1 Center of Epidemiology and Screening, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet3 Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.4 Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.5 Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.6 Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden.7 Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Environment Science Center, University of Augsburg, Augsburg, Germany.8 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.9 MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.10 Danish Cancer Society11 Aging Research Center (ARC), Division of Geriatric Epidemiology & Medicine, NEUROTEC, Karolinska Institutet and Stockholm Gerontology Research Center12 Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital - University of Turin, and Center for Cancer Prevention Piemonte, Turin, Italy.13 Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.14 IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.15 Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.16 IUF - Leibniz Research Institute for Environmental Medicine; and Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.17 National Institute for Public Health and the Environment, Bilthoven, the Netherlands.18 Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.19 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.20 Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.21 Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.22 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, University of Duisburg-Essen23 Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy.24 Molecular and Genetic Epidemiology Unit, Human Genetics Foundation, Turin, Italy.25 MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; Molecular and Genetic Epidemiology Unit, Human Genetics Foundation, Turin, Italy.26 Department of Neurology, University of Duisburg-Essen, Essen, Germany.27 IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.28 Institute for Risk Assessment Sciences, Utrecht University; and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.29 Center of Epidemiology and Screening, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
Results from 11 European Cohorts within the ESCAPE Project
BACKGROUND: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events. OBJECTIVES: We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts. METHODS: Data from 11 cohorts were collected and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the "European Study of Cohorts for Air Pollution Effects" (ESCAPE). The exposures were: PM2.5 (particulate matter [PM] below 2.5 µm in diameter), coarse PM (PM between 2.5 and 10 µm), PM10 (PM below 10 µm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation. RESULTS: 99,446 subjects were included, 3,086 of whom developed stroke. A 5-μg/m(3) increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke (hazard ratio [HR] = 1.19, 95% confidence interval [CI]: 0.88, 1.62). Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise co-exposure. The association with PM2.5 was apparent among those aged 60+ years (HR = 1.40, 95% CI: 1.05, 1.87), among never-smokers (HR = 1.74, 95% CI: 1.06, 2.88), and among subjects with PM2.5 exposure below 25 μg/m(3) (HR = 1.33, 95% CI: 1.01, 1.77). CONCLUSIONS: We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.
Environmental Health Perspectives, 2014, Vol 122, Issue 9, p. 919-925