22
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Boogaard H, Samoli E, Patton AP, Atkinson RW, Brook JR, Chang HH, Hoffmann B, Kutlar Joss M, Sagiv SK, Smargiassi A, Szpiro AA, Vienneau D, Weuve J, Lurmann FW, Forastiere F, Hoek G. Long-term exposure to traffic-related air pollution and non-accidental mortality: A systematic review and meta-analysis. Environ Int 2023; 176:107916. [PMID: 37210806 DOI: 10.1016/j.envint.2023.107916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest across the globe. Following its 2010 review, the Health Effects Institute appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected health outcomes. This paper describes the main findings of the systematic review on non-accidental mortality. METHODS The Panel used a systematic approach to conduct the review. An extensive search was conducted of literature published between 1980 and 2019. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP, which included studies beyond the near-roadway environment. We performed random-effects meta-analysis when at least three estimates were available of an association between a specific exposure and outcome. We evaluated confidence in the evidence using a modified Office of Health Assessment and Translation (OHAT) approach, supplemented with a broader narrative synthesis. RESULTS Thirty-six cohort studies were included. Virtually all studies adjusted for a large number of individual and area-level covariates-including smoking, body mass index, and individual and area-level socioeconomic status-and were judged at a low or moderate risk for bias. Most studies were conducted in North America and Europe, and a few were based in Asia and Australia. The meta-analytic summary estimates for nitrogen dioxide, elemental carbon and fine particulate matter-pollutants with more than 10 studies-were 1.04 (95% CI 1.01, 1.06), 1.02 (1.00, 1.04) and 1.03 (1.01, 1.05) per 10, 1 and 5 µg/m3, respectively. Effect estimates are interpreted as the relative risk of mortality when the exposure differs with the selected increment. The confidence in the evidence for these pollutants was judged as high, because of upgrades for monotonic exposure-response and consistency across populations. The consistent findings across geographical regions, exposure assessment methods and confounder adjustment resulted in a high confidence rating using a narrative approach as well. CONCLUSIONS The overall confidence in the evidence for a positive association between long-term exposure to TRAP and non-accidental mortality was high.
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Affiliation(s)
- H Boogaard
- Health Effects Institute, Boston, MA, United States.
| | - E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A P Patton
- Health Effects Institute, Boston, MA, United States
| | - R W Atkinson
- Population Health Research Institute, St. George's University of London, United Kingdom
| | - J R Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - H H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - M Kutlar Joss
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany; Swiss Tropical and Public Health Institute, Allschwill, Switzerland; University of Basel, Switzerland
| | - S K Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, QC, Canada
| | - A A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - D Vienneau
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland; University of Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - F W Lurmann
- Sonoma Technology, Inc., Petaluma, CA, United States
| | - F Forastiere
- Environmental Research Group, School of Public Health, Imperial College, London, United Kingdom
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Netherlands
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23
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Carapezza ML, Tarchini L, Ancona C, Forastiere F, Ranaldi M, Ricci T, De Simone G, Mataloni F, Pagliuca NM, Barberi F. Health impact of natural gas emission at Cava dei Selci residential zone (metropolitan city of Rome, Italy). Environ Geochem Health 2023; 45:707-729. [PMID: 35278168 PMCID: PMC10014802 DOI: 10.1007/s10653-022-01244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Natural gas hazard was assessed at Cava dei Selci, a residential neighbourhood of Marino (Rome) by a joint study of gas emissions and related health problems. Here a densely urbanized zone with 4000 residents surrounds a dangerous natural gas discharge where, along the years, dozens of animals were killed by the gas. Gas originates from Colli Albani volcano and consists mostly of CO2 with ~ 1 vol% of H2S. In recent years, several gas-related accidents occurred in the urbanized zone (gas blowouts and road collapses). Some houses were evacuated because of hazardous indoor air gas concentration. Gas hazard was assessed by soil CO2 flux and concentration surveys and indoor and outdoor air CO2 and H2S concentration measurements. Open fields and house gardens release a high quantity of CO2 (32.23 tonnes * day-1). Inside most houses, CO2 air concentration exceeds 0.1 vol%, the acceptable long-term exposure range. In several houses both CO2 and H2S exceed the IDLH level (Immediately Dangerous to Life and Health). An epidemiological cohort study was carried out on the residents of two Cava dei Selci zones with high (zone A) and medium (zone B) gas hazard exposure, using the rest of Marino as reference zone. We found excess mortality and emergency room visits (ERV) related to high exposure to CO2 and H2S; in particular, an increased risk of mortality and ERV for diseases of central nervous system (HR 1.57, 95% CI 0.76-3.25 and HR 5.82, 95% CI 1.27-26.56, respectively) was found among men living in zone A.
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Affiliation(s)
| | - Luca Tarchini
- INGV - Istituto Nazionale di Geofisica e Vulcanologia, Sezione Roma 1, Rome, Italy
| | - Carla Ancona
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Massimo Ranaldi
- INGV - Istituto Nazionale di Geofisica e Vulcanologia, Sezione Roma 1, Rome, Italy
| | - Tullio Ricci
- INGV - Istituto Nazionale di Geofisica e Vulcanologia, Sezione Roma 1, Rome, Italy
| | - Gabriele De Simone
- INGV - Istituto Nazionale di Geofisica e Vulcanologia, Sezione Roma 1, Rome, Italy
| | | | | | - Franco Barberi
- INGV - Istituto Nazionale di Geofisica e Vulcanologia, Sezione Roma 1, Rome, Italy
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24
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Behrens T, Ge C, Vermeulen R, Kendzia B, Olsson A, Schüz J, Kromhout H, Pesch B, Peters S, Portengen L, Gustavsson P, Mirabelli D, Guénel P, Luce D, Consonni D, Caporaso NE, Landi MT, Field JK, Karrasch S, Wichmann HE, Siemiatycki J, Parent ME, Richiardi L, Simonato L, Jöckel KH, Ahrens W, Pohlabeln H, Fernández-Tardón G, Zaridze D, McLaughlin JR, Demers PA, Świątkowska B, Lissowska J, Pándics T, Fabianova E, Mates D, Bencko V, Foretova L, Janout V, Boffetta P, Bueno-de-Mesquita B, Forastiere F, Straif K, Brüning T. Occupational exposure to nickel and hexavalent chromium and the risk of lung cancer in a pooled analysis of case-control studies (SYNERGY). Int J Cancer 2023; 152:645-660. [PMID: 36054442 DOI: 10.1002/ijc.34272] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023]
Abstract
There is limited evidence regarding the exposure-effect relationship between lung-cancer risk and hexavalent chromium (Cr(VI)) or nickel. We estimated lung-cancer risks in relation to quantitative indices of occupational exposure to Cr(VI) and nickel and their interaction with smoking habits. We pooled 14 case-control studies from Europe and Canada, including 16 901 lung-cancer cases and 20 965 control subjects. A measurement-based job-exposure-matrix estimated job-year-region specific exposure levels to Cr(VI) and nickel, which were linked to the subjects' occupational histories. Odds ratios (OR) and associated 95% confidence intervals (CI) were calculated by unconditional logistic regression, adjusting for study, age group, smoking habits and exposure to other occupational lung carcinogens. Due to their high correlation, we refrained from mutually adjusting for Cr(VI) and nickel independently. In men, ORs for the highest quartile of cumulative exposure to CR(VI) were 1.32 (95% CI 1.19-1.47) and 1.29 (95% CI 1.15-1.45) in relation to nickel. Analogous results among women were: 1.04 (95% CI 0.48-2.24) and 1.29 (95% CI 0.60-2.86), respectively. In men, excess lung-cancer risks due to occupational Cr(VI) and nickel exposure were also observed in each stratum of never, former and current smokers. Joint effects of Cr(VI) and nickel with smoking were in general greater than additive, but not different from multiplicative. In summary, relatively low cumulative levels of occupational exposure to Cr(VI) and nickel were associated with increased ORs for lung cancer, particularly in men. However, we cannot rule out a combined classical measurement and Berkson-type of error structure, which may cause differential bias of risk estimates.
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Affiliation(s)
- Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
| | - Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Beate Pesch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Per Gustavsson
- The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dario Mirabelli
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pascal Guénel
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, University Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | - Danièle Luce
- Univ. Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Pointe-à-Pitre, France
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Stefan Karrasch
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Jack Siemiatycki
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Laval, Quebec, Canada
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Simonato
- Department of Cardiovascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | - David Zaridze
- Department of Epidemiology and Prevention, N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | | | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Vladimir Bencko
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vladimír Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bas Bueno-de-Mesquita
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Francesco Forastiere
- Environmental Research Group, School of Public Health, Imperial College, London, UK, and National Research Council (CNR-Irib), Palermo, Italy
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance-Institute of the Ruhr-University Bochum (IPA), Germany
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25
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Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann BH, Katsouyanni K, Ketzel M, Brynedal B, Leander K, Ljungman PLS, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Boutron-Ruault MC, Samoli E, So R, Stafoggia M, Tjønneland A, Vermeulen R, Verschuren WMM, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Breast Cancer Incidence in Relation to Long-Term Low-Level Exposure to Air Pollution in the ELAPSE Pooled Cohort. Cancer Epidemiol Biomarkers Prev 2023; 32:105-113. [PMID: 36215200 DOI: 10.1158/1055-9965.epi-22-0720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Established risk factors for breast cancer include genetic disposition, reproductive factors, hormone therapy, and lifestyle-related factors such as alcohol consumption, physical inactivity, smoking, and obesity. More recently a role of environmental exposures, including air pollution, has also been suggested. The aim of this study, was to investigate the relationship between long-term air pollution exposure and breast cancer incidence. METHODS We conducted a pooled analysis among six European cohorts (n = 199,719) on the association between long-term residential levels of ambient nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone in the warm season (O3) and breast cancer incidence in women. The selected cohorts represented the lower range of air pollutant concentrations in Europe. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 3,592,885 person-years of follow-up, we observed a total of 9,659 incident breast cancer cases. The results of the fully adjusted linear analyses showed a HR (95% confidence interval) of 1.03 (1.00-1.06) per 10 μg/m³ NO2, 1.06 (1.01-1.11) per 5 μg/m³ PM2.5, 1.03 (0.99-1.06) per 0.5 10-5 m-1 BC, and 0.98 (0.94-1.01) per 10 μg/m³ O3. The effect estimates were most pronounced in the group of middle-aged women (50-54 years) and among never smokers. CONCLUSIONS The results were in support of an association between especially PM2.5 and breast cancer. IMPACT The findings of this study suggest a role of exposure to NO2, PM2.5, and BC in development of breast cancer.
