Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts

Ulla Arthur Hvidtfeldt; Gianluca Severi; Zorana Jovanovic Andersen; Richard Atkinson; Mariska Bauwelinck; Tom Bellander; Marie Christine Boutron-Ruault; Jørgen Brandt; Bert Brunekreef; Giulia Cesaroni; Jie Chen; Hans Concin; Francesco Forastiere; Carla H. van Gils; John Gulliver; Ole Hertel; Gerard Hoek; Barbara Hoffmann; Kees de Hoogh; Nicole Janssen; Karl Heinz Jöckel; Jeanette Therming Jørgensen; Klea Katsouyanni; Matthias Ketzel; Jochem O. Klompmaker; Norun Hjertager Krog; Alois Lang; Karin Leander; Shuo Liu; Petter L.S. Ljungman; Patrik K.E. Magnusson; Amar Jayant Mehta; Gabriele Nagel; Bente Oftedal; Göran Pershagen; Raphael Simon Peter; Annette Peters; Matteo Renzi; Debora Rizzuto; Sophia Rodopoulou; Evangelia Samoli; Per Everhard Schwarze; Torben Sigsgaard; Mette Kildevæld Simonsen; Massimo Stafoggia; Maciek Strak; Danielle Vienneau; Gudrun Weinmayr; Kathrin Wolf; Ole Raaschou-Nielsen; Daniela Fecht

doi:10.1016/j.envint.2020.106249

Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts

Ulla Arthur Hvidtfeldt, Gianluca Severi, Zorana Jovanovic Andersen, Richard Atkinson, Mariska Bauwelinck, Tom Bellander, Marie Christine Boutron-Ruault, Jørgen Brandt, Bert Brunekreef, Giulia Cesaroni, Jie Chen, Hans Concin, Francesco Forastiere, Carla H. van Gils, John Gulliver, Ole Hertel, Gerard Hoek, Barbara Hoffmann, Kees de Hoogh, Nicole JanssenKarl Heinz Jöckel, Jeanette Therming Jørgensen, Klea Katsouyanni, Matthias Ketzel, Jochem O. Klompmaker, Norun Hjertager Krog, Alois Lang, Karin Leander, Shuo Liu, Petter L.S. Ljungman, Patrik K.E. Magnusson, Amar Jayant Mehta, Gabriele Nagel, Bente Oftedal, Göran Pershagen, Raphael Simon Peter, Annette Peters, Matteo Renzi, Debora Rizzuto, Sophia Rodopoulou, Evangelia Samoli, Per Everhard Schwarze, Torben Sigsgaard, Mette Kildevæld Simonsen, Massimo Stafoggia, Maciek Strak, Danielle Vienneau, Gudrun Weinmayr, Kathrin Wolf, Ole Raaschou-Nielsen, Daniela Fecht

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Résumé

Background/aim: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence. Methods: The “Effects of Low-level Air Pollution: a Study in Europe” (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO₂), fine particulate matter (PM_2.5), black carbon (BC), and ozone (O₃) to assign exposure to cohort participants’ residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines. Results: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO₂, PM_2.5, BC and O₃ (warm season) were 24.2 µg/m³ (19.5, 29.7), 15.4 µg/m³ (12.8, 17.3), 1.6 10⁻⁵m⁻¹ (1.3, 1.8), and 86.6 µg/m³ (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM_2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m³). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m³. We did not observe associations between NO₂, BC or O₃ and lung cancer incidence. Conclusions: Long-term ambient PM_2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.

langue originale	Anglais
Numéro d'article	106249
journal	Environment International
Volume	146
Les DOIs	https://doi.org/10.1016/j.envint.2020.106249
état	Publié - 1 janv. 2021

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10.1016/j.envint.2020.106249

