Environment International (Jan 2021)
Long-term exposure to low-level air pollution and incidence of chronic obstructive pulmonary disease: The ELAPSE project
- Shuo Liu,
- Jeanette T. Jørgensen,
- Petter Ljungman,
- Göran Pershagen,
- Tom Bellander,
- Karin Leander,
- Patrik K.E. Magnusson,
- Debora Rizzuto,
- Ulla A. Hvidtfeldt,
- Ole Raaschou-Nielsen,
- Kathrin Wolf,
- Barbara Hoffmann,
- Bert Brunekreef,
- Maciej Strak,
- Jie Chen,
- Amar Mehta,
- Richard W. Atkinson,
- Mariska Bauwelinck,
- Raphaëlle Varraso,
- Marie-Christine Boutron-Ruault,
- Jørgen Brandt,
- Giulia Cesaroni,
- Francesco Forastiere,
- Daniela Fecht,
- John Gulliver,
- Ole Hertel,
- Kees de Hoogh,
- Nicole A.H. Janssen,
- Klea Katsouyanni,
- Matthias Ketzel,
- Jochem O. Klompmaker,
- Gabriele Nagel,
- Bente Oftedal,
- Annette Peters,
- Anne Tjønneland,
- Sophia P. Rodopoulou,
- Evangelia Samoli,
- Terese Bekkevold,
- Torben Sigsgaard,
- Massimo Stafoggia,
- Danielle Vienneau,
- Gudrun Weinmayr,
- Gerard Hoek,
- Zorana J. Andersen
Affiliations
- Shuo Liu
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Jeanette T. Jørgensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 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
- Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Patrik K.E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; The Stockholm Gerontology Research Center, Stockholm, Sweden
- Ulla A. Hvidtfeldt
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Barbara Hoffmann
- Institute of Occupational, Social and Environmental Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
- Maciej Strak
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Jie Chen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
- Amar Mehta
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Richard W. Atkinson
- Population Health Research Institute, St George's, University of London, London, United Kingdom
- Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
- Raphaëlle Varraso
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, Inserm UMR 1018, Villejuif, France
- Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, Inserm UMR 1018, Villejuif, France; Gustave Roussy, Villejuif, France
- Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Aarhus University Interdisciplinary Center for Climate Change, Roskilde, Denmark
- Giulia Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
- Francesco Forastiere
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
- Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
- John Gulliver
- UK Small Area Health Statistics Unit, Department of Epidemiology & Biostatistics, 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 Environmental Science, Aarhus University, Roskilde, Denmark
- Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Nicole A.H. Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Klea Katsouyanni
- 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; Global Centre for Clean Air Research, University of Surrey, Guildford, United Kingdom
- Jochem O. Klompmaker
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- 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
- Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
- Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark
- Sophia P. 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
- Terese Bekkevold
- Department of Infectious Diseases Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
- Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
- Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
- Zorana J. Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark; Corresponding author at: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Journal volume & issue
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Vol. 146
p. 106267
Abstract
Background: Air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD), but evidence is sparse and inconsistent. Objectives: We examined the association between long-term exposure to low-level air pollution and COPD incidence. Methods: Within the ‘Effects of Low-Level Air Pollution: A Study in Europe’ (ELAPSE) study, we pooled data from three cohorts, from Denmark and Sweden, with information on COPD hospital discharge diagnoses. Hybrid land use regression models were used to estimate annual mean concentrations of particulate matter with a diameter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) in 2010 at participants’ baseline residential addresses, which were analysed in relation to COPD incidence using Cox proportional hazards models. Results: Of 98,058 participants, 4,928 developed COPD during 16.6 years mean follow-up. The adjusted hazard ratios (HRs) and 95% confidence intervals for associations with COPD incidence were 1.17 (1.06, 1.29) per 5 µg/m3 for PM2.5, 1.11 (1.06, 1.16) per 10 µg/m3 for NO2, and 1.11 (1.06, 1.15) per 0.5 10−5m−1 for BC. Associations persisted in subset participants with PM2.5 or NO2 levels below current EU and US limit values and WHO guidelines, with no evidence for a threshold. HRs for NO2 and BC remained unchanged in two-pollutant models with PM2.5, whereas the HR for PM2.5 was attenuated to unity with NO2 or BC. Conclusions: Long-term exposure to low-level air pollution is associated with the development of COPD, even below current EU and US limit values and possibly WHO guidelines. Traffic-related pollutants NO2 and BC may be the most relevant.