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Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.,National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy.,Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara H Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | | | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roel Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria.,Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Cole-Hunter T, Zhang J, So R, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Jöckel KH, Mortensen LH, Ketzel M, Yacamán Méndez D, Leander K, Ljungman P, Faure E, Lee PC, Elbaz A, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Vermeulen RCH, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH, Andersen ZJ. Long-term air pollution exposure and Parkinson's disease mortality in a large pooled European cohort: An ELAPSE study. Environ Int 2023; 171:107667. [PMID: 36516478 DOI: 10.1016/j.envint.2022.107667] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The link between exposure to ambient air pollution and mortality from cardiorespiratory diseases is well established, while evidence on neurodegenerative disorders including Parkinson's Disease (PD) remains limited. OBJECTIVE We examined the association between long-term exposure to ambient air pollution and PD mortality in seven European cohorts. METHODS Within the project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven cohorts among six European countries. Annual mean residential concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3), as well as 8 PM2.5 components (copper, iron, potassium, nickel, sulphur, silicon, vanadium, zinc), for 2010 were estimated using Europe-wide hybrid land use regression models. PD mortality was defined as underlying cause of death being either PD, secondary Parkinsonism, or dementia in PD. We applied Cox proportional hazard models to investigate the associations between air pollution and PD mortality, adjusting for potential confounders. RESULTS Of 271,720 cohort participants, 381 died from PD during 19.7 years of follow-up. In single-pollutant analyses, we observed positive associations between PD mortality and PM2.5 (hazard ratio per 5 µg/m3: 1.25; 95% confidence interval: 1.01-1.55), NO2 (1.13; 0.95-1.34 per 10 µg/m3), and BC (1.12; 0.94-1.34 per 0.5 × 10-5m-1), and a negative association with O3 (0.74; 0.58-0.94 per 10 µg/m3). Associations of PM2.5, NO2, and BC with PD mortality were linear without apparent lower thresholds. In two-pollutant models, associations with PM2.5 remained robust when adjusted for NO2 (1.24; 0.95-1.62) or BC (1.28; 0.96-1.71), whereas associations with NO2 or BC attenuated to null. O3 associations remained negative, but no longer statistically significant in models with PM2.5. We detected suggestive positive associations with the potassium component of PM2.5. CONCLUSION Long-term exposure to PM2.5, at levels well below current EU air pollution limit values, may contribute to PD mortality.
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Affiliation(s)
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Pei-Chen Lee
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Alexis Elbaz
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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27
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Haddad P, Kutlar Joss M, Weuve J, Vienneau D, Atkinson R, Brook J, Chang H, Forastiere F, Hoek G, Kappeler R, Lurmann F, Sagiv S, Samoli E, Smargiassi A, Szpiro A, Patton AP, Boogaard H, Hoffmann B. Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis. Int J Hyg Environ Health 2023; 247:114079. [PMID: 36446272 DOI: 10.1016/j.ijheh.2022.114079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke. METHODS PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies. RESULTS Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98-1.09) per 1 μg/m3 EC, 1.09 (0.96-1.23) per 10 μg/m3 PM10, 1.08 (0.89-1.32) per 5 μg/m3 PM2.5, 0.98 (0.92; 1.05) per 10 μg/m3 NO2 and 0.99 (0.94; 1.04) per 20 μg/m3 NOx with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively. CONCLUSION The available literature provides low to moderate evidence for an association of TRAP with stroke.
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Affiliation(s)
- P Haddad
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - M Kutlar Joss
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany; Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - D Vienneau
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - R Atkinson
- Epidemiology, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - J Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - F Forastiere
- School of Public Health, Faculty of Medicine, Imperial College, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, UK
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, the Netherlands
| | - R Kappeler
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - F Lurmann
- Sonoma Technology, Inc, 1450 N McDowell Blvd #200, Petaluma, CA, 94954, USA
| | - S Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94704, USA
| | - E Samoli
- Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athina, 115 27, Greece
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, 7101 Park Ave, Montreal, Quebec, H3N 1X9, Canada
| | - A Szpiro
- Department of Biostatistics, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351617, Seattle, WA, 98195-1617, USA
| | - A P Patton
- Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA
| | - H Boogaard
- Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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28
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Hvidtfeldt UA, Taj T, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Jørgensen JT, Katsouyanni K, Ketzel M, Lager A, Leander K, Ljungman P, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Vermeulen R, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long term exposure to air pollution and kidney parenchyma cancer - Effects of low-level air pollution: a Study in Europe (ELAPSE). Environ Res 2022; 215:114385. [PMID: 36154858 DOI: 10.1016/j.envres.2022.114385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/05/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Particulate matter (PM) is classified as a group 1 human carcinogen. Previous experimental studies suggest that particles in diesel exhaust induce oxidative stress, inflammation and DNA damage in kidney cells, but the evidence from population studies linking air pollution to kidney cancer is limited. METHODS We pooled six European cohorts (N = 302,493) to assess the association of residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC), warm season ozone (O3) and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) with cancer of the kidney parenchyma. The main exposure model was developed for year 2010. We defined kidney parenchyma cancer according to the International Classification of Diseases 9th and 10th Revision codes 189.0 and C64. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS The participants were followed from baseline (1985-2005) to 2011-2015. A total of 847 cases occurred during 5,497,514 person-years of follow-up (average 18.2 years). Median (5-95%) exposure levels of NO2, PM2.5, BC and O3 were 24.1 μg/m3 (12.8-39.2), 15.3 μg/m3 (8.6-19.2), 1.6 10-5 m-1 (0.7-2.1), and 87.0 μg/m3 (70.3-97.4), respectively. The results of the fully adjusted linear analyses showed a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 0.92, 1.15) per 10 μg/m³ NO2, 1.04 (95% CI: 0.88, 1.21) per 5 μg/m³ PM2.5, 0.99 (95% CI: 0.89, 1.11) per 0.5 10-5 m-1 BCE, and 0.88 (95% CI: 0.76, 1.02) per 10 μg/m³ O3. We did not find associations between any of the elemental components of PM2.5 and cancer of the kidney parenchyma. CONCLUSION We did not observe an association between long-term ambient air pollution exposure and incidence of kidney parenchyma cancer.
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Affiliation(s)
| | - Tahir Taj
- Danish Cancer Society Research Center, Copenhagen, Denmark; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Climate - Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | | | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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29
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Andersen ZJ, Zhang J, Jørgensen JT, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Monique Verschuren WM, Jöckel KH, So R, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, van der Schouw YT, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH. Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study. Environ Int 2022; 170:107581. [PMID: 36244228 DOI: 10.1016/j.envint.2022.107581] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Ambient air pollution is an established risk factor for premature mortality from chronic cardiovascular, respiratory and metabolic diseases, while evidence on neurodegenerative diseases and psychiatric disorders remains limited. We examined the association between long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in seven European cohorts. Within the multicenter project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven European cohorts from six countries. Based on the residential addresses, annual mean levels of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), ozone (O3), and 8 PM2.5 components were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and mortality from dementia, psychiatric disorders, and suicide. Of 271,720 participants, 900 died from dementia, 241 from psychiatric disorders, and 164 from suicide, during a mean follow-up of 19.7 years. In fully adjusted models, we observed positive associations of NO2 (hazard ratio [HR] = 1.38; 95 % confidence interval [CI]: 1.13, 1.70 per 10 µg/m3), PM2.5 (HR = 1.29; 95 % CI: 0.98, 1.71 per 5 µg/m3), and BC (HR = 1.37; 95 % CI: 1.11, 1.69 per 0.5 × 10-5/m) with psychiatric disorders mortality, as well as with suicide (NO2: HR = 1.13 [95 % CI: 0.92, 1.38]; PM2.5: HR = 1.19 [95 % CI: 0.76, 1.87]; BC: HR = 1.08 [95 % CI: 0.87, 1.35]), and no association with dementia mortality. We did not detect any positive associations of O3 and 8 PM2.5 components with any of the three mortality outcomes. Long-term exposure to NO2, PM2.5, and BC may lead to premature mortality from psychiatric disorders and suicide.
