Environment International (Jan 2021)
Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts
- Ulla Arthur Hvidtfeldt,
- Gianluca Severi,
- Zorana Jovanovic Andersen,
- Richard Atkinson,
- Mariska Bauwelinck,
- Tom Bellander,
- Marie-Christine Boutron-Ruault,
- Jørgen Brandt,
- Bert Brunekreef,
- Giulia Cesaroni,
- Jie Chen,
- Hans Concin,
- Francesco Forastiere,
- Carla H. van Gils,
- John Gulliver,
- Ole Hertel,
- Gerard Hoek,
- Barbara Hoffmann,
- Kees de Hoogh,
- Nicole Janssen,
- Karl-Heinz Jöckel,
- Jeanette Therming Jørgensen,
- Klea Katsouyanni,
- Matthias Ketzel,
- Jochem O. Klompmaker,
- Norun Hjertager Krog,
- Alois Lang,
- Karin Leander,
- Shuo Liu,
- Petter L.S. Ljungman,
- Patrik K.E. Magnusson,
- Amar Jayant Mehta,
- Gabriele Nagel,
- Bente Oftedal,
- Göran Pershagen,
- Raphael Simon Peter,
- Annette Peters,
- Matteo Renzi,
- Debora Rizzuto,
- Sophia Rodopoulou,
- Evangelia Samoli,
- Per Everhard Schwarze,
- Torben Sigsgaard,
- Mette Kildevæld Simonsen,
- Massimo Stafoggia,
- Maciek Strak,
- Danielle Vienneau,
- Gudrun Weinmayr,
- Kathrin Wolf,
- Ole Raaschou-Nielsen,
- Daniela Fecht
Affiliations
- Ulla Arthur Hvidtfeldt
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Corresponding author at: Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
- Gianluca Severi
- CESP, UMR 1018, Université Paris-Saclay, Inserm, Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science and Applications “G. Parenti“ (DISIA), University of Florence, Italy
- Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
- Richard Atkinson
- Population Health Research Institute and MRC-PHE Centre for Environment and Health, St George's, University of London, London, UK
- Mariska Bauwelinck
- Interface Demography – Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Marie-Christine Boutron-Ruault
- CESP, UMR 1018, Université Paris-Saclay, Inserm, Gustave Roussy, Villejuif, France
- Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O.Box 358, 4000 Roskilde, Denmark; iClimate – Aarhus University Interdisciplinary Centre for Climate Change, Frederiksborgvej 399, P.O.Box 358, 4000 Roskilde, Denmark
- Bert Brunekreef
- Institute of Risk Assessment Sciences (IRAS), University of Utrecht, P.O. Box 80177, NL 3508 TD Utrecht, the Netherlands
- Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, 00147 Rome, Italy
- Jie Chen
- Institute of Risk Assessment Sciences (IRAS), University of Utrecht, P.O. Box 80177, NL 3508 TD Utrecht, the Netherlands
- Hans Concin
- Agency for Preventive and Social Medicine, Rheinstraße 61, 6900 Bregenz, Austria
- Francesco Forastiere
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, 90146 Palermo, Italy; Environmental Research Group, King’s College, London SE1 9NH, UK
- Carla H. van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
- John Gulliver
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, LE1 7RH, UK
- Ole Hertel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O.Box 358, 4000 Roskilde, Denmark
- Gerard Hoek
- Institute of Risk Assessment Sciences (IRAS), University of Utrecht, P.O. Box 80177, NL 3508 TD Utrecht, the Netherlands
- Barbara Hoffmann
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, Heinrich Heine University, Gurlittstraße 55, 40223 Dusseldorf, Germany
- Kees de Hoogh
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Petersplatz 1, Postfach, 4001 Basel, Switzerland
- Nicole Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
- Jeanette Therming Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
- Klea Katsouyanni
- Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodstrian University of Athens, Medical School 75, Mikras Asias Street 115 27 Athens, Greece; NIHR HPRU Health Impact of Environmental Hazards, Environmental Research Group, School of Public Health, Imperial College, London, UK
- Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O.Box 358, 4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
- Jochem O. Klompmaker
- Institute of Risk Assessment Sciences (IRAS), University of Utrecht, P.O. Box 80177, NL 3508 TD Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Norun Hjertager Krog
- Section of Air Pollution and Noise, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, N-0213 Oslo, Norway
- Alois Lang
- Cancer Registry Vorarlberg, Agency for Preventive and Social Medicine, Rheinstraße 61, Bregenz 6900, Austria
- Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
- Petter L.S. Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
- Patrik K.E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Amar Jayant Mehta
- Statistics Denmark, Sejrøgade 11, 2100 Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany; Agency for Preventive and Social Medicine, Rheinstraße 61, 6900 Bregenz, Austria
- Bente Oftedal
- Section of Air Pollution and Noise, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, N-0213 Oslo, Norway
- Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
- Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
- Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, 00147 Rome, Italy
- Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm 17165, Sweden; Stockholm Gerontology Research Center, Stockholm 11346, Sweden
- Sophia Rodopoulou
- Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodstrian University of Athens, Medical School 75, Mikras Asias Street 115 27 Athens, Greece
- Evangelia Samoli
- Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodstrian University of Athens, Medical School 75, Mikras Asias Street 115 27 Athens, Greece
- Per Everhard Schwarze
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
- Mette Kildevæld Simonsen
- Diakonissestiftelsen and Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, 00147 Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- Maciek Strak
- Institute of Risk Assessment Sciences (IRAS), University of Utrecht, P.O. Box 80177, NL 3508 TD Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Danielle Vienneau
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Petersplatz 1, Postfach, 4001 Basel, Switzerland
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
- Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O.Box 358, 4000 Roskilde, Denmark
- Daniela Fecht
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, School of Public Health, Imperial College London, W2 1PG London, UK
- Journal volume & issue
-
Vol. 146
p. 106249
Abstract
Background/aim: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence. Methods: The “Effects of Low-level Air Pollution: a Study in Europe” (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO2), fine particulate matter (PM2.5), black carbon (BC), and ozone (O3) to assign exposure to cohort participants’ residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines. Results: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO2, PM2.5, BC and O3 (warm season) were 24.2 µg/m3 (19.5, 29.7), 15.4 µg/m3 (12.8, 17.3), 1.6 10−5m−1 (1.3, 1.8), and 86.6 µg/m3 (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m3). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m3. We did not observe associations between NO2, BC or O3 and lung cancer incidence. Conclusions: Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.
