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

Shuo Liu; Youn-Hee Lim; Jie Chen; Maciek Strak; Kathrin Wolf; Gudrun Weinmayr; Sophia Rodopolou; Kees de Hoogh; Tom Bellander; Jørgen Brandt; Hans Concin; Emanuel Zitt; Daniela Fecht; Francesco Forastiere; John Gulliver; Ole Hertel; Barbara Hoffmann; Ulla A Hvidtfeldt; W M Monique Verschuren; Karl-Heinz Jöckel; Jeanette T Jørgensen; Rina So; Heresh Amini; Thomas Cole-Hunter; Amar J Mehta; Laust H Mortensen; Matthias Ketzel; Anton Lager; Karin Leander; Petter Ljungman; Gianluca Severi; Marie-Christine Boutron-Ruault; Patrik K E Magnusson; Gabriele Nagel; Göran Pershagen; Annette Peters; Ole Raaschou-Nielsen; Debora Rizzuto; Yvonne T van der Schouw; Sara Schramm; Mette Sørensen; Massimo Stafoggia; Anne Tjønneland; Klea Katsouyanni; Wei Huang; Evangelia Samoli; Bert Brunekreef; Gerard Hoek; Zorana J Andersen

doi:10.1164/rccm.202106-1484OC

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

Shuo Liu, Youn-Hee Lim, Jie Chen, Maciek Strak, Kathrin Wolf, Gudrun Weinmayr, Sophia Rodopolou, Kees de Hoogh, Tom Bellander, Jørgen Brandt, Hans Concin, Emanuel Zitt, Daniela Fecht, Francesco Forastiere, John Gulliver, Ole Hertel, Barbara Hoffmann, Ulla A Hvidtfeldt, W M Monique Verschuren, Karl-Heinz JöckelJeanette T Jørgensen, Rina So, Heresh Amini, Thomas Cole-Hunter, Amar J Mehta, Laust H Mortensen, Matthias Ketzel, Anton Lager, Karin Leander, Petter Ljungman, Gianluca Severi, Marie-Christine Boutron-Ruault, Patrik K E Magnusson, Gabriele Nagel, Göran Pershagen, Annette Peters, Ole Raaschou-Nielsen, Debora Rizzuto, Yvonne T van der Schouw, Sara Schramm, Mette Sørensen, Massimo Stafoggia, Anne Tjønneland, Klea Katsouyanni, Wei Huang, Evangelia Samoli, Bert Brunekreef, Gerard Hoek, Zorana J Andersen

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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 ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO ₂), black carbon (BC), and ozone 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 ²⁵m ²¹ 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 with normal weight, unemployed, or nonsmoking 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.

Original language	English
Pages (from-to)	1429-1439
Number of pages	11
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	205
Issue number	12
Early online date	8 Mar 2022
DOIs	https://doi.org/10.1164/rccm.202106-1484OC
Publication status	Published - 15 Jun 2022

Keywords

adults
air pollution
long-term exposure
respiratory infections

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10.1164/rccm.202106-1484OC

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Liu, S., Lim, Y.-H., Chen, J., Strak, M., Wolf, K., Weinmayr, G., Rodopolou, S., de Hoogh, K., Bellander, T., Brandt, J., Concin, H., Zitt, E., Fecht, D., Forastiere, F., Gulliver, J., Hertel, O., Hoffmann, B., Hvidtfeldt, U. A., Verschuren, W. M. M., ... Andersen, Z. J. (2022). Long-term Air Pollution Exposure and Pneumonia Related Mortality in a Large Pooled European Cohort. American Journal of Respiratory and Critical Care Medicine, 205(12), 1429-1439. https://doi.org/10.1164/rccm.202106-1484OC

@article{3a79cc29ff9a404d8c95dbd143a906fc,

title = "Long-term Air Pollution Exposure and Pneumonia Related Mortality in a Large Pooled European Cohort",

abstract = "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 ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO 2), black carbon (BC), and ozone 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 25m 21 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 with normal weight, unemployed, or nonsmoking 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.",

keywords = "adults, air pollution, long-term exposure, respiratory infections",

author = "Shuo Liu and Youn-Hee Lim and Jie Chen and Maciek Strak and Kathrin Wolf and Gudrun Weinmayr and Sophia Rodopolou and {de Hoogh}, Kees and Tom Bellander and J{\o}rgen Brandt and Hans Concin and Emanuel Zitt and Daniela Fecht and Francesco Forastiere and John Gulliver and Ole Hertel and Barbara Hoffmann and Hvidtfeldt, {Ulla A} and Verschuren, {W M Monique} and Karl-Heinz J{\"o}ckel and J{\o}rgensen, {Jeanette T} and Rina So and Heresh Amini and Thomas Cole-Hunter and Mehta, {Amar J} and Mortensen, {Laust H} and Matthias Ketzel and Anton Lager and Karin Leander and Petter Ljungman and Gianluca Severi and Marie-Christine Boutron-Ruault and Magnusson, {Patrik K E} and Gabriele Nagel and G{\"o}ran Pershagen and Annette Peters and Ole Raaschou-Nielsen and Debora Rizzuto and {van der Schouw}, {Yvonne T} and Sara Schramm and Mette S{\o}rensen and Massimo Stafoggia and Anne Tj{\o}nneland and Klea Katsouyanni and Wei Huang and Evangelia Samoli and Bert Brunekreef and Gerard Hoek and Andersen, {Zorana J}",

