Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project

被引：3

作者：

Wolf, Kathrin ^{[1
]}

Hoffmann, Barbara ^{[2
]}

Andersen, Zorana J. ^{[3
]}

Atkinson, Richard W. ^{[5
]}

Bauwelinck, Mariska ^{[6
]}

Bellander, Tom ^{[7
,10
]}

Brandt, Jorgen ^{[11
,13
]}

Brunekreef, Bert ^{[14
]}

Cesaroni, Giulia ^{[15
]}

Chen, Jie ^{[14
]}

de Faire, Ulf ^{[7
]}

de Hoogh, Kees ^{[16
,17
]}

Fecht, Daniela ^{[18
]}

Forastiere, Francesco ^{[15
,18
]}

Gulliver, John ^{[18
,19
,20
]}

Hertel, Ole ^{[12
]}

Hvidtfeldt, Ulla Arthur ^{[21
]}

Janssen, Nicole A. H. ^{[22
]}

Jorgensen, Jeanette T. ^{[3
]}

Katsouyanni, Klea ^{[18
,23
]}

Ketzel, Matthias ^{[11
,24
]}

Klompmaker, Jochem O. ^{[22
,25
]}

Lager, Anton ^{[8
]}

Liu, Shuo ^{[3
]}

MacDonald, Conor J. ^{[26
]}

Magnusson, Patrik K. E. ^{[9
]}

Mehta, Amar J. ^{[4
]}

Nagel, Gabriele ^{[27
]}

Oftedal, Bente ^{[28
]}

Pedersen, Nancy L. ^{[9
]}

Pershagen, Goran ^{[7
,10
]}

Raaschou-Nielsen, Ole ^{[21
]}

Renzi, Matteo ^{[15
]}

Rizzuto, Debora ^{[30
,31
,32
]}

Rodopoulou, Sophia ^{[23
]}

Samoli, Evangelia ^{[23
]}

van der Schouw, Yvonne T. ^{[33
]}

Schramm, Sara ^{[34
]}

Schwarze, Per ^{[29
]}

Sigsgaard, Torben ^{[35
]}

Sorensen, Mette ^{[21
,36
]}

Stafoggia, Massimo ^{[7
,15
]}

Strak, Maciek ^{[14
,22
]}

Tjonneland, Anne ^{[21
]}

Verschuren, W. M. Monique ^{[22
,33
]}

Vienneau, Danielle ^{[16
,17
]}

Weinmayr, Gudrun ^{[27
]}

Hoek, Gerard ^{[14
]}

Peters, Annette ^{[1
,37
]}

Ljungman, Petter L. S. ^{[7
,38
]}

机构：

[1] Helmholtz Zentrum Munchen, Inst Epidemiol, D-85764 Neuherberg, Germany

[2] Heinrich Heine Univ Dusseldorf, Med Fac, Ctr Hlth & Soc, Inst Occupat Social & Environm Med, Dusseldorf, Germany

[3] Univ Copenhagen, Dept Publ Hlth, Sect Environm Hlth, Copenhagen, Denmark

[4] Univ Copenhagen, Dept Publ Hlth, Sect Epidemiol, Copenhagen, Denmark

[5] St Georges Univ London, Populat Hlth Res Inst, London, England

[6] Vrije Univ Brussel, Dept Sociol, Interface Demog, Brussels, Belgium

[7] Karolinska Inst, Inst Environm Med, Stockholm, Sweden

[8] Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden

[9] Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden

[10] Ctr Occupat & Environm Med, Reg Stockholm, Stockholm, Sweden

[11] Aarhus Univ, Dept Environm Sci, Roskilde, Denmark

[12] Aarhus Univ, Dept Biosci, Roskilde, Denmark

[13] Aarhus Univ, Interdisciplinary Ctr Climate Change, iClimate, Aarhus, Denmark

[14] Univ Utrecht, Inst Risk Assessment Sci, Utrecht, Netherlands

[15] ASL Roma 1, Lazio Reg Hlth Serv, Dept Epidemiol, Rome, Italy

[16] Swiss Trop & Publ Hlth Inst, Basel, Switzerland

[17] Univ Basel, Basel, Switzerland

[18] Imperial Coll London, Fac Med, Sch Publ Hlth, London, England

[19] Univ Leicester, Ctr Environm Hlth & Sustainabil, Leicester, Leics, England

[20] Univ Leicester, Sch Geog Geol & Environm, Leicester, Leics, England

[21] Danish Canc Soc Res Ctr, Copenhagen, Denmark

[22] Natl Inst Publ Hlth & Environm, Bilthoven, Netherlands

[23] Natl & Kapodistrian Univ Athens, Med Sch, Dept Hyg Epidemiol & Med Stat, Athens, Greece

[24] Univ Surrey, Global Ctr Ckan Air Res, Surrey, England

[25] Harvard TH Chan Sch Publ Hlth, Boston, MA USA

[26] Univ Paris Sud, Univ Paris Saclay, Inst Gustave Roussy, INSERM,U1018,CESP, Villejuif, France

[27] Ulm Univ, Inst Epidemiol & Med Biometry, Ulm, Germany

[28] Norwegian Inst Publ Hlth, Dept Environm Hlth, Oslo, Norway

[29] Norwegian Inst Publ Hlth, Global Hlth Cluster, Oslo, Norway

[30] Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden

[31] Stockholm Univ, Stockholm, Sweden

[32] Stockholm Gerontol Res Ctr, Stockholm, Sweden

[33] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[34] Univ Duisburg Essen, Univ Hosp Essen, Inst Med Informat Biometry & Epidemiol, Essen, Germany

[35] Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth Environm Occupat & Hlth, Aarhus, Denmark

[36] Roskilde Univ, Dept Nat Sci & Environm, Roskilde, Denmark

[37] Ludwig Maximilians Univ Munchen, Munich, Germany

[38] Danderyd Hosp, Dept Cardiol, Stockholm, Sweden

来源：

LANCET PLANETARY HEALTH | 2021年 / 5卷 / 09期

基金：

瑞典研究理事会;

关键词：

FINE PARTICULATE MATTER; ALL-CAUSE MORTALITY; CARDIOVASCULAR-DISEASE; ASSOCIATIONS; MODELS; HEALTH; NOISE;

D O I：

暂无

中图分类号：

X [环境科学、安全科学];

学科分类号：

08 ; 0830 ;

摘要：

Background Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O-3) with the incidence of stroke and acute coronary heart disease. Methods We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. Findings From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17.2 years (IQR 13.8-19.5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2.5 (hazard ratio 1.10 [95% CI 1.01-1.21] per 5 mu g/m(3) increase), NO2 (1.08 [1.04-1.12] per 10 mu g/m(3) increase), and black carbon (1.06 [1.02-1.10] per 0.5 10(-5)/m increase), whereas coronary heart disease incidence was only associated with NO2 (1.04 [1.01-1.07]). Warm-season O-3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2.5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 mu g/m(3) for PM2.5 and 40 mu g/m(3) for NO2. Interpretation Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

引用

页码：E620 / E632

页数：13

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