Long-term exposure to particulate air pollution and black carbon in relation to natural and cause-specific mortality: a multicohort study in Sweden

Nilsson Sommar, Johan; Andersson, Eva M; Andersson, Niklas; Sallsten, Gerd; Stockfelt, Leonard; Ljungman, Petter LS; Segersson, David; Eneroth, Kristina; Gidhagen, Lars; Molnar, Peter; Wennberg, Patrik; Rosengren, Annika; Rizzuto, Debora; Leander, Karin; Lager, Anton; Magnusson, Patrik KE; Johansson, C.; Barregard, Lars; Bellander, Tom; Pershagen, Göran; Forsberg, Bertil
2021 | 11

Objectives To estimate concentration–response relationships for particulate matter (PM) and black carbon (BC) in relation to mortality in cohorts from three Swedish cities with comparatively low pollutant levels.

Setting Cohorts from Gothenburg, Stockholm and Umeå, Sweden.

Design High-resolution dispersion models were used to estimate annual mean concentrations of PM with aerodynamic diameter ≤10 µm (PM10) and ≤2.5 µm (PM2.5), and BC, at individual addresses during each year of follow-up, 1990–2011. Moving averages were calculated for the time windows 1–5 years (lag1–5) and 6–10 years (lag6–10) preceding the outcome. Cause-specific mortality data were obtained from the national cause of death registry. Cohort-specific HRs were estimated using Cox regression models and then meta-analysed including a random effect of cohort.

Participants During the study period, 7 340 cases of natural mortality, 2 755 cases of cardiovascular disease (CVD) mortality and 817 cases of respiratory and lung cancer mortality were observed among in total 68 679 individuals and 689 813 person-years of follow-up.

Results Both PM10 (range: 6.3–41.9 µg/m3) and BC (range: 0.2–6.8 µg/m3) were associated with natural mortality showing 17% (95% CI 6% to 31%) and 9% (95% CI 0% to 18%) increased risks per 10 µg/m3 and 1 µg/m3 of lag1-5 exposure, respectively. For PM2.5 (range: 4.0–22.4 µg/m3), the estimated increase was 13% per 5 µg/m3, but less precise (95% CI −9% to 40%). Estimates for CVD mortality appeared higher for both PM10 and PM2.5. No association was observed with respiratory mortality.

Conclusion The results support an effect of long-term air pollution on natural mortality and mortality in CVD with high relative risks also at low exposure levels. These findings are relevant for future decisions concerning air quality policies.

Near-Source Risk Functions for Particulate Matter Are Critical When Assessing the Health Benefits of Local Abatement Strategies

2021 | Int J Environ Res Public Health | 18

Long-term exposure to particulate air pollution and black carbon in relation to natural and cause-specific mortality: a multicohort study in Sweden

Sommar, JN; Andersson, EM; Andersson, N; Sallsten, G; Stockfelt, L; Ljungman, PLS; Segersson, D; Eneroth, K; Gidhagen, L; Molnar, P; Wennberg, P; Rosengren, A; Rizzuto, D; Leander, K; Lager, A; Magnusson, PKE; Johansson, C; Barregard, L; Bellander, T; Pershagen, G; Forsberg, B
2021 | BMJ Open | 11 (9)
associations , cardiac epidemiology , cardiovascular-disease , cohorts , coupled road dust , emissions , epidemiology , goteborg , lung-cancer , matter , particles , public health , surface moisture model
Objectives To estimate concentration-response relationships for particulate matter (PM) and black carbon (BC) in relation to mortality in cohorts from three Swedish cities with comparatively low pollutant levels. Setting Cohorts from Gothenburg, Stockholm and Umea, Sweden. Design High-resolution dispersion models were used to estimate annual mean concentrations of PM with aerodynamic diameter <= 10 mu m (PM10) and <= 2.5 mu m (PM2.5), and BC, at individual addresses during each year of follow-up, 1990-2011. Moving averages were calculated for the time windows 1-5 years (lag1-5) and 6-10 years (lag6-10) preceding the outcome. Cause-specific mortality data were obtained from the national cause of death registry. Cohort-specific HRs were estimated using Cox regression models and then meta-analysed including a random effect of cohort. Participants During the study period, 7 340 cases of natural mortality, 2 755 cases of cardiovascular disease (CVD) mortality and 817 cases of respiratory and lung cancer mortality were observed among in total 68 679 individuals and 689 813 person-years of follow-up. Results Both PM10 (range: 6.3-41.9 mu g/m(3)) and BC (range: 0.2-6.8 mu g/m(3)) were associated with natural mortality showing 17% (95% CI 6% to 31%) and 9% (95% CI 0% to 18%) increased risks per 10 mu g/m(3) and 1 mu g/m(3) of lag1-5 exposure, respectively. For PM2.5 (range: 4.0-22.4 mu g/m(3)), the estimated increase was 13% per 5 mu g/m(3), but less precise (95% CI -9% to 40%). Estimates for CVD mortality appeared higher for both PM10 and PM2.5. No association was observed with respiratory mortality. Conclusion The results support an effect of long-term air pollution on natural mortality and mortality in CVD with high relative risks also at low exposure levels. These findings are relevant for future decisions concerning air quality policies.

Long-Term Exposure to Transportation Noise and Risk of Incident Stroke: A Pooled Study of Nine Scandinavian Cohorts

Roswall, N; Pyko, A; Ogren, M; Oudin, A; Rosengren, A; Lager, A; Poulsen, AH; Eriksson, C; Segersson, D; Rizzuto, D; Andersson, EM; Aasvang, GM; Engstrom, G; Jorgensen, JT; Selander, J; Christensen, JH; Thacher, J; Leander, K; Overvad, K; Eneroth, K; Mattisson, K; Barregard, L; Stockfelt, L; Albin, M; Ketzel, M; Simonsen, MK; Spanne, M; Raaschou-Nielsen, O; Magnusson, PKE; Tuttanen, P; Molnar, P; Ljungman, P; Lanki, T; Lim, YH; Andersen, ZJ; Pershagen, G; Sorensen, M
2021 | Environ. Health Perspect. | 129 (10)
air pollution , cardiovascular-disease , men , mortality , road traffic noise , update
BACKGROUND: Transportation noise is increasingly acknowledged as a cardiovascular risk factor, but the evidence base for an association with stroke is sparse. OBJECTIVE: We aimed to investigate the association between transportation noise and stroke incidence in a large Scandinavian population. METHODS: We harmonized and pooled data from nine Scandinavian cohorts (seven Swedish, two Danish), totaling 135,951 participants. We identified residential address history and estimated road, railway, and aircraft noise for all addresses. Information on stroke incidence was acquired through linkage to national patient and mortality registries. We analyzed data using Cox proportional hazards models, including socioeconomic and lifestyle confounders, and air pollution. RESULTS: During follow-up (median = 19.5 y), 11,056 stroke cases were identified. Road traffic noise (Lden) was associated with risk of stroke, with a hazard ratio (HR) of 1.06 [95% confidence interval (CI): 1.03, 1.08] per 10-dB higher 5-y mean time-weighted exposure in analyses adjusted for individual- and area-level socioeconomic covariates. The association was approximately linear and persisted after adjustment for air pollution [particulate matter (PM) with an aerodynamic diameter of <= 2.5 mu m (PM2.5) and NO2]. Stroke was associated with moderate levels of 5-y aircraft noise exposure (40-50 vs. <= 40 dB) (HR = 1.12; 95% CI: 0.99, 1.27), but not with higher exposure (>= 50 dB, HR = 0.94; 95% CI: 0.79, 1.11). Railway noise was not associated with stroke. DISCUSSION: In this pooled study, road traffic noise was associated with a higher risk of stroke. This finding supports road traffic noise as an important cardiovascular risk factor that should be included when estimating the burden of disease due to traffic noise.

