TY - JOUR

T1 - Long-term Air Pollution Exposure and Pneumonia Related Mortality in a Large Pooled European Cohort

AU - Liu, Shuo

AU - Lim, Youn-Hee

AU - Chen, Jie

AU - Strak, Maciek

AU - Wolf, Kathrin

AU - Weinmayr, Gudrun

AU - Rodopolou, Sophia

AU - de Hoogh, Kees

AU - Bellander, Tom

AU - Brandt, Jørgen

AU - Concin, Hans

AU - Zitt, Emanuel

AU - Fecht, Daniela

AU - Forastiere, Francesco

AU - Gulliver, John

AU - Hertel, Ole

AU - Hoffmann, Barbara

AU - Hvidtfeldt, Ulla A

AU - Verschuren, W M Monique

AU - Jöckel, Karl-Heinz

AU - Jørgensen, Jeanette T

AU - So, Rina

AU - Amini, Heresh

AU - Cole-Hunter, Thomas

AU - Mehta, Amar J

AU - Mortensen, Laust H

AU - Ketzel, Matthias

AU - Lager, Anton

AU - Leander, Karin

AU - Ljungman, Petter

AU - Severi, Gianluca

AU - Boutron-Ruault, Marie-Christine

AU - Magnusson, Patrik K E

AU - Nagel, Gabriele

AU - Pershagen, Göran

AU - Peters, Annette

AU - Raaschou-Nielsen, Ole

AU - Rizzuto, Debora

AU - van der Schouw, Yvonne T

AU - Schramm, Sara

AU - Sørensen, Mette

AU - Stafoggia, Massimo

AU - Tjønneland, Anne

AU - Katsouyanni, Klea

AU - Huang, Wei

AU - Samoli, Evangelia

AU - Brunekreef, Bert

AU - Hoek, Gerard

AU - Andersen, Zorana J

PY - 2022

Y1 - 2022

N2 - 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 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter (PM 2.5), nitrogen dioxide (NO 2), black carbon (BC), and ozone (O 3) 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. NO 2 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/m 3 for NO 2; 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 NO 2 or BC in overweight, employed, or currently smoking participants compared to normal weight, unemployed, or non-smoking participants. CONCLUSIONS: Long-term exposure to combustion-related air pollutants NO 2 and BC may be associated with mortality from lower respiratory infections, but larger studies are needed to estimate these associations more precisely.

AB - 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 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter (PM 2.5), nitrogen dioxide (NO 2), black carbon (BC), and ozone (O 3) 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. NO 2 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/m 3 for NO 2; 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 NO 2 or BC in overweight, employed, or currently smoking participants compared to normal weight, unemployed, or non-smoking participants. CONCLUSIONS: Long-term exposure to combustion-related air pollutants NO 2 and BC may be associated with mortality from lower respiratory infections, but larger studies are needed to estimate these associations more precisely.

U2 - 10.1164/rccm.202106-1484OC

DO - 10.1164/rccm.202106-1484OC

M3 - Journal article

C2 - 35258439

VL - 205

SP - 1429

EP - 1439

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 12

ER -