TY - JOUR

T1 - Variability in the association between long-term exposure to ambient air pollution and mortality by exposure assessment method and covariate adjustment

T2 - A census-based country-wide cohort study

AU - Bauwelinck, Mariska

AU - Chen, Jie

AU - de Hoogh, Kees

AU - Katsouyanni, Klea

AU - Rodopoulou, Sophia

AU - Samoli, Evangelia

AU - Andersen, Zorana J.

AU - Atkinson, Richard

AU - Casas, Lidia

AU - Deboosere, Patrick

AU - Demoury, Claire

AU - Janssen, Nicole

AU - Klompmaker, Jochem O.

AU - Lefebvre, Wouter

AU - Mehta, Amar Jayant

AU - Nawrot, Tim S.

AU - Oftedal, Bente

AU - Renzi, Matteo

AU - Stafoggia, Massimo

AU - Strak, Maciek

AU - Vandenheede, Hadewijch

AU - Vanpoucke, Charlotte

AU - Van Nieuwenhuyse, An

AU - Vienneau, Danielle

AU - Brunekreef, Bert

AU - Hoek, Gerard

PY - 2022

Y1 - 2022

N2 - BackgroundAmbient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions.MethodsWe used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43).ResultsWe found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 μg/m3 increase for NO2 were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 μg/m3 increase for PM2.5 for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3].ConclusionLong-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.

AB - BackgroundAmbient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions.MethodsWe used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43).ResultsWe found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 μg/m3 increase for NO2 were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 μg/m3 increase for PM2.5 for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3].ConclusionLong-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.

KW - Population-based

KW - Environmental hazard

KW - Exposure assessment

KW - Survival analysis

KW - Health effects

KW - Cause-specific mortality

U2 - 10.1016/j.scitotenv.2021.150091

DO - 10.1016/j.scitotenv.2021.150091

M3 - Journal article

C2 - 34517316

VL - 804

JO - Science of the Total Environment

JF - Science of the Total Environment

SN - 0048-9697

M1 - 150091

ER -