Long-term exposure to particulate air pollution and black carbon in relation to natural and cause-specific mortality: a multicohort study in Sweden

Sommar, JN; Andersson, EM; Andersson, N; Sallsten, G; Stockfelt, L; Ljungman, PLS; Segersson, D; Eneroth, K; Gidhagen, L; Molnar, P; Wennberg, P; Rosengren, A; Rizzuto, D; Leander, K; Lager, A; Magnusson, PKE; Johansson, C; Barregard, L; Bellander, T; Pershagen, G; Forsberg, B
2021 | BMJ Open | 11 (9)
associations , cardiac epidemiology , cardiovascular-disease , cohorts , coupled road dust , emissions , epidemiology , goteborg , lung-cancer , matter , particles , public health , surface moisture model
Objectives To estimate concentration-response relationships for particulate matter (PM) and black carbon (BC) in relation to mortality in cohorts from three Swedish cities with comparatively low pollutant levels. Setting Cohorts from Gothenburg, Stockholm and Umea, Sweden. Design High-resolution dispersion models were used to estimate annual mean concentrations of PM with aerodynamic diameter <= 10 mu m (PM10) and <= 2.5 mu m (PM2.5), and BC, at individual addresses during each year of follow-up, 1990-2011. Moving averages were calculated for the time windows 1-5 years (lag1-5) and 6-10 years (lag6-10) preceding the outcome. Cause-specific mortality data were obtained from the national cause of death registry. Cohort-specific HRs were estimated using Cox regression models and then meta-analysed including a random effect of cohort. Participants During the study period, 7 340 cases of natural mortality, 2 755 cases of cardiovascular disease (CVD) mortality and 817 cases of respiratory and lung cancer mortality were observed among in total 68 679 individuals and 689 813 person-years of follow-up. Results Both PM10 (range: 6.3-41.9 mu g/m(3)) and BC (range: 0.2-6.8 mu g/m(3)) were associated with natural mortality showing 17% (95% CI 6% to 31%) and 9% (95% CI 0% to 18%) increased risks per 10 mu g/m(3) and 1 mu g/m(3) of lag1-5 exposure, respectively. For PM2.5 (range: 4.0-22.4 mu g/m(3)), the estimated increase was 13% per 5 mu g/m(3), but less precise (95% CI -9% to 40%). Estimates for CVD mortality appeared higher for both PM10 and PM2.5. No association was observed with respiratory mortality. Conclusion The results support an effect of long-term air pollution on natural mortality and mortality in CVD with high relative risks also at low exposure levels. These findings are relevant for future decisions concerning air quality policies.

Modelling urban cyclists exposure to black carbon particles using high spatiotemporal data A statistical approach

Krecl, P.; Cipoli Y. A.; Targino A. C.; Toloto M. O.; Segersson, D.; Parra A.; Polezer G.; Godoi R. H. M.; Gidhagen L.
2019 | Sci. Total Environ. (115-125)

Long-term exposure to particulate air pollution, black carbon and their source components in relation to ischemic heart disease and stroke

Ljungman, P.L.S.; Andersson, N.; Stockfelt, L.; Andersson, E.M.; Nilsson Sommar, J.; Eneroth, K.; Gidhagen, L.; Johansson, C.; Lager, A.; Leander, K.; Molnar, P.; Pedersen, N.L.; Rizzuto, D.; Rosengren, A.; Segersson, D.; Wennberg, P.; Barregard, L.; Forsberg, B.; Sallsten, G.; Bellander, T.; Pershagen, G.
2019 | Environ. Health Perspect. | 127 (10)

