Back-extrapolated and year-specific NO2 land use regression models for Great Britain - Do they yield different exposure assessment?

Air pollution prediction and backcasting through a combination of mobile monitoring and historical on-road traffic emission inventories

An important challenge for studies of air pollution and health effects is the derivation of historical exposures. These generally entail some form of backcasting, which refers to a range of approaches that aim to project a current surface into the past. Accurate backcasting is conditional upon the availability of historical data for predictor variables and the ability to capture spatial and temporal trends in these variables. This study proposes a method to backcast traffic-related air pollution surfaces developed using land-use regression models by including temporal variability of traffic and emissions and trends in concentrations measured at reference stations. Nitrogen dioxide (NO2) concentrations collected in the City of Toronto using the Urban Scanner mobile platform were adjusted for historical trends captured at reference stations. The Bayesian Estimator of Abrupt change, Seasonal change, and Trend (BEAST), a powerful tool for time series decomposition, was employed to isolate seasonal variations, annual trends, and abrupt changes in NO2 at reference stations, hence decomposing the signal. Exposure surfaces were generated for a period extending from 2006 to 2020, exhibiting decreases ranging from 10 to 50 % depending on the neighborhood, with an average of 20.46 % across the city. Yearly surfaces were intersected with mobility patterns of Torontonians extracted from travel survey data for 2006 and 2016, illustrating strong spatial gradients in the evolution of NO2 over time, with larger decreases along major roads and highways and in the central core. These findings demonstrate that air pollution improvements throughout the 14 years are inhomogeneous across space.

Development of Spatio-Temporal Land Use Regression Models for Fine Particulate Matter and Wood-Burning Tracers in Temuco, Chile

Biomass burning is common in much of the world, and in some areas, residential wood-burning has increased. However, air pollution resulting from biomass burning is an important public health problem. A sampling campaign was carried out between May 2017 and July 2018 in over 64 sites in four sessions, to develop a spatio-temporal land use regression (LUR) model for fine particulate matter (PM) and wood-burning tracers levoglucosan and soluble potassium (Ksol) in a city heavily impacted by wood-burning. The mean (sd) was 46.5 (37.4) μg m-3 for PM2.5, 0.607 (0.538) μg m-3 for levoglucosan, and 0.635 (0.489) μg m-3 for Ksol. LUR models for PM2.5, levoglucosan, and Ksol had a satisfactory performance (LOSOCV R2), explaining 88.8%, 87.4%, and 87.3% of the total variance, respectively. All models included sociodemographic predictors consistent with the pattern of use of wood-burning in homes. The models were applied to predict concentrations surfaces and to estimate exposures for an epidemiological study.

Europe-wide air pollution modeling from 2000 to 2019 using geographically weighted regression

Previous European land-use regression (LUR) models assumed fixed linear relationships between air pollution concentrations and predictors such as traffic and land use. We evaluated whether including spatially-varying relationships could improve European LUR models by using geographically weighted regression (GWR) and random forest (RF). We built separate LUR models for each year from 2000 to 2019 for NO2, O3, PM2.5 and PM10 using annual average monitoring observations across Europe. Potential predictors included satellite retrievals, chemical transport model estimates and land-use variables. Supervised linear regression (SLR) was used to select predictors, and then GWR estimated the potentially spatially-varying coefficients. We developed multi-year models using geographically and temporally weighted regression (GTWR). Five-fold cross-validation per year showed that GWR and GTWR explained similar spatial variations in annual average concentrations (average R2 = NO2: 0.66; O3: 0.58; PM10: 0.62; PM2.5: 0.77), which are better than SLR (average R2 = NO2: 0.61; O3: 0.46; PM10: 0.51; PM2.5: 0.75) and RF (average R2 = NO2: 0.64; O3: 0.53; PM10: 0.56; PM2.5: 0.67). The GTWR predictions and a previously-used method of back-extrapolating 2010 model predictions using CTM were overall highly correlated (R2 > 0.8) for all pollutants. Including spatially-varying relationships using GWR modestly improved European air pollution annual LUR models, allowing time-varying exposure-health risk models.

