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

Carey, IM; Atkinson, RW; Kent, AJ; van Staa, T; Cook, DG; Anderson, HR; (2013) Mortality Associations with Long-Term Exposure to Outdoor Air Pollution in a National English Cohort. American journal of respiratory and critical care medicine. ISSN 1073-449X DOI:

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Rationale: Cohort evidence linking long-term exposure to outdoor particulate air pollution and mortality has come largely from the US. 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: 835,607 patients aged 40-89 years, registered with 205 general practices were followed from 2003-7. Annual average concentrations in 2002 for particulate matter with a median aerodynamic diameter <10 (PM10) and <2.5 microns (PM2.5), nitrogen dioxide (NO2), ozone and sulphur dioxide (SO2) at 1km2 resolution, estimated from emission based models, were linked to residential postcode. Deaths (n=83,103) were ascertained from linkage to death certificates, and hazards ratios (HR) for all- and cause-specific mortality for pollutants were estimated for inter-quartile (IQR) 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, 1.04, 1.03 for PM2.5, NO2 and SO2 respectively). Associations for PM2.5, NO2 and SO2 were larger for respiratory deaths (HR=1.09 each) and lung cancer (HR=1.02, 1.06 and 1.04) 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 the majority of US studies in which associations with cardiovascular causes of death tend to predominate.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
PubMed ID: 23590261
Web of Science ID: 319860400014


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