Long-term exposure to NO2 and PM10 and all-cause and cause-specific mortality in a prospective cohort of women

• Published in: Occupational and environmental medicine (London, England) Vol. 70; no. 3; pp. 179 - 186
• Main Authors: Heinrich, Joachim, Thiering, Elisabeth, Rzehak, Peter, Krämer, Ursula, Hochadel, Matthias, Rauchfuss, Knut M, Gehring, Ulrike, Wichmann, H-Erich
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.03.2013; BMJ Publishing Group; BMJ Publishing Group LTD
• Series: Original article
• Subjects: Air Pollutants - adverse effects; Air pollution; Biological and medical sciences; Cardiovascular Diseases - mortality; Cause of Death; Chemical and industrial products toxicology. Toxic occupational diseases; Codes; Cohort analysis; Cross-sectional studies; Environment; Environmental Monitoring; European studies; Exposure; Fatalities; Female; Follow-Up Studies; Gas, fumes; Geographic Information Systems; Germany; Humans; Inhalation Exposure - adverse effects; Lung cancer; Lung Diseases - mortality; Lung Neoplasms - mortality; Medical sciences; Middle Aged; Mortality; Nitric Oxide - adverse effects; Nitrogen dioxide; Particulate matter; Particulate Matter - adverse effects; Proportional Hazards Models; Prospective Studies; Registration; Remote sensing; Residence Characteristics; Toxicology; Transportation; Vehicle Emissions; Womens health; Europe; Germany; Human; Toxic gas; Toxicity; Mortality; Exposure; Epidemiology; Long term; Coarse particle; Prospective; Etiology; Cohort study; Aerosols; Female; Nitrogen dioxide; Woman; Public health
• ISSN: 1351-0711; 1470-7926; 1470-7926
• DOI: 10.1136/oemed-2012-100876

We assessed whether long-term exposure to air pollution is associated with all-cause and cause-specific mortality during a period of declining particulate matter concentrations. Approximately 4800 women aged 55 years from North Rhine-Westphalia, Germany, were followed for up to 18 years. Exposure to air pollution was assessed in two ways: (1) using the distance between the residential address and the nearest major road, as calculated from Geographic Information System data and (2) calculating 1-year average particulate matter concentrations below 10 µm (PM10) and nitrogen dioxide (NO2) levels using data from the nearest air-monitoring station data to the subjects’ residences. Ninety-two per cent of all subjects lived in the same community during the entire follow-up period. Associations between mortality and exposure were assessed using Cox's proportional hazards models, including confounder adjustment. Sixteen per cent of women passed away during the follow-up period. An increase of 7 μg/m3 PM10 (IQR) was associated with an increased HR for all-cause (HR 1.15, 95% CI (1.04 to 1.27)), cardiopulmonary (HR 1.39, 95% CI (1.17 to 1.64)), and lung cancer mortality (HR 1.84, 95% CI (1.23 to 2.74)). An increase of 16 μg/m3 (IQR) NO2 exposure was associated with all-cause (HR 1.18, 95% CI (1.07 to 1.30)) and cardiopulmonary mortality (HR 1.55, 95% CI (1.30 to 1.84)). The association between cardiopulmonary mortality and PM10 was reduced for the extended follow-up period, during which PM10 concentrations (but not NO2 concentrations) were lower. Living close to a major road was associated with an increased relative risk for all-cause, cardiopulmonary and respiratory mortality. These associations were temporally stable. Long-term exposure to ambient PM10 and NO2 was associated with increased mortality rates.