Associations of air pollution with COVID-19 positivity, hospitalisations, and mortality: Observational evidence from UK Biobank

Individual-level studies with adjustment for important COVID-19 risk factors suggest positive associations of long-term air pollution exposure (particulate matter and nitrogen dioxide) with COVID-19 infection, hospitalisations and mortality. The evidence, however, remains limited and mechanisms unclear. We aimed to investigate these associations within UK Biobank, and to examine the role of underlying chronic disease as a potential mechanism. UK Biobank COVID-19 positive laboratory test results were ascertained via Public Health England and general practitioner record linkage, COVID-19 hospitalisations via Hospital Episode Statistics, and COVID-19 mortality via Office for National Statistics mortality records from March-December 2020. We used annual average outdoor air pollution modelled at 2010 residential addresses of UK Biobank participants who resided in England (n = 424,721). We obtained important COVID-19 risk factors from baseline UK Biobank questionnaire responses (2006-2010) and general practitioner record linkage. We used logistic regression models to assess associations of air pollution with COVID-19 outcomes, adjusted for relevant confounders, and conducted sensitivity analyses. We found positive associations of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) with COVID-19 positive test result after adjustment for confounders and COVID-19 risk factors, with odds ratios of 1.05 (95% confidence intervals (CI) = 1.02, 1.08), and 1.05 (95% CI = 1.01, 1.08), respectively. PM 2.5 and NO 2 were positively associated with COVID-19 hospitalisations and deaths in minimally adjusted models, but not in fully adjusted models. No associations for PM₁₀ were found. In analyses with additional adjustment for pre-existing chronic disease, effect estimates were not substantially attenuated, indicating that underlying chronic disease may not fully explain associations. We found some evidence that long-term exposure to PM_2.5 and NO₂ was associated with a COVID-19 positive test result in UK Biobank, though not with COVID-19 hospitalisations or deaths.

Exposure to Elevated Nitrogen Dioxide Concentrations and Cardiac Remodeling in Patients With Dilated Cardiomyopathy

BACKGROUND

Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalizations, and mortality, but the biological basis of this remains unclear. We sought to determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy.

METHODS AND RESULTS

We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015, n = 716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO2) and particulate matter with diameter of 2.5 µm or less (PM2.5) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO2 was associated with higher indexed left ventricular (LV) mass (4.3 g/m2 increase per interquartile range increase in NO2, 95% confidence interval 1.9-7.0 g/m2) and lower LV ejection fraction (-1.5% decrease per interquartile range increase in NO2, 95% confidence interval -2.7% to -0.2%), independent of age, sex, socioeconomic status, and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on LV mass was greatest in women. These effects were specific to NO2 exposure.

CONCLUSIONS

Exposure to air pollution is associated with raised LV mass and lower LV ejection fraction, with the strongest effect in women. Although epidemiological associations between air pollution and heart failure have been established and supported by preclinical studies, our findings provide novel empirical evidence of cardiac remodeling and exposure to air pollution with important clinical and public health implications.

Fine-Scale Air Pollution Models for Epidemiologic Research: Insights From Approaches Developed in the Multi-ethnic Study of Atherosclerosis and Air Pollution (MESA Air)

PURPOSE OF REVIEW

Epidemiological studies of short- and long-term health impacts of ambient air pollutants require accurate exposure estimates. We describe the evolution in exposure assessment and assignment in air pollution epidemiology, with a focus on spatiotemporal techniques first developed to meet the needs of the Multi-ethnic Study of Atherosclerosis and Air Pollution (MESA Air). Initially designed to capture the substantial variation in pollutant levels and potential health impacts that can occur over small spatial and temporal scales in metropolitan areas, these methods have now matured to permit fine-scale exposure characterization across the contiguous USA and can be used for understanding long- and short-term health effects of exposure across the lifespan. For context, we highlight how the MESA Air models compare to other available exposure models.

RECENT FINDINGS

Newer model-based exposure assessment techniques provide predictions of pollutant concentrations with fine spatial and temporal resolution. These validated models can predict concentrations of several pollutants, including particulate matter less than 2.5 μm in diameter (PM2.5), oxides of nitrogen, and ozone, at specific locations (such as at residential addresses) over short time intervals (such as 2 weeks) across the contiguous USA between 1980 and the present. Advances in statistical methods, incorporation of supplemental pollutant monitoring campaigns, improved geographic information systems, and integration of more complete satellite and chemical transport model outputs have contributed to the increasing validity and refined spatiotemporal spans of available models. Modern models for predicting levels of outdoor concentrations of air pollutants can explain a substantial amount of the spatiotemporal variation in observations and are being used to provide critical insights into effects of air pollutants on the prevalence, incidence, progression, and prognosis of diseases across the lifespan. Additional enhancements in model inputs and model design, such as incorporation of better traffic data, novel monitoring platforms, and deployment of machine learning techniques, will allow even further improvements in the performance of pollutant prediction models.