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Hvidtfeldt, U. A., Severi, G., Andersen, Z. J., Atkinson, R., Bauwelinck, M., Bellander, T., Boutron-Ruault, M. C., Brandt, J., Brunekreef, B., Cesaroni, G., Chen, J., Concin, H., Forastiere, F., van Gils, C. H., Gulliver, J., Hertel, O., Hoek, G., Hoffmann, B., de Hoogh, K., ... Fecht, D. (2021). Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts. Environment International, 146, Article 106249. https://doi.org/10.1016/j.envint.2020.106249

@article{99abf630f7f24f33855858b85f7ee083,

title = "Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts",

abstract = "Background/aim: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence. Methods: The “Effects of Low-level Air Pollution: a Study in Europe” (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO2), fine particulate matter (PM2.5), black carbon (BC), and ozone (O3) to assign exposure to cohort participants{\textquoteright} residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines. Results: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO2, PM2.5, BC and O3 (warm season) were 24.2 µg/m3 (19.5, 29.7), 15.4 µg/m3 (12.8, 17.3), 1.6 10−5m−1 (1.3, 1.8), and 86.6 µg/m3 (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m3). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m3. We did not observe associations between NO2, BC or O3 and lung cancer incidence. Conclusions: Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.",

keywords = "Air pollution, Dose response relationship, Lung cancer incidence, Particulate matter",

author = "Hvidtfeldt, {Ulla Arthur} and Gianluca Severi and Andersen, {Zorana Jovanovic} and Richard Atkinson and Mariska Bauwelinck and Tom Bellander and Boutron-Ruault, {Marie Christine} and J{\o}rgen Brandt and Bert Brunekreef and Giulia Cesaroni and Jie Chen and Hans Concin and Francesco Forastiere and {van Gils}, {Carla H.} and John Gulliver and Ole Hertel and Gerard Hoek and Barbara Hoffmann and {de Hoogh}, Kees and Nicole Janssen and J{\"o}ckel, {Karl Heinz} and J{\o}rgensen, {Jeanette Therming} and Klea Katsouyanni and Matthias Ketzel and Klompmaker, {Jochem O.} and Krog, {Norun Hjertager} and Alois Lang and Karin Leander and Shuo Liu and Ljungman, {Petter L.S.} and Magnusson, {Patrik K.E.} and Mehta, {Amar Jayant} and Gabriele Nagel and Bente Oftedal and G{\"o}ran Pershagen and Peter, {Raphael Simon} and Annette Peters and Matteo Renzi and Debora Rizzuto and Sophia Rodopoulou and Evangelia Samoli and Schwarze, {Per Everhard} and Torben Sigsgaard and Simonsen, {Mette Kildev{\ae}ld} and Massimo Stafoggia and Maciek Strak and Danielle Vienneau and Gudrun Weinmayr and Kathrin Wolf and Ole Raaschou-Nielsen and Daniela Fecht",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s)",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.envint.2020.106249",

language = "English",

volume = "146",

journal = "Environment International",

issn = "0160-4120",

}

Hvidtfeldt, UA, Severi, G, Andersen, ZJ, Atkinson, R, Bauwelinck, M, Bellander, T, Boutron-Ruault, MC, Brandt, J, Brunekreef, B, Cesaroni, G, Chen, J, Concin, H, Forastiere, F, van Gils, CH, Gulliver, J, Hertel, O, Hoek, G, Hoffmann, B, de Hoogh, K, Janssen, N, Jöckel, KH, Jørgensen, JT, Katsouyanni, K, Ketzel, M, Klompmaker, JO, Krog, NH, Lang, A, Leander, K, Liu, S, Ljungman, PLS, Magnusson, PKE, Mehta, AJ, Nagel, G, Oftedal, B, Pershagen, G, Peter, RS, Peters, A, Renzi, M, Rizzuto, D, Rodopoulou, S, Samoli, E, Schwarze, PE, Sigsgaard, T, Simonsen, MK, Stafoggia, M, Strak, M, Vienneau, D, Weinmayr, G, Wolf, K, Raaschou-Nielsen, O & Fecht, D 2021, 'Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts', Environment International, VOL. 146, 106249. https://doi.org/10.1016/j.envint.2020.106249

