Objective To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. Design Pooled analysis of eight cohorts. Setting Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. Participants 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon. Main outcome measures Deaths due to natural causes and cause specific mortality. Results Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. Conclusions Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease. No additional data available.

中文翻译：

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ELAPSE 项目中八个欧洲队列的长期暴露于低水平空气污染和死亡率：汇总分析

目的 调查空气污染与死亡率之间的关联，重点关注低于当前欧盟、美国和世界卫生组织标准和指南的关联。设计 8 个队列的汇总分析。设置低水平空气污染的多中心项目影响：在六个欧洲国家的欧洲研究 (ELAPSE)。参与者 325 367 名普通人群中的成年人大多在 1990 年代或 2000 年代招募，并提供详细的生活方式数据。分层 Cox 比例风险模型用于分析空气污染与死亡率之间的关联。西欧范围内的土地利用回归模型用于表征住宅空气污染中环境细颗粒物 (PM2.5)、二氧化氮、臭氧和黑碳的浓度。主要结果衡量自然原因导致的死亡和特定死亡率。结果 325 367 名成人平均随访 19.5 年，观察到 47 131 例死亡。更多地暴露于 PM2.5、二氧化氮和黑碳与几乎所有结果的风险显着增加有关。PM2.5 增加 5 µg/m3 与自然死亡人数增加 13%（95% 置信区间 10.6% 至 15.5%）相关；二氧化氮增加 10 µg/m3 的相应数字为 8.6%（从 7% 到 10.2%）。与 PM2.5、二氧化氮和黑碳的关联在低浓度下仍然显着。对于暴露量低于美国标准 12 µg/m3 的参与者，PM2.5 增加 5 µg/m3 与自然死亡人数增加 29.6%（14% 至 47.4%）相关。结论 我们的研究有助于证明室外空气污染与死亡率相关，即使在低于当前欧洲和北美标准和 WHO 指导值的低污染水平下也是如此。因此，这些发现对有关修订空气质量限制、指南和标准以及全球疾病负担的未来评估的辩论具有重要贡献。没有可用的额外数据。