Characterizing long-term NO2 concentration surfaces across a large metropolitan area through spatiotemporal land use regression modelling of mobile measurements

A spatiotemporal land use regression (LUR) model optimized to predict nitrogen dioxide (NO₂) concentrations obtained from on-road, mobile measurements collected in 2015-16 was independently evaluated using concentrations observed at multiple sites across Toronto, Canada, obtained more than ten years earlier. This spatiotemporal LUR modelling approach improves upon estimates of historical NO₂ concentrations derived from the previously used method of back-extrapolation. The optimal spatiotemporal LUR model (R² = 0.71 for prediction of NO₂ data in 2002 and 2004) uses daily average NO₂ concentrations observed at multiple long-term monitoring sites and hourly average wind speed recorded at a single site, along with spatial predictors based on geographical information system data, to estimate NO₂ levels for time periods outside of those used for model development. While the model tended to underestimate samplers located close to the roadway, it showed great accuracy when estimating samplers located beyond 100 m which are probably more relevant for exposure at residences. This study shows that spatiotemporal LUR models developed from strategic, multi-day (30 days in 3 different months) mobile measurements can enhance LUR model's ability to estimate long-term, intra-urban NO₂ patterns. Furthermore, the mobile sampling strategy enabled this new LUR model to cover a larger domain of Toronto and outlying suburban communities, thereby increasing the potential population for future epidemiological studies.

Long-term Exposure to Low Air Pollutant Concentrations and the Relationship with All-Cause Mortality and Stroke in Older Men

BACKGROUND

Long-term air pollution exposure has been associated with increased risk of mortality and stroke. Less is known about the risk at lower concentrations. The association of long-term exposure to PM2.5, PM2.5 absorbance, NO2, and NOx with all-cause mortality and stroke was investigated in a cohort of men aged ≥ 65 years who lived in metropolitan Perth, Western Australia.

METHODS

Land use regression models were used to estimate long-term exposure to air pollutants at participant's home address (n = 11,627) over 16 years. Different metrics of exposure were assigned: baseline; year before the outcome event; and average exposure across follow-up period. The Mortality Register and Hospital Morbidity Data from the Western Australia Data Linkage System were used to ascertain mortality and stroke cases. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models, adjusting for age, smoking, education, and body mass index for all-cause mortality. For fatal and hospitalized stroke, the models included variables controlled for all-cause mortality plus hypertension.

RESULTS

Fifty-four percent of all-participants died, 3% suffered a fatal stroke, and 14% were hospitalized stroke cases. PM2.5 absorbance increased the risk of all-cause mortality with adjusted HR of 1.12 (1.02-1.23) for baseline and average exposures, and 1.14 (1.02-1.24) for past-year exposure. There were no associations between PM2.5 absorbance, NO2, and NOx and stroke outcomes. However, PM2.5 was associated with reduced risks of fatal stroke.

CONCLUSION

Long-term exposure to PM2.5 absorbance was associated with all-cause mortality among older men exposed to low concentrations; and exposure to PM2.5 was associated with reduced risk of fatal stroke.

Assessing NO2 Concentration and Model Uncertainty with High Spatiotemporal Resolution across the Contiguous United States Using Ensemble Model Averaging

NO₂ is a combustion byproduct that has been associated with multiple adverse health outcomes. To assess NO₂ levels with high accuracy, we propose the use of an ensemble model to integrate multiple machine learning algorithms, including neural network, random forest, and gradient boosting, with a variety of predictor variables, including chemical transport models. This NO₂ model covers the entire contiguous U.S. with daily predictions on 1-km-level grid cells from 2000 to 2016. The ensemble produced a cross-validated R² of 0.788 overall, a spatial R² of 0.844, and a temporal R² of 0.729. The relationship between daily monitored and predicted NO₂ is almost linear. We also estimated the associated monthly uncertainty level for the predictions and address-specific NO₂ levels. This NO₂ estimation has a very high spatiotemporal resolution and allows the examination of the health effects of NO₂ in unmonitored areas. We found the highest NO₂ levels along highways and in cities. We also observed that nationwide NO₂ levels declined in early years and stagnated after 2007, in contrast to the trend at monitoring sites in urban areas, where the decline continued. Our research indicates that the integration of different predictor variables and fitting algorithms can achieve an improved air pollution modeling framework.

