Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study

Zorana J Andersen¹, Jiawei Zhang¹, Jeanette T Jørgensen¹, Evangelia Samoli², Shuo Liu¹, Jie Chen³, Maciej Strak⁴, Kathrin Wolf⁵, Gudrun Weinmayr⁶, Sophia Rodopolou², Elizabeth Remfry⁷, Kees de Hoogh⁸, Tom Bellander⁹, Jørgen Brandt¹⁰, Hans Concin¹¹, Emanuel Zitt¹², Daniela Fecht¹³, Francesco Forastiere¹⁴, John Gulliver¹⁵, Barbara Hoffmann¹⁶, Ulla A Hvidtfeldt¹⁷, W M Monique Verschuren¹⁸, Karl-Heinz Jöckel¹⁹, Rina So¹, Tom Cole-Hunter¹, Amar J Mehta²⁰, Laust H Mortensen²¹, Matthias Ketzel²², Anton Lager²³, Karin Leander²⁴, Petter Ljungman²⁵, Gianluca Severi²⁶, Marie-Christine Boutron-Ruault²⁷, Patrik K E Magnusson²⁸, Gabriele Nagel⁶, Göran Pershagen⁹, Annette Peters²⁹, Debora Rizzuto³⁰, Yvonne T van der Schouw³¹, Sara Schramm¹⁹, Massimo Stafoggia³², Klea Katsouyanni³³, Bert Brunekreef³, Gerard Hoek³, Youn-Hee Lim³⁴

Affiliations

¹ Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
² Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
³ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
⁴ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
⁵ Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
⁶ Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom.
⁸ Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
⁹ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
¹⁰ Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark.
¹¹ Agency for Preventive and Social Medicine (aks), Bregenz, Austria.
¹² Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
¹³ MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
¹⁴ Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom.
¹⁵ MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom.
¹⁶ Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
¹⁷ Danish Cancer Society Research Center, Copenhagen, Denmark.
¹⁸ National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁹ Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
²⁰ Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
²¹ Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark.
²² Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
²³ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
²⁴ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁵ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
²⁶ University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy.
²⁷ University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France.
²⁸ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
²⁹ Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany.
³⁰ Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
³¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
³² Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
³³ Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom.
³⁴ Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: younhee.lim@sund.ku.dk.

PMID: 36244228
DOI: 10.1016/j.envint.2022.107581

Free article

Multicenter Study

Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study

Zorana J Andersen et al. Environ Int. 2022 Dec.

Free article

. 2022 Dec:170:107581.

doi: 10.1016/j.envint.2022.107581. Epub 2022 Oct 12.

Authors

Affiliations

¹ Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
² Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
³ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
⁴ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
⁵ Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
⁶ Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom.
⁸ Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
⁹ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
¹⁰ Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark.
¹¹ Agency for Preventive and Social Medicine (aks), Bregenz, Austria.
¹² Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
¹³ MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
¹⁴ Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom.
¹⁵ MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom.
¹⁶ Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
¹⁷ Danish Cancer Society Research Center, Copenhagen, Denmark.
¹⁸ National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁹ Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
²⁰ Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
²¹ Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark.
²² Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
²³ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
²⁴ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
²⁵ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
²⁶ University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy.
²⁷ University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France.
²⁸ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
²⁹ Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany.
³⁰ Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
³¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
³² Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
³³ Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom.
³⁴ Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: younhee.lim@sund.ku.dk.

PMID: 36244228
DOI: 10.1016/j.envint.2022.107581

Abstract

Ambient air pollution is an established risk factor for premature mortality from chronic cardiovascular, respiratory and metabolic diseases, while evidence on neurodegenerative diseases and psychiatric disorders remains limited. We examined the association between long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in seven European cohorts. Within the multicenter project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven European cohorts from six countries. Based on the residential addresses, annual mean levels of fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), black carbon (BC), ozone (O₃), and 8 PM_2.5 components were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and mortality from dementia, psychiatric disorders, and suicide. Of 271,720 participants, 900 died from dementia, 241 from psychiatric disorders, and 164 from suicide, during a mean follow-up of 19.7 years. In fully adjusted models, we observed positive associations of NO₂ (hazard ratio [HR] = 1.38; 95 % confidence interval [CI]: 1.13, 1.70 per 10 µg/m³), PM_2.5 (HR = 1.29; 95 % CI: 0.98, 1.71 per 5 µg/m³), and BC (HR = 1.37; 95 % CI: 1.11, 1.69 per 0.5 × 10^-5/m) with psychiatric disorders mortality, as well as with suicide (NO₂: HR = 1.13 [95 % CI: 0.92, 1.38]; PM_2.5: HR = 1.19 [95 % CI: 0.76, 1.87]; BC: HR = 1.08 [95 % CI: 0.87, 1.35]), and no association with dementia mortality. We did not detect any positive associations of O₃ and 8 PM_2.5 components with any of the three mortality outcomes. Long-term exposure to NO₂, PM_2.5, and BC may lead to premature mortality from psychiatric disorders and suicide.

Keywords: Air pollution; Dementia; Long-term exposure; Mortality; Psychiatric disorders; Suicide.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study

Affiliations

Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical