Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project
Kathrin Wolf, Barbara Hoffmann, Zorana Jovanovic Andersen, Richard Atkinson, Mariska Bauwelinck, Tom Bellander, Jørgen Brandt, Bert Brunekreef, Giulia Cesaroni, Jie Chen, Ulf dé Fairé, Kees de Hoogh, Daniela Fecht, Francesco Forastiere, John Gulliver, Ole Hertel, Ulla Arthur Hvidtfeldt, Nicole Janssen, Jeanette T. Jørgensen, Klea Katsouyanni, Matthias Ketzel, Jochem O. Klompmaker, Anton Lager, Shuo Liu, Conor MacDonald, Patrik K. E. Magnusson, Amar Mehta, Gabriele Nagel, Bente Oftedal, Nancy L. Pedersen, Göran Pershagen, Ole Raaschou‐Nielsen, Matteo Renzi, Debora Rizzuto, Sophia Rodopoulou, Evangelia Samoli, Yvonne T. van der Schouw, Sara Schramm, Per E. Schwarze, Torben Sigsgaard, Mette Sørensen, Massimo Stafoggia, Maciek Strak, Anne Tjønneland, W. M. Monique Verschuren, Danielle Vienneau, Gudrun Weinmayr, Gerard Hoek, Annette Peters, Petter Ljungman
Abstract
BACKGROUND: ) with the incidence of stroke and acute coronary heart disease. METHODS: We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. FINDINGS: . INTERPRETATION: Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. FUNDING: Health Effects Institute.