Mortality Associations with Long-Term Exposure to Outdoor Air Pollution in a National English Cohort

Abstract

Rationale: Cohort evidence linking long-term exposure to outdoor particulate air pollution and mortality has come largely from the United States. There is relatively little evidence from nationally representative cohorts in other countries. Objectives: To investigate the relationship between long-term exposure to a range of pollutants and causes of death in a national English cohort. Methods: A total of 835,607 patients aged 40-89 years registered with 205 general practices were followed from [2003][2004][2005][2006][2007]. Annual average concentrations in 2002 for particulate matter with a median aerodynamic diameter less than 10 (PM 10 ) and less than 2.5 mm (PM 2.5 ), nitrogen dioxide (NO 2 ), ozone, and sulfur dioxide (SO 2 ) at 1 km 2 resolution, estimated from emission-based models, were linked to residential postcode. Deaths (n ¼ 83,103) were ascertained from linkage to death certificates, and hazard ratios (HRs) for all-and cause-specific mortality for pollutants were estimated for interquartile pollutant changes from Cox models adjusting for age, sex, smoking, body mass index, and area-level socioeconomic status markers. Measurements and Main Results:Residential concentrations of all pollutants except ozone were positively associated with all-cause mortality (HR, 1.02, 1.03, and 1.04 for PM 2.5 , NO 2 , and SO 2 , respectively). Associations for PM 2.5 , NO 2 , and SO 2 were larger for respiratory deaths (HR, 1.09 each) and lung cancer (HR, 1.02, 1.06, and 1.05) but nearer unity for cardiovascular deaths (1.00, 1.00, and 1.04). Conclusions: These results strengthen the evidence linking long-term ambient air pollution exposure to increased all-cause mortality. However, the stronger associations with respiratory mortality are not consistent with most US studies in which associations with cardiovascular causes of death tend to predominate.

Long-Term Ozone Exposure and Mortality in a Large Prospective Study

“…Possible biological mechanisms include oxidative stress and inflammatory pathways as well as adverse neural, epithelial, smooth muscle, and immune system impacts (4). In contrast, no positive association was observed in a large (n = 800,000) U.K. patient cohort (8). There O 3 was negatively correlated with PM 2.5 (r = 20.39), and regional patterns in O 3 and mortality may explain the findings observed.…”

“…In two-pollutant models, the association with IHD was confounded by PM 2.5 . No positive mortality associations were observed in a U.K. patient cohort (8).…”

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

“…Although there was a trend towards more adults with ID being found in increasing quintiles of IMD, representing higher deprivation, this mirrors the pattern seen in complete population extracts of CPRD, 68 and reflects a small geographical bias within CPRD whereby there are comparatively fewer practices in the north of England. 45 Almost three in four adults with ID (73%) had been registered at their practice for at least 5 years.…”

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis

“…We identified 17 cohort studies Beeson et al 1998;Cao et al 2011;Carey et al 2013;Cesaroni et al 2013;Hales et al 2012;Hart et al 2011;Heinrich et al 2013;Jerrett et al 2013;Katanoda et al 2011;Krewski et al 2009;Lepeule et al 2012;Lipsett et al 2011;McDonnell et al 2000;Naess et al 2007;Pope et al 2002;Raaschou-Nielsen et al 2013) and one case-control study (Hystad et al 2013) of lung cancer that provided estimates of the quantitative relationships between the risk of lung cancer and exposure to PM 2.5 or PM 10 that could be expressed per 10-μg/m 3 change in PM. Estimates from one cohort study (Naess et al 2007) could not be converted to units of 10-μg/m 3 , and thus, this study did not contribute to the meta-estimates.…”