Long-term exposure to air pollution and mortality in a prospective cohort: The Ontario Health Study,Environment International

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Long-term exposure to air pollution and mortality in a prospective cohort: The Ontario Health Study
Environment International ( IF 11.8 ) Pub Date : 2021-04-23 , DOI: 10.1016/j.envint.2021.106570
Zilong Zhang ₁ , John Wang ₂ , Jeffrey C Kwong ₃ , Richard T Burnett ₄ , Aaron van Donkelaar ₅ , Perry Hystad ₆ , Randall V Martin ₇ , Li Bai ₈ , John McLaughlin ₉ , Hong Chen ₁₀

Affiliation

Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
College of Public Health and Human Studies, Oregon State University, Corvallis, OR, USA.
Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA.
ICES, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.

Background

Air pollution has been associated with increased mortality. However, updated evidence from cohort studies with detailed information on various risk factors is needed, especially in regions with low air pollution levels. We investigated the associations between long-term exposure to air pollution and mortality in a prospective cohort.

Methods

We studied 88,615 participants aged ≥30 years from an ongoing cohort study in Ontario, Canada from 2009 to 2017. Exposure to ambient fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) was estimated at participants’ residence. Cox proportional hazard models were used to investigate the associations between air pollution and non-accidental, cardiovascular, and respiratory mortality, adjusted for a wide array of individual-level and contextual covariates. Potential effect modification by socio-demographic and behavioral factors was also examined in exploratory stratified analyses.

Results

The fully adjusted hazard ratios (HRs) per 1 µg/m³ increment in PM_2.5 were 1.037 [95% confidence interval (CI): 1.018, 1.057]¸ 1.083 (95% CI: 1.040, 1.128) and 1.109 (95% CI: 1.035, 1.187) for non-accidental, cardiovascular, and respiratory mortality, respectively. Positive associations were also found for NO₂; the corresponding HRs per 1 ppb increment were 1.027 (95% CI: 1.021, 1.034), 1.032 (95% CI: 1.019, 1.046) and 1.044 (95% CI: 1.020, 1.068). We found suggestive evidence of stronger associations in physically active participants, smokers, and those with lower household income.

Conclusions

Long-term exposure to PM_2.5 and NO₂ was associated with increased risks for non-accidental, cardiovascular, and respiratory mortality, suggesting potential benefits of further improvement in air quality even in low-exposure environments.

中文翻译：

预期人群中长期暴露于空气污染和死亡的情况：安大略省健康研究

背景

空气污染与死亡率增加有关。但是，需要队列研究的最新证据，并提供有关各种风险因素的详细信息，尤其是在空气污染水平较低的地区。我们调查了预期队列中长期暴露于空气污染与死亡率之间的关系。

方法

我们从2009年至2017年在加拿大安大略省进行的一项队列研究中，对88,615位年龄≥30岁的参与者进行了研究。据估计，参与者的住所暴露于环境细颗粒物（PM _2.5）和二氧化氮（NO ₂）。使用Cox比例风险模型研究了空气污染与非偶然性，心血管和呼吸系统死亡率之间的关联，并针对各种个体水平和背景协变量进行了调整。在探索性分层分析中，还研究了社会人口统计学和行为因素对潜在影响的修正。

结果

在PM _2.5中每1 µg / m ³增量经过完全调整的危险比（HRs）为1.037 [95％置信区间（CI）：1.018，1.057]¸1.083（95％CI：1.040，1.128）和1.109（95％CI ：1.035，1.187）分别用于非意外，心血管和呼吸道疾病的死亡率。积极协会还发现了NO ₂ ; 每1 ppb增量对应的HR为1.027（95％CI：1.021，1.034），1.032（95％CI：1.019，1.046）和1.044（95％CI：1.020，1.068）。我们发现了一些有力的证据，表明体育锻炼的参与者，吸烟者和家庭收入较低的人之间的关联性增强。