Ultrafine Particle Number Concentration Model for Estimating Retrospective and Prospective Long-Term Ambient Exposures in Urban Neighborhoods

Short-term exposure to ultrafine particles (UFP; <100 nm in diameter), which are present at high concentrations near busy roadways, is associated with markers of cardiovascular and respiratory disease risk. To date, few long-term studies (months to years) have been conducted due to the challenges of long-term exposure assignment. To address this, we modified hybrid land-use regression models of particle number concentrations (PNCs; a proxy for UFP) for two study areas in Boston (MA) by replacing the measured PNC term with an hourly model and adjusting for overprediction. The hourly PNC models used covariates for meteorology, traffic, and sulfur dioxide concentrations (a marker of secondary particle formation). We compared model performance against long-term PNC data collected continuously from 9 years before and up to 3 years after the model-development period. Model predictions captured the major temporal variations in the data and model performance remained relatively stable retrospectively and prospectively. The Pearson correlation of modeled versus measured hourly log-transformed PNC at a long-term monitoring site for 9 years prior was 0.74. Our results demonstrate that highly resolved spatial-temporal PNC models are capable of estimating ambient concentrations retrospectively and prospectively with generally good accuracy, giving us confidence in using these models in epidemiological studies.

Satellite-Based Land-Use Regression for Continental-Scale Long-Term Ambient PM2.5 Exposure Assessment in Australia

Australia has relatively diverse sources and low concentrations of ambient fine particulate matter (<2.5 μm, PM_2.5). Few comparable regions are available to evaluate the utility of continental-scale land-use regression (LUR) models including global geophysical estimates of PM_2.5, derived by relating satellite-observed aerosol optical depth to ground-level PM_2.5 ("SAT-PM_2.5"). We aimed to determine the validity of such satellite-based LUR models for PM_2.5 in Australia. We used global SAT-PM_2.5 estimates (∼10 km grid) and local land-use predictors to develop four LUR models for year-2015 (two satellite-based, two nonsatellite-based). We evaluated model performance at 51 independent monitoring sites not used for model development. An LUR model that included the SAT-PM_2.5 predictor variable (and six others) explained the most spatial variability in PM_2.5 (adjusted R² = 0.63, RMSE (μg/m³ [%]): 0.96 [14%]). Performance decreased modestly when evaluated (evaluation R² = 0.52, RMSE: 1.15 [16%]). The evaluation R² of the SAT-PM_2.5 estimate alone was 0.26 (RMSE: 3.97 [56%]). SAT-PM_2.5 estimates improved LUR model performance, while local land-use predictors increased the utility of global SAT-PM_2.5 estimates, including enhanced characterization of within-city gradients. Our findings support the validity of continental-scale satellite-based LUR modeling for PM_2.5 exposure assessment in Australia.

Spatial PM2.5, NO2, O3 and BC models for Western Europe - Evaluation of spatiotemporal stability

BACKGROUND

In order to investigate associations between air pollution and adverse health effects consistent fine spatial air pollution surfaces are needed across large areas to provide cohorts with comparable exposures. The aim of this paper is to develop and evaluate fine spatial scale land use regression models for four major health relevant air pollutants (PM_2.5, NO₂, BC, O₃) across Europe.

METHODS

We developed West-European land use regression models (LUR) for 2010 estimating annual mean PM_2.5, NO₂, BC and O₃ concentrations (including cold and warm season estimates for O₃). The models were based on AirBase routine monitoring data (PM_2.5, NO₂ and O₃) and ESCAPE monitoring data (BC), and incorporated satellite observations, dispersion model estimates, land use and traffic data. Kriging was performed on the residual spatial variation from the LUR models and added to the exposure estimates. One model was developed using all sites (100%). Robustness of the models was evaluated by performing a five-fold hold-out validation and for PM_2.5 and NO₂ additionally with independent comparison at ESCAPE measurements. To evaluate the stability of each model's spatial structure over time, separate models were developed for different years (NO₂ and O₃: 2000 and 2005; PM_2.5: 2013).

RESULTS

The PM_2.5, BC, NO₂, O₃ annual, O₃ warm season and O₃ cold season models explained respectively 72%, 54%, 59%, 65%, 69% and 83% of spatial variation in the measured concentrations. Kriging proved an efficient technique to explain a part of residual spatial variation for the pollutants with a strong regional component explaining respectively 10%, 24% and 16% of the R² in the PM_2.5, O₃ warm and O₃ cold models. Explained variance at fully independent sites vs the internal hold-out validation was slightly lower for PM_2.5 (65% vs 66%) and lower for NO₂ (49% vs 57%). Predictions from the 2010 model correlated highly with models developed in other years at the overall European scale.