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Affiliation(s)
- Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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30
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Weinmayr G, Forastiere F. A health-based long term vision to face air pollution and climate change. Front Public Health 2022; 10:947971. [PMID: 36091540 PMCID: PMC9449330 DOI: 10.3389/fpubh.2022.947971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany,*Correspondence: Gudrun Weinmayr
| | - Francesco Forastiere
- Environmental Research Group, School of Public Health, Imperial College, London, United Kingdom,IFT-National Research Council (CNR), Palermo, Italy
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31
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Bereziartua A, Chen J, de Hoogh K, Rodopoulou S, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Arthur Hvidtfeldt U, Verschuren WMM, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Hjertager Krog N, Brynedal B, Leander K, Liu S, Ljungman P, Faure E, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rizzuto D, Samoli E, van der Schouw YT, Schramm S, Severi G, Stafoggia M, Strak M, Sørensen M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G. Exposure to surrounding greenness and natural-cause and cause-specific mortality in the ELAPSE pooled cohort. Environ Int 2022; 166:107341. [PMID: 35717714 DOI: 10.1016/j.envint.2022.107341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/28/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The majority of studies have shown higher greenness exposure associated with reduced mortality risks, but few controlled for spatially correlated air pollution and traffic noise exposures. We aim to address this research gap in the ELAPSE pooled cohort. METHODS Mean Normalized Difference Vegetation Index (NDVI) in a 300-m grid cell and 1-km radius were assigned to participants' baseline home addresses as a measure of surrounding greenness exposure. We used Cox proportional hazards models to estimate the association of NDVI exposure with natural-cause and cause-specific mortality, adjusting for a number of potential confounders including socioeconomic status and lifestyle factors at individual and area-levels. We further assessed the associations between greenness exposure and mortality after adjusting for fine particulate matter (PM2.5), nitrogen dioxide (NO2) and road traffic noise. RESULTS The pooled study population comprised 327,388 individuals who experienced 47,179 natural-cause deaths during 6,374,370 person-years of follow-up. The mean NDVI in the pooled cohort was 0.33 (SD 0.1) and 0.34 (SD 0.1) in the 300-m grid and 1-km buffer. In the main fully adjusted model, 0.1 unit increment of NDVI inside 300-m grid was associated with 5% lower risk of natural-cause mortality (Hazard Ratio (HR) 0.95 (95% CI: 0.94, 0.96)). The associations attenuated after adjustment for air pollution [HR (95% CI): 0.97 (0.96, 0.98) adjusted for PM2.5; 0.98 (0.96, 0.99) adjusted for NO2]. Additional adjustment for traffic noise hardly affected the associations. Consistent results were observed for NDVI within 1-km buffer. After adjustment for air pollution, NDVI was inversely associated with diabetes, respiratory and lung cancer mortality, yet with wider 95% confidence intervals. No association with cardiovascular mortality was found. CONCLUSIONS We found a significant inverse association between surrounding greenness and natural-cause mortality, which remained after adjusting for spatially correlated air pollution and traffic noise.
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Affiliation(s)
- Ainhoa Bereziartua
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Center for Climate Change, Aarhus University, Denmark.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
| | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Norun Hjertager Krog
- Section of Air Pollution and Noise, Norwegian Institute of Public Health, Norway.
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Diet, Genes and Environment (DGE), Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
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32
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Chen J, Hoek G, de Hoogh K, Rodopoulou S, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Verschuren WMM, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Méndez DY, Leander K, Liu S, Ljungman P, Faure E, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, Samoli E, van der Schouw YT, Schramm S, Severi G, Stafoggia M, Strak M, Sørensen M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Thurston GD. Long-Term Exposure to Source-Specific Fine Particles and Mortality─A Pooled Analysis of 14 European Cohorts within the ELAPSE Project. Environ Sci Technol 2022; 56:9277-9290. [PMID: 35737879 PMCID: PMC9261290 DOI: 10.1021/acs.est.2c01912] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
We assessed mortality risks associated with source-specific fine particles (PM2.5) in a pooled European cohort of 323,782 participants. Cox proportional hazard models were applied to estimate mortality hazard ratios (HRs) for source-specific PM2.5 identified through a source apportionment analysis. Exposure to 2010 annual average concentrations of source-specific PM2.5 components was assessed at baseline residential addresses. The source apportionment resulted in the identification of five sources: traffic, residual oil combustion, soil, biomass and agriculture, and industry. In single-source analysis, all identified sources were significantly positively associated with increased natural mortality risks. In multisource analysis, associations with all sources attenuated but remained statistically significant with traffic, oil, and biomass and agriculture. The highest association per interquartile increase was observed for the traffic component (HR: 1.06; 95% CI: 1.04 and 1.08 per 2.86 μg/m3 increase) across five identified sources. On a 1 μg/m3 basis, the residual oil-related PM2.5 had the strongest association (HR: 1.13; 95% CI: 1.05 and 1.22), which was substantially higher than that for generic PM2.5 mass, suggesting that past estimates using the generic PM2.5 exposure response function have underestimated the potential clean air health benefits of reducing fossil-fuel combustion. Source-specific associations with cause-specific mortality were in general consistent with findings of natural mortality.
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Affiliation(s)
- Jie Chen
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
| | - Gerard Hoek
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
| | - Kees de Hoogh
- Swiss
Tropical and Public Health Institute, 4051 Basel, Switzerland
- University
of Basel, 4001 Basel, Switzerland
| | - Sophia Rodopoulou
- Department
of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Zorana J. Andersen
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Tom Bellander
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Centre
for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Jørgen Brandt
- Department
of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
- iClimate—Interdisciplinary
Center for Climate Change, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
| | - Daniela Fecht
- MRC
Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2
1PG London, U.K.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region
Health Service, ASL Roma
1, 00147 Rome, Italy
- Environmental Research Group, School of
Public Health, Imperial College London, W2 1PG London, U.K.
| | - John Gulliver
- MRC
Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2
1PG London, U.K.
- Centre for Environmental Health and Sustainability
& School of
Geography, Geology and the Environment, University of Leicester, LE1 7RH Leicester, U.K.
| | - Ole Hertel
- Department of Ecoscience, Aarhus
University, 4000 Roskilde, Denmark
| | - Barbara Hoffmann
- Institute
for Occupational, Social and Environmental Medicine, Centre
for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, 40001 Düsseldorf, Germany
| | | | - W. M. Monique Verschuren
- National Institute for Public Health and
the Environment, 3720 BA Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, the Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical
Informatics, Biometry and Epidemiology, Medical
Faculty, University of Duisburg-Essen, 45259 Essen, Germany
| | - Jeanette T. Jørgensen
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Klea Katsouyanni
- Department
of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Environmental Research Group, School of
Public Health, Imperial College London, W2 1PG London, U.K.
| | - Matthias Ketzel
- Department
of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, GU2
7XH Guildford, United Kingdom
| | - Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Karin Leander
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Shuo Liu
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Petter Ljungman
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Cardiology, Danderyd
University
Hospital, 182 88 Stockholm, Sweden
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy,
“Exposome and Heredity” Team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K. E. Magnusson
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gabriele Nagel
- Institute
of Epidemiology and Medical Biometry, Ulm
University, Helmholtzstrasse 22, 89081 Ulm, Germany
| | - Göran Pershagen
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Centre
for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Annette Peters
- Institute
of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Chair of Epidemiology, Ludwig
Maximilians Universität München, 81377 Munich, Germany
| | - Ole Raaschou-Nielsen
- Department
of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
- Danish
Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences,
and Society, Karolinska Institutet and Stockholm
University, 171 77 Stockholm, Sweden
| | - Evangelia Samoli
- Department
of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical
Informatics, Biometry and Epidemiology, Medical
Faculty, University of Duisburg-Essen, 45259 Essen, Germany
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy,
“Exposome and Heredity” Team, CESP UMR1018, 94805 Villejuif, France
- Department of Statistics, Computer Science and Applications
“G. Parenti” (DISIA), University
of Florence, 50121 Firenze FI, Italy
| | - Massimo Stafoggia
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Epidemiology, Lazio Region
Health Service, ASL Roma
1, 00147 Rome, Italy
| | - Maciej Strak
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
- National Institute for Public Health and
the Environment, 3720 BA Bilthoven, The Netherlands
| | - Mette Sørensen
- Danish
Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, 4000 Roskilde, Denmark
| | - Anne Tjønneland
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
- Danish
Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute
of Epidemiology and Medical Biometry, Ulm
University, Helmholtzstrasse 22, 89081 Ulm, Germany
| | - Kathrin Wolf
- Institute
of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), 6900 Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, 6800 Feldkirch, Austria
| | - Bert Brunekreef
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
| | - George D. Thurston
- Departments of Environmental Medicine and
Population
Health, New York University Grossman School
of Medicine, New York, 10010-2598 New York, United States
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33
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Olsson A, Guha N, Bouaoun L, Kromhout H, Peters S, Siemiatycki J, Ho V, Gustavsson P, Boffetta P, Vermeulen R, Behrens T, Brüning T, Kendzia B, Guénel P, Luce D, Karrasch S, Wichmann HE, Consonni D, Landi MT, Caporaso NE, Merletti F, Mirabelli D, Richiardi L, Jöckel KH, Ahrens W, Pohlabeln H, Tardón A, Zaridze D, Field JK, Lissowska J, Świątkowska B, McLaughlin JR, Demers PA, Bencko V, Foretova L, Janout V, Pándics T, Fabianova E, Mates D, Forastiere F, Bueno-de-Mesquita B, Schüz J, Straif K. Occupational Exposure to Polycyclic Aromatic Hydrocarbons and Lung Cancer Risk: Results from a Pooled Analysis of Case-Control Studies (SYNERGY). Cancer Epidemiol Biomarkers Prev 2022; 31:1433-1441. [PMID: 35437574 PMCID: PMC9377765 DOI: 10.1158/1055-9965.epi-21-1428] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Exposure to polycyclic aromatic hydrocarbons (PAH) occurs widely in occupational settings. We investigated the association between occupational exposure to PAH and lung cancer risk and joint effects with smoking within the SYNERGY project. METHODS We pooled 14 case-control studies with information on lifetime occupational and smoking histories conducted between 1985 and 2010 in Europe and Canada. Exposure to benzo[a]pyrene (BaP) was used as a proxy of PAH and estimated from a quantitative general population job-exposure matrix. Multivariable unconditional logistic regression models, adjusted for smoking and exposure to other occupational lung carcinogens, estimated ORs, and 95% confidence intervals (CI). RESULTS We included 16,901 lung cancer cases and 20,965 frequency-matched controls. Adjusted OR for PAH exposure (ever) was 1.08 (CI, 1.02-1.15) in men and 1.20 (CI, 1.04-1.38) in women. When stratified by smoking status and histologic subtype, the OR for cumulative exposure ≥0.24 BaP μg/m3-years in men was higher in never smokers overall [1.31 (CI, 0.98-1.75)], for small cell [2.53 (CI, 1.28-4.99)] and squamous cell cancers [1.33 (CI, 0.80-2.21)]. Joint effects between PAH and smoking were observed. Restricting analysis to the most recent studies showed no increased risk. CONCLUSIONS Elevated lung cancer risk associated with PAH exposure was observed in both sexes, particularly for small cell and squamous cell cancers, after accounting for cigarette smoking and exposure to other occupational lung carcinogens. IMPACT The lack of association between PAH and lung cancer in more recent studies merits further research under today's exposure conditions and worker protection measures.