TY - JOUR

T1 - Long-term low-level ambient air pollution exposure and risk of lung cancer – A pooled analysis of 7 European cohorts

AU - Hvidtfeldt, Ulla Arthur

AU - Severi, Gianluca

AU - Andersen, Zorana Jovanovic

AU - Atkinson, Richard

AU - Bauwelinck, Mariska

AU - Bellander, Tom

AU - Boutron-Ruault, Marie Christine

AU - Brandt, Jørgen

AU - Brunekreef, Bert

AU - Cesaroni, Giulia

AU - Chen, Jie

AU - Concin, Hans

AU - Forastiere, Francesco

AU - van Gils, Carla H.

AU - Gulliver, John

AU - Hertel, Ole

AU - Hoek, Gerard

AU - Hoffmann, Barbara

AU - de Hoogh, Kees

AU - Janssen, Nicole

AU - Jöckel, Karl Heinz

AU - Jørgensen, Jeanette Therming

AU - Katsouyanni, Klea

AU - Ketzel, Matthias

AU - Klompmaker, Jochem O.

AU - Krog, Norun Hjertager

AU - Lang, Alois

AU - Leander, Karin

AU - Liu, Shuo

AU - Ljungman, Petter L.S.

AU - Magnusson, Patrik K.E.

AU - Mehta, Amar Jayant

AU - Nagel, Gabriele

AU - Oftedal, Bente

AU - Pershagen, Göran

AU - Peter, Raphael Simon

AU - Peters, Annette

AU - Renzi, Matteo

AU - Rizzuto, Debora

AU - Rodopoulou, Sophia

AU - Samoli, Evangelia

AU - Schwarze, Per Everhard

AU - Sigsgaard, Torben

AU - Simonsen, Mette Kildevæld

AU - Stafoggia, Massimo

AU - Strak, Maciek

AU - Vienneau, Danielle

AU - Weinmayr, Gudrun

AU - Wolf, Kathrin

AU - Raaschou-Nielsen, Ole

AU - Fecht, Daniela

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Background/aim: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence. Methods: The “Effects of Low-level Air Pollution: a Study in Europe” (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO2), fine particulate matter (PM2.5), black carbon (BC), and ozone (O3) to assign exposure to cohort participants’ residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines. Results: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO2, PM2.5, BC and O3 (warm season) were 24.2 µg/m3 (19.5, 29.7), 15.4 µg/m3 (12.8, 17.3), 1.6 10−5m−1 (1.3, 1.8), and 86.6 µg/m3 (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m3). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m3. We did not observe associations between NO2, BC or O3 and lung cancer incidence. Conclusions: Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.

AB - Background/aim: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence. Methods: The “Effects of Low-level Air Pollution: a Study in Europe” (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO2), fine particulate matter (PM2.5), black carbon (BC), and ozone (O3) to assign exposure to cohort participants’ residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines. Results: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO2, PM2.5, BC and O3 (warm season) were 24.2 µg/m3 (19.5, 29.7), 15.4 µg/m3 (12.8, 17.3), 1.6 10−5m−1 (1.3, 1.8), and 86.6 µg/m3 (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m3). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m3. We did not observe associations between NO2, BC or O3 and lung cancer incidence. Conclusions: Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.

KW - Air pollution

KW - Dose response relationship

KW - Lung cancer incidence

KW - Particulate matter

UR - http://www.scopus.com/inward/record.url?scp=85095993048&partnerID=8YFLogxK

U2 - 10.1016/j.envint.2020.106249

DO - 10.1016/j.envint.2020.106249

M3 - Article

C2 - 33197787

AN - SCOPUS:85095993048

SN - 0160-4120

VL - 146

JO - Environment International

JF - Environment International

M1 - 106249

ER -