CONCLUSIONS

We developed robust PM_2.5, NO₂, O₃ and BC hybrid LUR models. At the West-European scale models were robust in time, becoming less robust at smaller spatial scales. Models were applied to 100 × 100 m surfaces across Western Europe to allow for exposure assignment for 35 million participants from 18 European cohorts participating in the ELAPSE study.

Prenatal air pollution exposure, smoking, and uterine vascular resistance

BACKGROUND

Prenatal exposure to air pollution and smoking increases the risk of pregnancy complications and adverse birth outcomes, but pathophysiologic mechanisms are still debated. Few studies to date have examined the influence of air pollution on uterine vascular resistance and no studies have examined the independent impact of these exposures. We aimed to assess the impact of prenatal exposure to traffic-related air pollution and smoking on uterine vascular resistance.

METHODS

Our study included 566 pregnant women recruited between 1993 and 1996 in Los Angeles who completed visits at three gestational ages. Information on smoking was collected and uterine vascular resistance was measured at each visit by Doppler ultrasound. We calculated three resistance indices: the resistance index (RI), the pulsatility index (PI), and the systolic/diastolic (S/D) ratio. We estimated exposure to NO2 at the home address of the mother using a land use regression (LUR) model and to NOx using CALINE4 air dispersion modeling. We used generalized linear mixed models to estimate the effects of air pollution and smoking on uterine vascular resistance indices.

RESULTS

LUR-derived NO2 and CALINE4-derived NOx exposure increased the risk of high uterine artery resistance in late pregnancy. Smoking during pregnancy also increased the risk of higher uterine resistance and contributed to bilateral notching in mid-pregnancy.

CONCLUSION

Our results suggest that uterine vascular resistance is a mechanism underlying the association between smoking and air pollution, and adverse birth outcomes.

Long-term nitrogen dioxide exposure assessment using back-extrapolation of satellite-based land-use regression models for Australia

Assessing historical exposure to air pollution in epidemiological studies is often problematic because of limited spatial and temporal measurement coverage. Several methods for modelling historical exposures have been described, including land-use regression (LUR). Satellite-based LUR is a recent technique that seeks to improve predictive ability and spatial coverage of traditional LUR models by using satellite observations of pollutants as inputs to LUR. Few studies have explored its validity for assessing historical exposures, reflecting the absence of historical observations from popular satellite platforms like Aura (launched mid-2004). We investigated whether contemporary satellite-based LUR models for Australia, developed longitudinally for 2006-2011, could capture nitrogen dioxide (NO₂) concentrations during 1990-2005 at 89 sites around the country. We assessed three methods to back-extrapolate year-2006 NO₂ predictions: (1) 'do nothing' (i.e., use the year-2006 estimates directly, for prior years); (2) change the independent variable 'year' in our LUR models to match the years of interest (i.e., assume a linear trend prior to year-2006, following national average patterns in 2006-2011), and; (3) adjust year-2006 predictions using selected historical measurements. We evaluated prediction error and bias, and the correlation and absolute agreement of measurements and predictions using R² and mean-square error R² (MSE-R²), respectively. We found that changing the year variable led to best performance; predictions captured between 41% (1991; MSE-R² = 31%) and 80% (2003; MSE-R² = 78%) of spatial variability in NO₂ in a given year, and 76% (MSE-R² = 72%) averaged over 1990-2005. We conclude that simple methods for back-extrapolating prior to year-2006 yield valid historical NO₂ estimates for Australia during 1990-2005. These results suggest that for the time scales considered here, satellite-based LUR has a potential role to play in long-term exposure assessment, even in the absence of historical predictor data.