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Affiliation(s)
- Ann Olsson
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Neela Guha
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
| | - Liacine Bouaoun
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jack Siemiatycki
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Vikki Ho
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany
| | - Pascal Guénel
- Center for research in Epidemiology and Population Health (CESP), Exposome and Heredity team, Inserm U1018, University Paris-Saclay, Villejuif, France
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Heinz-Erich Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institut für Medizinische Informatik Biometrie Epidemiologie, Ludwig Maximilians University, Munich, Germany
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Dario Mirabelli
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Adonina Tardón
- Department of Public Health, University of Oviedo. ISPA and CIBERESP, Oviedo, Spain
| | - David Zaridze
- Department of cancer epidemiology and Prevention, N.N. Blokhin National Research Centre of oncology, Moscow, Russia
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Jolanta Lissowska
- Epidemiology Unit, Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Department of Environmental Epidemiology, The Nofer Institute of Occupational Medicine, Lodz, Poland
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Vladimir Bencko
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czechia
| | | | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czechia
| | | | - Eleonora Fabianova
- Regional Authority of Public Health, Banská Bystrica, Slovakia
- Faculty of Health, Catholic University, Ružomberok, Slovakia
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Bas Bueno-de-Mesquita
- Former senior scientist, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Massachusetts
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34
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Liu S, Lim YH, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Verschuren WMM, Jöckel KH, Jørgensen JT, So R, Amini H, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, van der Schouw YT, Schramm S, Sørensen M, Stafoggia M, Tjønneland A, Katsouyanni K, Huang W, Samoli E, Brunekreef B, Hoek G, Andersen ZJ. Long-term Air Pollution Exposure and Pneumonia-related Mortality in a Large Pooled European Cohort. Am J Respir Crit Care Med 2022; 205:1429-1439. [PMID: 35258439 DOI: 10.1164/rccm.202106-1484oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Ambient air pollution exposure has been linked to mortality from chronic cardiorespiratory diseases, while evidence on respiratory infections remains more limited. Objectives: We examined the association between long-term exposure to air pollution and pneumonia-related mortality in adults in a pool of eight European cohorts. Methods: Within the multicenter project ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO2), black carbon (BC), and ozone were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and pneumonia, influenza, and acute lower respiratory infections (ALRI) mortality. Measurements and Main Results: Of 325,367 participants, 712 died from pneumonia and influenza combined, 682 from pneumonia, and 695 from ALRI during a mean follow-up of 19.5 years. NO2 and BC were associated with 10-12% increases in pneumonia and influenza combined mortality, but 95% confidence intervals included unity (hazard ratios, 1.12 [0.99-1.26] per 10 μg/m3 for NO2; 1.10 [0.97-1.24] per 0.5 10-5m-1 for BC). Associations with pneumonia and ALRI mortality were almost identical. We detected effect modification suggesting stronger associations with NO2 or BC in overweight, employed, or currently smoking participants compared with normal weight, unemployed, or nonsmoking participants. Conclusions: Long-term exposure to combustion-related air pollutants NO2 and BC may be associated with mortality from lower respiratory infections, but larger studies are needed to estimate these associations more precisely.
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Affiliation(s)
| | | | - Jie Chen
- Institute for Risk Assessment Sciences and
| | - Maciek Strak
- Institute for Risk Assessment Sciences and.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science.,iClimate, Interdisciplinary Centre for Climate Change, and
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria.,Department of Internal Medicine 3, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/Azienda Sanitaria Locale Roma 1, Rome, Italy.,Science Policy & Epidemiology Environmental Research Group King's College London, London, United Kingdom
| | - John Gulliver
- Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | | | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Rina So
- Section of Environmental Health
| | | | | | - Amar J Mehta
- Section of Epidemiology, and.,Statistics Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, and.,Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | | | | | - Petter Ljungman
- Institute of Environmental Medicine.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, University of Versailles Saint-Quentin, Inserm, Gustave Roussy, "Exposome and Heredity" team, The Centre de Recherche en Epidémiologie et Santé des Populations UMR1018, Villejuif, France.,Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, University of Versailles Saint-Quentin, Inserm, Gustave Roussy, "Exposome and Heredity" team, The Centre de Recherche en Epidémiologie et Santé des Populations UMR1018, Villejuif, France
| | | | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.,Chair of Epidemiology, Ludwig Maximilians Universität München, Germany
| | - Ole Raaschou-Nielsen
- Department of Environmental Science.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine.,Department of Epidemiology, Lazio Region Health Service/Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Diet, Genes and Environment (DGE), Copenhagen, Denmark; and
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Science Policy & Epidemiology Environmental Research Group King's College London, London, United Kingdom
| | - Wei Huang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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35
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Boogaard H, Patton AP, Atkinson RW, Brook JR, Chang HH, Crouse DL, Fussell JC, Hoek G, Hoffmann B, Kappeler R, Kutlar Joss M, Ondras M, Sagiv SK, Samoli E, Shaikh R, Smargiassi A, Szpiro AA, Van Vliet EDS, Vienneau D, Weuve J, Lurmann FW, Forastiere F. Long-term exposure to traffic-related air pollution and selected health outcomes: A systematic review and meta-analysis. Environ Int 2022; 164:107262. [PMID: 35569389 DOI: 10.1016/j.envint.2022.107262] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 05/26/2023]
Abstract
The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, the Health Effects Institute (HEI) appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected adverse health outcomes. Health outcomes were selected based on evidence of causality for general air pollution (broader than TRAP) cited in authoritative reviews, relevance for public health and policy, and resources available. The Panel used a systematic approach to search the literature, select studies for inclusion in the review, assess study quality, summarize results, and reach conclusions about the confidence in the evidence. An extensive search was conducted of literature published between January 1980 and July 2019 on selected health outcomes. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP. In total, 353 studies were included in the review. Respiratory effects in children (118 studies) and birth outcomes (86 studies) were the most commonly studied outcomes. Fewer studies investigated cardiometabolic effects (57 studies), respiratory effects in adults (50 studies), and mortality (48 studies). The findings from the systematic review, meta-analyses, and evaluation of the quality of the studies and potential biases provided an overall high or moderate-to-high level of confidence in an association between long-term exposure to TRAP and the adverse health outcomes all-cause, circulatory, ischemic heart disease and lung cancer mortality, asthma onsetin chilldren and adults, and acute lower respiratory infections in children. The evidence was considered moderate, low or very low for the other selected outcomes. In light of the large number of people exposed to TRAP - both in and beyond the near-road environment - the Panel concluded that the overall high or moderate-to-high confidence in the evidence for an association between long-term exposure to TRAP and several adverse health outcomes indicates that exposures to TRAP remain an important public health concern and deserve greater attention from the public and from policymakers.
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Affiliation(s)
- H Boogaard
- Health Effects Institute, Boston, MA, United States.