note = "Funding Information: Acknowledgment: The research described in this article was conducted under contract to the Health Effects Institute (HEI), an organization jointly funded by the U.S. Environmental Protection Agency (EPA) (Assistance Award No. R-82811201) and certain motor vehicle and engine manufacturers. The authors would also like to thank all participants in the pooled cohort studies and the respective study teams of the ELAPSE project for their hard work and effort. The authors thank Marjan Tewis for the data management tasks in creating the pooled cohort database. Funding Information: Supported by the Health Effects Institute (HEI) (#4954-RFA14-3/16-5-3), the Novo Nordisk Foundation Challenge Programme (#NNF17OC0027812), and a scholarship from the China Scholarship Council (No. 201806010406). Stockholm Screening Across the Lifespan Twin and TwinGene are substudies of The Swedish Twin Registry (STR), which is managed by the Karolinska Institutet and receives additional funding through the Swedish Research Council (No. 2017-00641). The Cooperative Health Research in the Region of Augsburg study was initiated and financed by the Helmholtz Zentrum Mu€nchen–German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria. The China Scholarship Council, the Swedish Research Council, the German Federal Ministry of Education and Research, and the State of Bavaria were not involved in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this article do not necessarily reflect the views of HEI or its sponsors, nor do they necessarily reflect the views and policies of the U.S. Environmental Protection Agency or motor vehicle and engine manufacturers. HEI has reviewed and approved the study design. HEI was not involved in data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: Copyright {\textcopyright} 2022 by the American Thoracic Society",

year = "2022",

month = jun,

day = "15",

doi = "10.1164/rccm.202106-1484OC",

language = "English",

volume = "205",

pages = "1429--1439",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "12",

}

Liu, S, Lim, Y-H, Chen, J, Strak, M, Wolf, K, Weinmayr, G, Rodopolou, S, de Hoogh, K, Bellander, T, Brandt, J, Concin, H, Zitt, E, Fecht, D, Forastiere, F, Gulliver, J, Hertel, O, Hoffmann, B, Hvidtfeldt, UA, Verschuren, WMM, Jöckel, K-H, Jørgensen, JT, So, R, Amini, H, Cole-Hunter, T, Mehta, AJ, Mortensen, LH, Ketzel, M, Lager, A, Leander, K, Ljungman, P, Severi, G, Boutron-Ruault, M-C, Magnusson, PKE, Nagel, G, Pershagen, G, Peters, A, Raaschou-Nielsen, O, Rizzuto, D, van der Schouw, YT, Schramm, S, Sørensen, M, Stafoggia, M, Tjønneland, A, Katsouyanni, K, Huang, W, Samoli, E, Brunekreef, B, Hoek, G & Andersen, ZJ 2022, 'Long-term Air Pollution Exposure and Pneumonia Related Mortality in a Large Pooled European Cohort', American Journal of Respiratory and Critical Care Medicine, vol. 205, no. 12, pp. 1429-1439. https://doi.org/10.1164/rccm.202106-1484OC

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

N1 - Funding Information: Acknowledgment: The research described in this article was conducted under contract to the Health Effects Institute (HEI), an organization jointly funded by the U.S. Environmental Protection Agency (EPA) (Assistance Award No. R-82811201) and certain motor vehicle and engine manufacturers. The authors would also like to thank all participants in the pooled cohort studies and the respective study teams of the ELAPSE project for their hard work and effort. The authors thank Marjan Tewis for the data management tasks in creating the pooled cohort database. Funding Information: Supported by the Health Effects Institute (HEI) (#4954-RFA14-3/16-5-3), the Novo Nordisk Foundation Challenge Programme (#NNF17OC0027812), and a scholarship from the China Scholarship Council (No. 201806010406). Stockholm Screening Across the Lifespan Twin and TwinGene are substudies of The Swedish Twin Registry (STR), which is managed by the Karolinska Institutet and receives additional funding through the Swedish Research Council (No. 2017-00641). The Cooperative Health Research in the Region of Augsburg study was initiated and financed by the Helmholtz Zentrum Mu€nchen–German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria. The China Scholarship Council, the Swedish Research Council, the German Federal Ministry of Education and Research, and the State of Bavaria were not involved in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this article do not necessarily reflect the views of HEI or its sponsors, nor do they necessarily reflect the views and policies of the U.S. Environmental Protection Agency or motor vehicle and engine manufacturers. HEI has reviewed and approved the study design. HEI was not involved in data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: Copyright © 2022 by the American Thoracic Society

PY - 2022/6/15

Y1 - 2022/6/15

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 ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO 2), black carbon (BC), and ozone 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 25m 21 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 with normal weight, unemployed, or nonsmoking 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 ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO 2), black carbon (BC), and ozone 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 25m 21 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 with normal weight, unemployed, or nonsmoking 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.

KW - adults

KW - air pollution

KW - long-term exposure

KW - respiratory infections

UR - http://www.scopus.com/inward/record.url?scp=85132314944&partnerID=8YFLogxK

U2 - 10.1164/rccm.202106-1484OC

DO - 10.1164/rccm.202106-1484OC

M3 - Article

C2 - 35258439

SN - 1073-449X

VL - 205

SP - 1429

EP - 1439

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 12

ER -

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

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