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

RationaleAmbient air pollution exposure has been linked to mortality from chronic cardiorespiratory diseases, while evidence on respiratory infections remains more limited.ObjectivesWe examined the association between long-term exposure to air pollution and pneumonia related mortality in adults in a pool of eight European cohorts.MethodsWithin 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 (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3) 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 resultsOf 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 to normal weight, unemployed, or non-smoking participants.ConclusionsLong-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

Long-term exposure to air pollution and liver cancer incidence in six European cohorts

Particulate matter air pollution and diesel engine exhaust have been classified as carcinogenic for lung cancer, yet few studies have explored associations with liver cancer. We used six European adult cohorts which were recruited between 1985 and 2005, pooled within the “Effects of low-level air pollution: A study in Europe” (ELAPSE) project, and followed for the incidence of liver cancer until 2011 to 2015. The annual average exposure to nitrogen dioxide (NO2), particulate matter with diameter <2.5 μm (PM2.5), black carbon (BC), warm-season ozone (O3), and eight elemental components of PM2.5 (copper, iron, zinc, sulfur, nickel, vanadium, silicon, and potassium) were estimated by European-wide hybrid land-use regression models at participants' residential addresses. We analyzed the association between air pollution and liver cancer incidence by Cox proportional hazards models adjusting for potential confounders. Of 330 064 cancer-free adults at baseline, 512 developed liver cancer during a mean follow-up of 18.1 years. We observed positive linear associations between NO2 (hazard ratio, 95% confidence interval: 1.17, 1.02-1.35 per 10 μg/m3), PM2.5 (1.12, 0.92-1.36 per 5 μg/m3), and BC (1.15, 1.00-1.33 per 0.5 10−5/m) and liver cancer incidence. Associations with NO2 and BC persisted in two-pollutant models with PM2.5. Most components of PM2.5 were associated with the risk of liver cancer, with the strongest associations for sulfur and vanadium, which were robust to adjustment for PM2.5 or NO2. Our study suggests that ambient air pollution may increase the risk of liver cancer, even at concentrations below current EU standards