| | - A P Patton
- Health Effects Institute, Boston, MA, United States
| | - R W Atkinson
- Epidemiology, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St. George's, University of London, London, United Kingdom
| | - J R Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - H H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - D L Crouse
- Health Effects Institute, Boston, MA, United States
| | - J C Fussell
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - R Kappeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - M Kutlar Joss
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - M Ondras
- Health Effects Institute, Boston, MA, United States
| | - S K Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States
| | - E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - R Shaikh
- Health Effects Institute, Boston, MA, United States
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - A A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | - D Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - F W Lurmann
- Sonoma Technology, Inc, Petaluma, CA, United States
| | - F Forastiere
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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36
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So R, Andersen ZJ, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Rodopoulou S, Samoli E, Lim YH, Jørgensen JT, Amini H, Cole-Hunter T, Mahmood Taghavi Shahri S, Maric M, Bergmann M, Liu S, Azam S, Loft S, Westendorp RGJ, Mortensen LH, Bauwelinck M, Klompmaker JO, Atkinson R, Janssen NAH, Oftedal B, Renzi M, Forastiere F, Strak M, Thygesen LC, Brunekreef B, Hoek G, Mehta AJ. Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer. Environ Int 2022; 164:107241. [PMID: 35544998 DOI: 10.1016/j.envint.2022.107241] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association between long-term exposure to air pollution and mortality from cardiorespiratory diseases is well established, yet the evidence for other diseases remains limited. OBJECTIVES To examine the associations of long-term exposure to air pollution with mortality from diabetes, dementia, psychiatric disorders, chronic kidney disease (CKD), asthma, acute lower respiratory infection (ALRI), as well as mortality from all-natural and cardiorespiratory causes in the Danish nationwide administrative cohort. METHODS We followed all residents aged ≥ 30 years (3,083,227) in Denmark from 1 January 2000 until 31 December 2017. Annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (warm season) were estimated using European-wide hybrid land-use regression models (100 m × 100 m) and assigned to baseline residential addresses. We used Cox proportional hazard models to evaluate the association between air pollution and mortality, accounting for demographic and socioeconomic factors. We additionally applied indirect adjustment for smoking and body mass index (BMI). RESULTS During 47,023,454 person-years of follow-up, 803,881 people died from natural causes. Long-term exposure to PM2.5 (mean: 12.4 µg/m3), NO2 (20.3 µg/m3), and/or BC (1.0 × 10-5/m) was statistically significantly associated with all studied mortality outcomes except CKD. A 5 µg/m3 increase in PM2.5 was associated with higher mortality from all-natural causes (hazard ratio 1.11; 95% confidence interval 1.09-1.13), cardiovascular disease (1.09; 1.07-1.12), respiratory disease (1.11; 1.07-1.15), lung cancer (1.19; 1.15-1.24), diabetes (1.10; 1.04-1.16), dementia (1.05; 1.00-1.10), psychiatric disorders (1.38; 1.27-1.50), asthma (1.13; 0.94-1.36), and ALRI (1.14; 1.09-1.20). Associations with long-term exposure to ozone (mean: 80.2 µg/m3) were generally negative but became significantly positive for several endpoints in two-pollutant models. Generally, associations were attenuated but remained significant after indirect adjustment for smoking and BMI. CONCLUSION Long-term exposure to PM2.5, NO2, and/or BC in Denmark were associated with mortality beyond cardiorespiratory diseases, including diabetes, dementia, psychiatric disorders, asthma, and ALRI.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Shadi Azam
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard Atkinson
- Population Health Research Institute, St George's University of London, London, UK
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bente Oftedal
- Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
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37
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Forastiere F, Peters A. Response to "Comment on 'Invited Perspective: The NO2 and Mortality Dilemma Solved? Almost There!'". Environ Health Perspect 2022; 130:38002. [PMID: 35294263 PMCID: PMC8926162 DOI: 10.1289/ehp11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Francesco Forastiere
- Institute for Biomedical Research and Innovation – National Research Council, Palermo, Italy
- Environmental Research Group, Imperial College, London, UK
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
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38
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Rodopoulou S, Stafoggia M, Chen J, de Hoogh K, Bauwelinck M, Mehta AJ, Klompmaker JO, Oftedal B, Vienneau D, Janssen NAH, Strak M, Andersen ZJ, Renzi M, Cesaroni G, Nordheim CF, Bekkevold T, Atkinson R, Forastiere F, Katsouyanni K, Brunekreef B, Samoli E, Hoek G. Long-term exposure to fine particle elemental components and mortality in Europe: Results from six European administrative cohorts within the ELAPSE project. Sci Total Environ 2022; 809:152205. [PMID: 34890671 DOI: 10.1016/j.scitotenv.2021.152205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 05/25/2023]
Abstract
Evidence for the association between long-term exposure to ambient particulate matter components and mortality from natural causes is sparse and inconsistent. We evaluated this association in six large administrative cohorts in the framework of the Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) project. We analyzed data from country-wide administrative cohorts in Norway, Denmark, the Netherlands, Belgium, Switzerland and in Rome (Italy). Annual 2010 mean concentrations of copper (Cu), iron (Fe), potassium (K), nickel (Ni), sulfur (S), silicon (Si), vanadium (V) and zinc (Zn) in fine particulate matter (PM2.5) were estimated using 100 × 100 m Europe-wide hybrid land use regression models assigned to the participants' residential addresses. We applied cohort-specific Cox proportional hazard models controlling for area- and individual-level covariates to evaluate associations with natural mortality. Two pollutant models adjusting for PM2.5 total mass or nitrogen dioxide (NO2) were also applied. We pooled cohort-specific estimates using a random effects meta-analysis. We included almost 27 million participants contributing more than 240 million person-years. All components except Zn were significantly associated with natural mortality [pooled Hazard Ratios (HRs) (95% CI): 1.037 (1.014, 1.060) per 5 ng/m3 Cu; 1.069 (1.031, 1.108) per 100 ng/m3 Fe; 1.039 (1.018, 1.062) per 50 ng/m3 K; 1.024 (1.006, 1.043) per 1 ng/m3 Ni; 1.036 (1.016, 1.057) per 200 ng/m3 S; 1.152 (1.048, 1.266) per 100 ng/m3 Si; 1.020 (1.006, 1.034) per 2 ng/m3 V]. Only K and Si were robust to PM2.5 or NO2 adjustment [pooled HRs (95% CI) per 50 ng/m3 in K: 1.025 (1.008, 1.044), 1.020 (0.999, 1.042) and per 100 ng/m3 in Si: 1.121 (1.039, 1.209), 1.068 (1.022, 1.117) adjusted for PM2.5 and NO2 correspondingly]. Our findings indicate an association of natural mortality with most components, which was reduced after adjustment for PM2.5 and especially NO2.
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Affiliation(s)
- Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Methodology and Analysis, Statistics Denmark, Copenhagen, Denmark.
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Maciej Strak
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Institute for Risk Assessment Sciences, Utrecht University, the Netherlands.
| | - Zorana J Andersen
- Section of Environmental and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy.
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy.
| | - Carl Fredrik Nordheim
- Department of Zoonotic, Food- and Waterborne Infections, Norwegian Institute of Public Health, Oslo, Norway.
| | - Terese Bekkevold
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway.
| | - Richard Atkinson
- Population Health Research, Institute St George's, University of London, London, UK.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, UK
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, UK.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
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Renzi M, Scortichini M, Forastiere F, De' Donato F, Michelozzi P, Davoli M, Gariazzo C, Viegi G, Stafoggia M, Ancona C, Bucci S, De' Donato F, Michelozzi P, Renzi M, Scortichini M, Stafoggia M, Bonafede M, Gariazzo C, Marinaccio A, Argentini S, Sozzi R, Bonomo S, Fasola S, Forastiere F, La Grutta S, Viegi G, Cernigliaro A, Scondotto S, Baldacci S, Maio S, Licitra G, Moro A, Angelini P, Bonvicini L, Broccoli S, Ottone M, Rossi PG, Colacci A, Parmagnani F, Ranzi A, Galassi C, Migliore E, Bisceglia L, Chieti A, Brusasca G, Calori G, Finardi S, Nanni A, Pepe N, Radice P, Silibello C, Tinarelli G, Uboldi F, Carlino G. A nationwide study of air pollution from particulate matter and daily hospitalizations for respiratory diseases in Italy. Sci Total Environ 2022; 807:151034. [PMID: 34666080 DOI: 10.1016/j.scitotenv.2021.151034] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND/AIM The relationship between air pollution and respiratory morbidity has been widely addressed in urban and metropolitan areas but little is known about the effects in non-urban settings. Our aim was to assess the short-term effects of PM10 and PM2.5 on respiratory admissions in the whole country of Italy during 2006-2015. METHODS We estimated daily PM concentrations at the municipality level using satellite data and spatiotemporal predictors. We collected daily counts of respiratory hospital admissions for each Italian municipality. We considered five different outcomes: all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), lower and upper respiratory tract infections (LRTI and URTI). Meta-analysis of province-specific estimates obtained by time-series models, adjusting for temperature, humidity and other confounders, was applied to extrapolate national estimates for each outcome. At last, we tested for effect modification by sex, age, period, and urbanization score. Analyses for PM2.5 were restricted to 2013-2015 cause the goodness of fit of exposure estimation. RESULTS A total of 4,154,887 respiratory admission were registered during 2006-2015, of which 29% for LRTI, 12% for COPD, 6% for URTI, and 3% for asthma. Daily mean PM10 and PM2.5 concentrations over the study period were 23.3 and 17 μg/m3, respectively. For each 10 μg/m3 increases in PM10 and PM2.5 at lag 0-5 days, we found excess risks of total respiratory diseases equal to 1.20% (95% confidence intervals, 0.92, 1.49) and 1.22% (0.76, 1.68), respectively. The effects for the specific diseases were similar, with the strongest ones for asthma and COPD. Higher effects were found in the elderly and in less urbanized areas. CONCLUSIONS Short-term exposure to PM is harmful for the respiratory system throughout an entire country, especially in elderly patients. Strong effects can be found also in less urbanized areas.