Satellite-Based Estimates of Daily NO2 Exposure in China Using Hybrid Random Forest and Spatiotemporal Kriging Model

A novel model named random-forest-spatiotemporal-kriging (RF-STK) was developed to estimate the daily ambient NO₂ concentrations across China during 2013-2016 based on the satellite retrievals and geographic covariates. The RF-STK model showed good prediction performance, with cross-validation R² = 0.62 (RMSE = 13.3 μg/m³) for daily and R² = 0.73 (RMSE = 6.5 μg/m³) for spatial predictions. The nationwide population-weighted multiyear average of NO₂ was predicted to be 30.9 ± 11.7 μg/m³ (mean ± standard deviation), with a slowly but significantly decreasing trend at a rate of -0.88 ± 0.38 μg/m³/year. Among the main economic zones of China, the Pearl River Delta showed the fastest decreasing rate of -1.37 μg/m³/year, while the Beijing-Tianjin Metro did not show a temporal trend ( P = 0.32). The population-weighted NO₂ was predicted to be the highest in North China (40.3 ± 10.3 μg/m³) and lowest in Southwest China (24.9 ± 9.4 μg/m³). Approximately 25% of the population lived in nonattainment areas with annual-average NO₂ > 40 μg/m³. A piecewise linear function with an abrupt point around 100 people/km² characterized the relationship between the population density and the NO₂, indicating a threshold of aggravated NO₂ pollution due to urbanization. Leveraging the ground-level NO₂ observations, this study fills the gap of statistically modeling nationwide NO₂ in China, and provides essential data for epidemiological research and air quality management.

Modelling daily PM2.5 concentrations at high spatio-temporal resolution across Switzerland

Spatiotemporal resolved models were developed predicting daily fine particulate matter (PM_2.5) concentrations across Switzerland from 2003 to 2013. Relatively sparse PM_2.5 monitoring data was supplemented by imputing PM_2.5 concentrations at PM₁₀ sites, using PM_2.5/PM₁₀ ratios at co-located sites. Daily PM_2.5 concentrations were first estimated at a 1 × 1km resolution across Switzerland, using Multiangle Implementation of Atmospheric Correction (MAIAC) spectral aerosol optical depth (AOD) data in combination with spatiotemporal predictor data in a four stage approach. Mixed effect models (1) were used to predict PM_2.5 in cells with AOD but without PM_2.5 measurements (2). A generalized additive mixed model with spatial smoothing was applied to generate grid cell predictions for those grid cells where AOD was missing (3). Finally, local PM_2.5 predictions were estimated at each monitoring site by regressing the residuals from the 1 × 1km estimate against local spatial and temporal variables using machine learning techniques (4) and adding them to the stage 3 global estimates. The global (1 km) and local (100 m) models explained on average 73% of the total,71% of the spatial and 75% of the temporal variation (all cross validated) globally and on average 89% (total) 95% (spatial) and 88% (temporal) of the variation locally in measured PM_2.5 concentrations.

Air pollution and cardiovascular mortality with over 25years follow-up: A combined analysis of two British cohorts

BACKGROUND

Adverse effects of air pollution on cardiovascular disease (CVD) mortality are well established. There are comparatively fewer studies in Europe, and in the UK particularly, than in North America. We examined associations in two British cohorts with >25years of follow-up.

METHODS

Annual average NO₂, SO₂ and black smoke (BS) air pollution exposure estimates for 1991 were obtained from land use regression models using contemporaneous monitoring data. From the European Study of Cohorts and Air Pollution (ESCAPE), air pollution estimates in 2010-11 were obtained for NO₂, NO_x, PM₁₀, PM_coarse and PM_2.5. The exposure estimates were assigned to place of residence 1989 for participants in a national birth cohort born in 1946, the MRC National Study of Health and Development (NSHD), and an adult multi-ethnic London cohort, Southall and Brent Revisited (SABRE) recruited 1988-91. The combined median follow-up was 26years. Single-pollutant competing risk models were employed, adjusting for individual risk factors.

RESULTS

Elevated non-significant hazard ratios for CVD mortality were seen with 1991 BS and SO₂ and with ESCAPE PM₁₀ and PM_2.5 in fully adjusted linear models. Per 10μg/m³ increase HRs were 1.11 [95% CI: 0.76-1.61] for BS, 1.05 [95% CI: 0.91-1.22] for SO₂, 1.16 [95% CI: 0.70-1.92] for PM₁₀ and 1.30 [95% CI: 0.39-4.34] for PM_2.5, with largest effects seen in the fourth quartile of BS and PM_2.5 compared to the first with HR 1.24 [95% CI: 0.91-1.61] and 1.21 [95% CI: 0.88-1.66] respectively. There were no consistent associations with other ESCAPE pollutants, or with 1991 NO₂. Modelling using Cox regression led to similar results.

CONCLUSION

Our results support a detrimental long-term effect for air pollutants on cardiovascular mortality.