Background: Long-term exposure to particulate matter (PM) in ambient air has been associated with cardiovascular mortality but few studies have considered incident disease in relation to PM from different sources.
Objectives: To study associations between long-term exposure to different types of PM and sources, and incident ischemic heart disease (IHD) and stroke in three Swedish cities.
Methods: Based on detailed emission databases, monitoring data and high-resolution dispersion models we calculated source contributions to PM10, PM2.5, black carbon (BC) from road wear, traffic exhaust, residential heating and other sources in Gothenburg, Stockholm, and Umeå. Registry data for participants from four cohorts were used to obtain incidence of IHD and stroke for first hospitalization or death. We constructed time-windows of exposure for same year, 1-5 year and 6-10 year averages preceding
incidence from annual averages at residential addresses. Risk estimates were based on random effects meta-analyses of cohort-specific Cox proportional hazard models. Results: We observed 5166 and 3119 incident IHD and stroke cases respectively in 114,758 participants. Overall, few consistent associations were observed between the different air pollution measures and IHD or stroke incidence. However, same year levels of ambient locally emitted BC (range 0.01-4.6 μg/m3) were associated with a 4.0% higher risk of incident stroke per interquartile range, 0.30 μg/m3 (95% CI: 0.04%, 7.8%). This association was primarily related to BC from traffic exhaust. PM10 (range 4.4-52 μg/m3) and PM2.5 (range 2.9-22 μg/m3) were not associated with stroke. Associations with incident IHD were observed only for PM2.5 exposure from residential heating.
Discussion: Few consistent associations were observed between different particulate components and IHD or stroke. However, long-term residential exposure to locally
emitted BC from traffic exhaust was associated with stroke incidence. The comparatively low exposure levels may have contributed to the paucity of associations.

Integrated Urban Services for European cities: the Stockholm case

Amorim J. H.; Asker C.; Belusic D.; Carvalho A. C.; Engardt M.; Gidhagen L.; Hundecha Y.; Körnich H.; Lind P.; Olsson E.; Olsson J.; Segersson, D.; Strömbäck L.
2018 | Bull. World Health Organ. | 67 (2) (33-40)

Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden

Oudin, A.; Segersson, D.; Adolfsson, R.; Forsberg, B.
2018 | PLoS ONE | 13 (6)

Health Impact of PM10, PM2.5 and Black Carbon Exposure Due to Different Source Sectors in Stockholm, Gothenburg and Umea, Sweden.

Segersson, D.; Eneroth, K.; Gidhagen, L.; Johansson, C.; Omstedt, G.; Nylén A.E.; Forsberg, B.
2017 | Int J Environ Res Public Health | 14 (7)

The most important anthropogenic sources of primary particulate matter (PM) in ambient air in Europe are exhaust and non-exhaust emissions from road traffic and combustion of solid biomass. There is convincing evidence that PM, almost regardless of source, has detrimental health effects. An important issue in health impact assessments is what metric, indicator and exposure-response function to use for different types of PM. The aim of this study is to describe sectorial contributions to PM exposure and related premature mortality for three Swedish cities: Gothenburg, Stockholm and Umea. Exposure is calculated with high spatial resolution using atmospheric dispersion models. Attributed premature mortality is calculated separately for the main local sources and the contribution from long-range transport (LRT), applying different relative risks. In general, the main part of the exposure is due to LRT, while for black carbon, the local sources are equally or more important. The major part of the premature deaths is in our assessment related to local emissions, with road traffic and residential wood combustion having the largest impact. This emphasizes the importance to resolve within-city concentration gradients when assessing exposure. It also implies that control actions on local PM emissions have a strong potential in abatement strategies.

Long-term effects of total and source-specific particulate air pollution on incident cardiovascular disease in Gothenburg, Sweden.

Stockfelt L.; Andersson E., M.; Molnár, P.; Gidhagen, L.; Segersson, D.; Rosengren, A.; Barregard, L.; Sallsten, G.
2017 | Environ. Res. | 158 (61-71)

Indicators of residential traffic exposure: Modelled NO X , traffic proximity, and self-reported exposure in RHINE III

Carlsen, H.K.; Bäck, E.; Holm, M.; Janson, C.; Jensen, C. S.; Johannessen, A.; Kaasik, M.; Modig, L.; Segersson, D.; Sigsgaard, T.; Forsberg, B.; Olsson, D.; Orru, H.
2017 | Atmos. Environ., Part A | 167 (416-425)

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