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Affiliation(s)
- Matteo Renzi
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy.
| | - Matteo Scortichini
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Francesco Forastiere
- CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy; Environmental Research Group, School of Public Health, Imperial College, London, UK
| | - Francesca De' Donato
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Paola Michelozzi
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Marina Davoli
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Monteporzio Catone (RM), Italy
| | - Giovanni Viegi
- CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy; CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, ASL Rome 1, Local Health Authority, Lazio Region, Italy
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40
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Di Blasi C, Renzi M, Michelozzi P, De' Donato F, Scortichini M, Davoli M, Forastiere F, Mannucci PM, Stafoggia M. Association between air temperature, air pollution and hospital admissions for pulmonary embolism and venous thrombosis in Italy. Eur J Intern Med 2022; 96:74-80. [PMID: 34702659 DOI: 10.1016/j.ejim.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies reported a link between short-term exposure to environmental stressors (air pollution and air temperature) and atherothrombotic cardiovascular diseases. However, only few of them reported consistent associations with venous thromboembolism (VTE). Our aim was to estimate the association between daily air temperature and particulate matter (PM) air pollution with hospital admissions for pulmonary embolism (PE) and venous thrombosis (VT) at national level in Italy. METHODS We collected daily hospital PE and VT admissions from the Italian Ministry of Health during 2006-2015 in all the 8,084 municipalities of Italy, and we merged them with air temperature and daily PM10 concentrations estimated by satellite-based spatiotemporal models. First, we applied multivariate Poisson regression models at province level. Then, we obtained national overall effects by random-effects meta-analysis. RESULTS This analysis was conducted on 219,952 PE and 275,506 VT hospitalizations. Meta-analytical results showed weak associations between the two exposures and the study outcomes in the full year analysis. During autumn and winter, PE hospital admissions increased by 1.07% (95% confidence intervals [CI]: 0.21%; 1.92%) and 0.96% (95% CI: 0.07%; 1.83%) respectively, per 1 °C decrement of air temperature in the previous 10 days (lag 0-10). In summer we observed adverse effects at high temperatures, with a 1% (95% CI: 0.10%; 1.91%) increasing risk per 1 °C increment. We found no association between VT and cold temperatures. CONCLUSION Results show a significant effect of air temperature on PE hospitalizations in the cold seasons and summer. No effect of particulate matter was detected.
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Affiliation(s)
- Chiara Di Blasi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma1.
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma1
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma1
| | | | | | - Marina Davoli
- Department of Epidemiology, Lazio Region Health Service / ASL Roma1
| | - Francesco Forastiere
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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De Matteis S, Forastiere F, Baldacci S, Maio S, Tagliaferro S, Fasola S, Cilluffo G, La Grutta S, Viegi G. Issue 1 - “Update on adverse respiratory effects of outdoor air pollution”. Part 1): Outdoor air pollution and respiratory diseases: A general update and an Italian perspective. Pulmonology 2022; 28:284-296. [DOI: 10.1016/j.pulmoe.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022] Open
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42
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Renzi M, Stafoggia M, Michelozzi P, Davoli M, Forastiere F, Solimini AG. Long-term exposure to air pollution and risk of venous thromboembolism in a large administrative cohort. Environ Health 2022; 21:21. [PMID: 35086531 PMCID: PMC8793234 DOI: 10.1186/s12940-022-00834-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Venous thromboembolisms (VTE) are one of the most frequent cause among the cardiovascular diseases. Despite the association between long-term exposure to air pollution and cardiovascular outcomes have been widely explored in epidemiological literature, little is known about the air pollution related effects on VTE. We aimed to evaluate this association in a large administrative cohort in 15 years of follow-up. METHODS Air pollution exposure (NO2, PM10 and PM2.5) was derived by land use regression models obtained by the ESCAPE framework. Administrative health databases were used to identify VTE cases. To estimate the association between air pollutant exposures and risk of hospitalizations for VTE (in total and divided in deep vein thrombosis (DVT) and pulmonary embolism (PE)), we used Cox regression models, considering individual, environmental (noise and green areas), and contextual characteristics. Finally, we considered potential effect modification for individual covariates and previous comorbidities. RESULTS We identified 1,954 prevalent cases at baseline and 20,304 cases during the follow-up period. We found positive associations between PM2.5 exposures and DVT, PE and VTE with hazard ratios (HRs) up to 1.082 (95% confidence intervals: 0.992, 1.181), 1.136 (0.994, 1.298) and 1.074 (0.996, 1.158) respectively for 10 μg/m3 increases. The association was stronger in younger subjects (< 70 years old compared to > 70 years old) and among those who had cancer. CONCLUSION The effect of pollutants on PE and VTE hospitalizations, although marginally non-significant, should be interpreted as suggestive of a health effect that deserves attention in future studies.
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Affiliation(s)
- Matteo Renzi
- Department of Epidemiology, Health Authority Service, ASL Rome 1, 00147, Rome, Italy.
- Department of Health Statistics and Biometry, University of Rome "La Sapienza", Rome, Italy.
| | - Massimo Stafoggia
- Department of Epidemiology, Health Authority Service, ASL Rome 1, 00147, Rome, Italy
- Institute of Environmental Medicine, Karolinska Instituet, Stockholm, Sweden
| | - Paola Michelozzi
- Department of Epidemiology, Health Authority Service, ASL Rome 1, 00147, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Health Authority Service, ASL Rome 1, 00147, Rome, Italy
| | - Francesco Forastiere
- National Research Council of Italy, Institute of Innovation and Biomedical Research (IRIB), , Palermo, Italy
| | - Angelo G Solimini
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy
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Ancona C, Assennato G, Bianchi F, Biggeri A, Cadum E, Consonni D, Forastiere F, Ranzi A. Health impact assessment should be based on correct methods. Med Lav 2022; 113:e2022019. [PMID: 35481578 PMCID: PMC9073761 DOI: 10.23749/mdl.v113i2.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
The methodology of health impact assessment (HIA), originally proposed by WHO, is widely used to predict the potential health effects in a community living in a place in which a new project (e.g., an industrial plant) will be implemented. One of the key quantities to calculate the impact (i.e., the number of attributable cases) is the baseline (i.e., before the project implementation) rate of selected diseases in the community. In a recent paper on this journal, this methodology has been challenged. Specifically, the use of baseline rate has been questioned, proposing to use only the fraction of the baseline rate due to the exposures related to the project, and not the rate due to all risk factors for the disease. In this commentary, we argue that the proposal is logically and epidemiologically unsound, and devoid of scientific motivation. The conclusion that the traditional approach overestimates the health impact should be rejected as based on flawed assumptions. On the contrary, the proposal may produce a (seriously biased) underestimation of attributable cases.
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Affiliation(s)
- Carla Ancona
- Epidemiology Department Lazio Regional Health Authority, Rome, Italy
| | - Giorgio Assennato
- Commissione Valutazione Impatto Ambientale - VIA e VAS, Ministero della Transizione Ecologica, Rome, Italy
| | - Fabrizio Bianchi
- Unit of Environmental Epidemiology, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Annibale Biggeri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ennio Cadum
- Department of Hygiene and Health Prevention, Health Protection Agency, Pavia, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Andrea Ranzi
- Center for Environment, Prevention and Health, Regional Agency for Prevention, Environment and Energy Emilia-Romagna Region (Arpae), Modena, Italy
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Stafoggia M, Oftedal B, Chen J, Rodopoulou S, Renzi M, Atkinson RW, Bauwelinck M, Klompmaker JO, Mehta A, Vienneau D, Andersen ZJ, Bellander T, Brandt J, Cesaroni G, de Hoogh K, Fecht D, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Kristoffersen DT, Lager A, Leander K, Liu S, Ljungman PLS, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, Schramm S, Schwarze PE, Severi G, Sigsgaard T, Strak M, van der Schouw YT, Verschuren M, Weinmayr G, Wolf K, Zitt E, Samoli E, Forastiere F, Brunekreef B, Hoek G, Janssen NAH. Long-term exposure to low ambient air pollution concentrations and mortality among 28 million people: results from seven large European cohorts within the ELAPSE project. Lancet Planet Health 2022; 6:e9-e18. [PMID: 34998464 DOI: 10.1016/s2542-5196(21)00277-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND 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). METHODS 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 (PM2·5), nitrogen dioxide (NO2), black carbon, and tropospheric warm-season ozone (O3) 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. FINDINGS 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 PM2·5, NO2, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m3 increment in PM2·5, 1·044 (1·019-1·069) per 10 μg/m3 NO2, and 1·039 (1·018-1·059) per 0·5 × 10-5/m black carbon. Associations with PM2·5, NO2, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O3 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 PM2·5 (10 μg/m3) and NO2 (40 μg/m3) were 1·078 (1·046-1·111) per 5 μg/m3 PM2·5 and 1·049 (1·024-1·075) per 10 μg/m3 NO2. 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× 10-5/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10-5/m. INTERPRETATION Long-term exposure to concentrations of PM2·5 and NO2 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. FUNDING Health Effects Institute.
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Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography-Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Amar Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate Aarhus University Interdisciplinary Centre for Climate Change, Aarhus, Denmark
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Fecht
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - John Gulliver
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Centre for Environmental Health and Sustainability and School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research, University of Surrey, Guildford, UK
| | | | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, Munich, Germany
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany
| | - Per E Schwarze
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gianluca Severi
- Exposome and Heredity Team, University Paris-Saclay, UVSQ, INSERM, Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science and Applications "G Parenti", University of Florence, Italy
| | - Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Forastiere F, Peters A. Invited Perspective: The NO2 and Mortality Dilemma Solved? Almost There! Environ Health Perspect 2021; 129:121304. [PMID: 34962423 PMCID: PMC8713649 DOI: 10.1289/ehp10286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 05/30/2023]
Affiliation(s)
- Francesco Forastiere
- Istituto per la Ricerca e l’Innovazione Biomedica Consiglio Nazionale delle Ricerche, Palermo, Italy
- Environmental Research Group, Imperial College, London, UK
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, Neuherberg, Germany
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Feulefack J, Khan A, Forastiere F, Sergi CM. Parental Pesticide Exposure and Childhood Brain Cancer: A Systematic Review and Meta-Analysis Confirming the IARC/WHO Monographs on Some Organophosphate Insecticides and Herbicides. Children (Basel) 2021; 8:children8121096. [PMID: 34943292 PMCID: PMC8700205 DOI: 10.3390/children8121096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/19/2022]
Abstract
Background: Brain tumors are the second most common neoplasm in the pediatric age. Pesticides may play an etiologic role, but literature results are conflicting. This review provides a systematic overview, meta-analysis, and IARC/WHO consideration of data on parental exposure to pesticides and childhood brain tumors. Methods: We searched PubMed, SCOPUS, and Google Scholar for literature (1 January 1966–31 December 2020) that assessed childhood brain tumors and parental exposure to pesticides. We undertook a meta-analysis addressing prenatal exposure, exposure after birth, occupational exposure, and residential exposure. A total of 130 case-control investigations involving 43,598 individuals (18,198 cases and 25,400 controls) were included. Results: Prenatal exposure is associated with childhood brain tumors (odds ratio, OR = 1.32; 95% CI: 1.17–1.49; I2 = 41.1%). The same occurs after birth exposure (OR = 1.22; 95% CI: 1.03–1.45, I2 = 72.3%) and residential exposure to pesticides (OR = 1.31; 95% CI: 1.11–1.54, I2 = 67.2%). Parental occupational exposure is only marginally associated with CBT (OR = 1.17, 95% CI: 0.99–1.38, I2 = 67.0%). Conclusions: There is an association between CBT and parental pesticides exposure before childbirth, after birth, and residential exposure. It is in line with the IARC Monograph evaluating the carcinogenicity of diazinon, glyphosate, malathion, parathion, and tetrachlorvinphos.
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Affiliation(s)
- Joseph Feulefack
- National “111” Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China;
- Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Aiza Khan
- Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Francesco Forastiere
- Department of Epidemiology, Regional Health Service of Lazio, 00147 Rome, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London SW7 2AZ, UK
| | - Consolato M. Sergi
- National “111” Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China;
- Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Stollery Children’s Hospital, Edmonton, AB T6G 2R3, Canada
- Anatomic Pathology Division, Department of Lab. Medicine and Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
- Correspondence: ; Tel.: +1-613-737-7600 (ext. 2427); Fax: +1-613-738-4837
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Micheli A, Forastiere F, Candela S, Richiardi L. [Like an atomic wind]. Epidemiol Prev 2021; 45:438-440. [PMID: 35001585 DOI: 10.19191/ep21.6.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Hoffmann B, Boogaard H, de Nazelle A, Andersen ZJ, Abramson M, Brauer M, Brunekreef B, Forastiere F, Huang W, Kan H, Kaufman JD, Katsouyanni K, Krzyzanowski M, Kuenzli N, Laden F, Nieuwenhuijsen M, Mustapha A, Powell P, Rice M, Roca-Barceló A, Roscoe CJ, Soares A, Straif K, Thurston G. WHO Air Quality Guidelines 2021-Aiming for Healthier Air for all: A Joint Statement by Medical, Public Health, Scientific Societies and Patient Representative Organisations. Int J Public Health 2021; 66:1604465. [PMID: 34630006 PMCID: PMC8494774 DOI: 10.3389/ijph.2021.1604465] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Medical School, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | | | | | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Wei Huang
- Department of Occupational and Environmental Health, Peking University, Beijing, China
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Klea Katsouyanni
- Imperial College London, London, United Kingdom
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nino Kuenzli
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Francine Laden
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Adetoun Mustapha
- Imperial College London, London, United Kingdom
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Pippa Powell
- European Lung Foundation, Sheffield, United Kingdom
| | - Mary Rice
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | | | - Agnes Soares
- Pan American Health Organization, Washington D.C., DC, United States
| | - Kurt Straif
- Boston College, Chestnut Hill, MA, United States
| | - George Thurston
- Department of Population Health, New York University School of Medicine, New York City, NY, United States
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Strak M, Weinmayr G, Rodopoulou S, Chen J, de Hoogh K, Andersen ZJ, Atkinson R, Bauwelinck M, Bekkevold T, Bellander T, Boutron-Ruault MC, Brandt J, Cesaroni G, Concin H, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Janssen NAH, Jöckel KH, Jørgensen JT, Ketzel M, Klompmaker JO, Lager A, Leander K, Liu S, Ljungman P, Magnusson PKE, Mehta AJ, Nagel G, Oftedal B, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rizzuto D, van der Schouw YT, Schramm S, Severi G, Sigsgaard T, Sørensen M, Stafoggia M, Tjønneland A, Verschuren WMM, Vienneau D, Wolf K, Katsouyanni K, Brunekreef B, Hoek G, Samoli E. Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis. BMJ 2021; 374:n1904. [PMID: 34470785 PMCID: PMC8409282 DOI: 10.1136/bmj.n1904] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, Section of Environment and Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Terese Bekkevold
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Hans Concin
- Agency for Preventive and Social Medicine (AKS), Bregenz, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Science Policy and Epidemiology Environmental Research Group King's College London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability and School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jeanette T Jørgensen
- Department of Public Health, Section of Environment and Health, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shuo Liu
- Department of Public Health, Section of Environment and Health, University of Copenhagen, Copenhagen, Denmark
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amar J Mehta
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Ludwig Maximilians Universität München, Munich, Germany
| | | | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, Paris, France
- Department of Statistics, Computer Science and Applications "G Parenti" (DISIA), University of Florence, Italy
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Science Policy and Epidemiology Environmental Research Group King's College London, London, UK
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Brunekreef B, Strak M, Chen J, Andersen ZJ, Atkinson R, Bauwelinck M, Bellander T, Boutron MC, Brandt J, Carey I, Cesaroni G, Forastiere F, Fecht D, Gulliver J, Hertel O, Hoffmann B, de Hoogh K, Houthuijs D, Hvidtfeldt U, Janssen N, Jorgensen J, Katsouyanni K, Ketzel M, Klompmaker J, Hjertager Krog N, Liu S, Ljungman P, Mehta A, Nagel G, Oftedal B, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rodopoulou S, Samoli E, Schwarze P, Sigsgaard T, Stafoggia M, Vienneau D, Weinmayr G, Wolf K, Hoek G. Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM 2.5, BC, NO 2, and O 3: An Analysis of European Cohorts in the ELAPSE Project. Res Rep Health Eff Inst 2021; 2021:1-127. [PMID: 36106702 PMCID: PMC9476567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Epidemiological cohort studies have consistently found associations between long-term exposure to outdoor air pollution and a range of morbidity and mortality endpoints. Recent evaluations by the World Health Organization and the Global Burden of Disease study have suggested that these associations may be nonlinear and may persist at very low concentrations. Studies conducted in North America in particular have suggested that associations with mortality persisted at concentrations of particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5) well below current air quality standards and guidelines. The uncertainty about the shape of the concentration-response function at the low end of the concentration distribution, related to the scarcity of observations in the lowest range, was the basis of the current project. Previous studies have focused on PM2.5, but increasingly associations with nitrogen dioxide (NO2) are being reported, particularly in studies that accounted for the fine spatial scale variation of NO2. Very few studies have evaluated the effects of long-term exposure to low concentrations of ozone (O3). Health effects of black carbon (BC), representing primary combustion particles, have not been studied in most large cohort studies of PM2.5. Cohort studies assessing health effects of particle composition, including elements from nontailpipe traffic emissions (iron, copper, and zinc) and secondary aerosol (sulfur) have been few in number and reported inconsistent results. The overall objective of our study was to investigate the shape of the relationship between long-term exposure to four pollutants (PM2.5, NO2, BC, and O3) and four broad health effect categories using a number of different methods to characterize the concentration-response function (i.e., linear, nonlinear, or threshold). The four health effect categories were (1) natural- and cause-specific mortality including cardiovascular and nonmalignant as well as malignant respiratory and diabetes mortality; and morbidity measured as (2) coronary and cerebrovascular events; (3) lung cancer incidence; and (4) asthma and chronic obstructive pulmonary disease (COPD) incidence. We additionally assessed health effects of PM2.5 composition, specifically the copper, iron, zinc, and sulfur content of PM2,5. METHODS We focused on analyses of health effects of air pollutants at low concentrations, defined as less than current European Union (EU) Limit Values, U.S. Environmental Protection Agency (U.S. EPA), National Ambient Air Quality Standards (NAAQS), and/or World Health Organization (WHO) Air Quality Guideline values for PM2.5, NO2, and O3. We address the health effects at low air pollution levels by performing new analyses within selected cohorts of the ESCAPE study (European Study of Cohorts for Air Pollution Effects; Beelen et al. 2014a) and within seven very large European administrative cohorts. By combining well-characterized ESCAPE cohorts and large administrative cohorts in one study the strengths and weaknesses of each approach can be addressed. The large administrative cohorts are more representative of national or citywide populations, have higher statistical power, and can efficiently control for area-level confounders, but have fewer possibilities to control for individual-level confounders. The ESCAPE cohorts have detailed information on individual confounders, as well as country-specific information on area-level confounding. The data from the seven included ESCAPE cohorts and one additional non-ESCAPE cohort have been pooled and analyzed centrally. More than 300,000 adults were included in the pooled cohort from existing cohorts in Sweden, Denmark, Germany, the Netherlands, Austria, France, and Italy. Data from the administrative cohorts have been analyzed locally, without transfer to a central database. Privacy regulations prevented transfer of data from administrative cohorts to a central database. More than 28 million adults were included from national administrative cohorts in Belgium, Denmark, England, the Netherlands, Norway, and Switzerland as well as an administrative cohort in Rome, Italy. We developed central exposure assessment using Europewide hybrid land use regression (LUR) models, which incorporated European routine monitoring data for PM2.5, NO2, and O3, and ESCAPE monitoring data for BC and PM2.5 composition, land use, and traffic data supplemented with satellite observations and chemical transport model estimates. For all pollutants, we assessed exposure at a fine spatial scale, 100 × 100 m grids. These models have been applied to individual addresses of all cohorts including the administrative cohorts. In sensitivity analyses, we applied the PM2.5 models developed within the companion HEI-funded Canadian MAPLE study (Brauer et al. 2019) and O3 exposures on a larger spatial scale for comparison with previous studies. Identification of outcomes included linkage with mortality, cancer incidence, hospital discharge registries, and physician-based adjudication of cases. We analyzed natural-cause, cardiovascular, ischemic heart disease, stroke, diabetes, cardiometabolic, respiratory, and COPD mortality. We also analyzed lung cancer incidence, incidence of coronary and cerebrovascular events, and incidence of asthma and COPD (pooled cohort only). We applied the Cox proportional hazard model with increasing control for individual- and area-level covariates to analyze the associations between air pollution and mortality and/or morbidity for both the pooled cohort and the individual administrative cohorts. Age was used as the timescale because of evidence that this results in better adjustment for potential confounding by age. Censoring occurred at the time of the event of interest, death from other causes, emigration, loss to follow-up for other reasons, or at the end of follow-up, whichever came first. A priori we specified three confounder models, following the modeling methods of the ESCAPE study. Model 1 included only age (time axis), sex (as strata), and calendar year of enrollment. Model 2 added individual-level variables that were consistently available in the cohorts contributing to the pooled cohort or all variables available in the administrative cohorts, respectively. Model 3 further added area-level socioeconomic status (SES) variables. A priori model 3 was selected as the main model. All analyses in the pooled cohort were stratified by subcohort. All analyses in the administrative cohorts accounted for clustering of the data in neighborhoods by adjusting the variance of the effect estimates. The main exposure variable we analyzed was derived from the Europewide hybrid models based on 2010 monitoring data. Sensitivity analyses were conducted using earlier time periods, time-varying exposure analyses, local exposure models, and the PM2.5 models from the Canadian MAPLE project. We first specified linear single-pollutant models. Two-pollutant models were specified for all combinations of the four main pollutants. Two-pollutant models for particle composition were analyzed with PM2.5 and NO2 as the second pollutant. We then investigated the shape of the concentration-response function using natural splines with two, three, and four degrees of freedom; penalized splines with the degrees of freedom determined by the algorithm and shape-constrained health impact functions (SCHIF) using confounder model 3. Additionally, we specified linear models in subsets of the concentration range, defined by removing concentrations above a certain value from the analysis, such as for PM2.5 25 μg/m3 (EU limit value), 20, 15, 12 μg/m3 (U.S. EPA National Ambient Air Quality Standard), and 10 μg/m3 (WHO Air Quality Guideline value). Finally, threshold models were evaluated to investigate whether the associations persisted below specific concentration values. For PM2.5, we evaluated 10, 7.5, and 5 μg/m3 as potential thresholds. Performance of threshold models versus the corresponding no-threshold linear model were evaluated using the Akaike information criterion (AIC). RESULTS In the pooled cohort, virtually all subjects in 2010 had PM2.5 and NO2 annual average exposures below the EU limit values (25 μg/m3 and 40 μg/m3, respectively). More than 50,000 had a residential PM2.5 exposure below the U.S. EPA NAAQS (12 μg/m3). More than 25,000 subjects had a residential PM2.5 exposure below the WHO guideline (10 μg/m3). We found significant positive associations between PM2.5, NO2, and BC and natural-cause, respiratory, cardiovascular, and diabetes mortality. In our main model, the hazard ratios (HRs) (95% [confidence interval] CI) were 1.13 (CI = 1.11, 1.16) for an increase of 5 μg/m3 PM2.5, 1.09 (CI = 1.07, 1.10) for an increase of 10 μg/m3 NO2, and 1.08 (CI = 1.06, 1.10) for an increase of 0.5 × 10-5/m BC for natural-cause mortality. The highest HRs were found for diabetes mortality. Associations with O3 were negative, both in the fine spatial scale of the main ELAPSE model and in large spatial scale exposure models. For PM2.5, NO2, and BC, we generally observed a supralinear association with steeper slopes at low exposures and no evidence of a concentration below which no association was found. Subset analyses further confirmed that these associations remained at low levels: below 10 μg/m3 for PM2.5 and 20 μg/m3 for NO2. HRs were similar to the full cohort HRs for subjects with exposures below the EU limit values for PM2.5 and NO2, the U.S. NAAQS values for PM2.5, and the WHO guidelines for PM2.5 and NO2. The mortality associations were robust to alternative specifications of exposure, including different time periods, PM2.5 from the MAPLE project, and estimates from the local ESCAPE model. Time-varying exposure natural spline analyses confirmed associations at low pollution levels. HRs in two-pollutant models were attenuated but remained elevated and statistically significant for PM2.5 and NO2. In two-pollutant models of PM2.5 and NO2 HRs for natural-cause mortality were 1.08 (CI = 1.05, 1.11) for PM2.5 and 1.05 (CI = 1.03, 1.07) for NO2. Associations with O3 were attenuated but remained negative in two-pollutant models with NO2, BC, and PM2.5. We found significant positive associations between PM2.5, NO2, and BC and incidence of stroke and asthma and COPD hospital admissions. Furthermore, NO2 was significantly related to acute coronary heart disease and PM2.5 was significantly related to lung cancer incidence. We generally observed linear to supralinear associations with no evidence of a threshold, with the exception of the association between NO2 and acute coronary heart disease, which was sublinear. Subset analyses documented that associations remained even with PM2.5 below 20 μg/m3 and possibly 12 μg/m3. Associations remained even when NO2 was below 30 μg/m3 and in some cases 20 μg/m3. In two-pollutant models, NO2 was most consistently associated with acute coronary heart disease, stroke, asthma, and COPD hospital admissions. PM2.5 was not associated with these outcomes in two-pollutant models with NO2. PM2.5 was the only pollutant that was associated with lung cancer incidence in two-pollutant models. Associations with O3 were negative though generally not statistically significant. In the administrative cohorts, virtually all subjects in 2010 had PM2.5 and NO2 annual average exposures below the EU limit values. More than 3.9 million subjects had a residential PM2.5 exposure below the U.S. EPA NAAQS (12 μg/m3) and more than 1.9 million had residential PM2.5 exposures below the WHO guideline (10 μg/m3). We found significant positive associations between PM2.5, NO2, and BC and natural-cause, respiratory, cardiovascular, and lung cancer mortality, with moderate to high heterogeneity between cohorts. We found positive but statistically nonsignificant associations with diabetes mortality. In our main model meta-analysis, the HRs (95% CI) for natural-cause mortality were 1.05 (CI = 1.02, 1.09) for an increase of 5 μg/m3 PM2.5, 1.04 (CI = 1.02, 1.07) for an increase of 10 μg/m3 NO2, and 1.04 (CI = 1.02, 1.06) for an increase of 0.5 × 10-5/m BC, and 0.95 (CI = 0.93, 0.98) for an increase of 10 μg/m3 O3. The shape of the concentration-response functions differed between cohorts, though the associations were generally linear to supralinear, with no indication of a level below which no associations were found. Subset analyses documented that these associations remained at low levels: below 10 μg/m3 for PM2.5 and 20 μg/m3 for NO2. BC and NO2 remained significantly associated with mortality in two-pollutant models with PM2.5 and O3. The PM2.5 HR attenuated to unity in a two-pollutant model with NO2. The negative O3 association was attenuated to unity and became nonsignificant. The mortality associations were robust to alternative specifications of exposure, including time-varying exposure analyses. Time-varying exposure natural spline analyses confirmed associations at low pollution levels. Effect estimates in the youngest participants (<65 years at baseline) were much larger than in the elderly (>65 years at baseline). Effect estimates obtained with the ELAPSE PM2.5 model did not differ from the MAPLE PM2.5 model on average, but in individual cohorts, substantial differences were found. CONCLUSIONS Long-term exposure to PM2.5, NO2, and BC was positively associated with natural-cause and cause-specific mortality in the pooled cohort and the administrative cohorts. Associations were found well below current limit values and guidelines for PM2.5 and NO2. Associations tended to be supralinear, with steeper slopes at low exposures with no indication of a threshold. Two-pollutant models documented the importance of characterizing the ambient mixture with both NO2 and PM2.5. We mostly found negative associations with O3. In two-pollutant models with NO2, the negative associations with O3 were attenuated to essentially unity in the mortality analysis of the administrative cohorts and the incidence analyses in the pooled cohort. In the mortality analysis of the pooled cohort, significant negative associations with O3 remained in two-pollutant models. Long-term exposure to PM2.5, NO2, and BC was also positively associated with morbidity outcomes in the pooled cohort. For stroke, asthma, and COPD, positive associations were found for PM2.5, NO2, and BC. For acute coronary heart disease, an increased HR was observed for NO2. For lung cancer, an increased HR was found only for PM2.5. Associations mostly showed steeper slopes at low exposures with no indication of a threshold.
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Affiliation(s)
- Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard Atkinson
- Population Health Research, Institute St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography-Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, and Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Jorgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Iain Carey
- Population Health Research, Institute St George's, University of London, London, UK
| | - Giulia Cesaroni
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
- Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Danny Houthuijs
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Nicole Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Klea Katsouyanni
- Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jochem Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Norun Hjertager Krog
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Shuo Liu
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, and Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Amar Mehta
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Goran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, and Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
| | | | - Matteo Renzi
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evi Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Per Schwarze
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Torben Sigsgaard
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Massimo Stafoggia
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
| | | | - Gudrun Weinmayr
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
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