Thomas Ellermann

Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE)

BACKGROUND Ambient air pollution is suspected to cause lung cancer. We aimed to assess the association between long-term exposure to ambient air pollution and lung cancer incidence in European populations. METHODS This prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Effects used data from 17 cohort studies based in nine European countries. Baseline addresses were geocoded and we assessed air pollution by land-use regression models for particulate matter (PM) with diameter of less than 10 μm (PM10), less than 2·5 μm (PM2·5), and between 2·5 and 10 μm (PMcoarse), soot (PM2·5absorbance), nitrogen oxides, and two traffic indicators. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses. FINDINGS The 312 944 cohort members contributed 4 013 131 person-years at risk. During follow-up (mean 12·8 years), 2095 incident lung cancer cases were diagnosed. The meta-analyses showed a statistically significant association between risk for lung cancer and PM10 (hazard ratio [HR] 1·22 [95% CI 1·03-1·45] per 10 μg/m(3)). For PM2·5 the HR was 1·18 (0·96-1·46) per 5 μg/m(3). The same increments of PM10 and PM2·5 were associated with HRs for adenocarcinomas of the lung of 1·51 (1·10-2·08) and 1·55 (1·05-2·29), respectively. An increase in road traffic of 4000 vehicle-km per day within 100 m of the residence was associated with an HR for lung cancer of 1·09 (0·99-1·21). The results showed no association between lung cancer and nitrogen oxides concentration (HR 1·01 [0·95-1·07] per 20 μg/m(3)) or traffic intensity on the nearest street (HR 1·00 [0·97-1·04] per 5000 vehicles per day). INTERPRETATION Particulate matter air pollution contributes to lung cancer incidence in Europe. FUNDING European Communitys Seventh Framework Programme.

Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project

BACKGROUND Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. METHODS We used data from 22 European cohort studies, which created a total study population of 367,251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and between 10 μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. FINDINGS The total study population consisted of 367,251 participants who contributed 5,118,039 person-years at risk (average follow-up 13.9 years), of whom 29,076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m(3) (1.07, 1.01-1.13). INTERPRETATION Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value. FUNDING European Communitys Seventh Framework Program (FP7/2007-2011).

Coarse and fine particles but not ultrafine particles in urban air trigger hospital admission for asthma in children

Background Short-term exposure to air pollution can trigger hospital admissions for asthma in children, but it is not known which components of air pollution are most important. There are no available studies on the particular effect of ultrafine particles (UFPs) on paediatric admissions for asthma. Aim To study whether short-term exposure to air pollution is associated with hospital admissions for asthma in children. It is hypothesised that (1) the association between asthma admissions and air pollution is stronger with UFPs than with coarse (PM10) and fine (PM2.5) particles, nitrogen oxides (NOx) or nitrogen dioxide (NO2); and (2) infants are more susceptible to the effects of exposure to air pollution than older children. Method Daily counts of admissions for asthma in children aged 0–18 years to hospitals located within a 15 km radius of the central fixed background urban air pollution measurement station in Copenhagen between 2001 and 2008 were extracted from the Danish National Patient Registry. A time-stratified case crossover design was applied and data were analysed using conditional logistic regression to estimate the effect of air pollution on asthma admissions. Results A significant association was found between hospital admissions for asthma in children aged 0–18 years and NOx (OR 1.11; 95% CI 1.05 to 1.17), NO2 (1.10; 95% CI 1.04 to 1.16), PM10 (1.07; 95% CI 1.03 to 1.12) and PM2.5 (1.09; 95% CI 1.04 to 1.13); there was no association with UFPs. The association was stronger in infants than in older children for all pollutants, but no statistically significant interaction was detected. Conclusion Short-term exposure to air pollution can trigger hospital admission for asthma in children, with infants possibly being most susceptible. These effects seemed to be mediated by larger particles and traffic-related gases, whereas UFPs showed no effect.

Modelling Nitrogen Deposition on a Local Scale—A Review of the Current State of the Art

Abstract. Local ammonia emissions from agricultural activities are often associated with high nitrogen deposition in the close vicinity of the sources. High nitrogen (N) inputs may significantly affect the local ecosystems. Over a longer term, high loads may change the composition of the ecosystems, leading to a general decrease in local biodiversity. In Europe there is currently a significant focus on the impact of atmospheric N load on local ecosystems among environmental managers and policy makers. Model tools designed for application in N deposition assessment and aimed for use in the regulation of anthropogenic nitrogen emissions are, therefore, under development in many European countries. The aim of this paper is to present a review of the current understanding and modelling parameterizations of atmospheric N deposition. A special focus is on the development of operational tools for use in environmental assessment and regulation related to agricultural ammonia emissions. For the often large number of environmental impact assessments needed to be carried out by local environmental managers there is, furthermore, a need for simple and fast model systems. These systems must capture the most important aspects of dispersion and deposition of N in the nearby environment of farms with animal production. The paper includes a discussion on the demands on the models applied in environmental assessment and regulation and how these demands are fulfilled in current state-of-the-art models.

Apparent temperature and acute myocardial infarction hospital admissions in Copenhagen, Denmark: a case-crossover study

BackgroundThe influence of temperature on acute myocardial infarction (AMI) has not been investigated as extensively as the effects of broader outcomes of morbidity and mortality. Sixteen studies reported inconsistent results and two considered confounding by air pollution. We addressed some of the methodological limitations of the previous studies in this study.MethodsThis is the first study of the association between the daily 3-hour maximum apparent temperature (Tappmax) and AMI hospital admissions in Copenhagen. The study period covered 1 January 1999-31 December 2006, stratified in warm (April - September) and cold (October - March) periods. A case-crossover epidemiology study design was applied. Models were adjusted for public holidays and influenza, confounding by PM10, NO2 and CO was investigated, the lag and non-linear effects of Tappmax was examined, effect modification by age, sex and SES was explored, and the results of the case-crossover models were compared to those of the generalised additive Poisson time-series and generalised estimating equation models.Results14 456 AMI hospital admissions (12 995 people) occurred during the study period. For an inter-quartile range (6 or 7°C) increase in the 5-day cumulative average of Tappmax, a 4% (95% CI:-2%; 10%) and 9% (95% CI: 3%; 14%) decrease in the AMI admission rate was observed in the warm and cold periods, respectively. The 19-65 year old group, men and highest SES group seemed to be more susceptible in the cold period.ConclusionAn increase in Tappmax is associated with a decrease in AMI admissions during the colder months.

Apparent temperature and cause-specific emergency hospital admissions in Greater Copenhagen, Denmark.

One of the key climate change factors, temperature, has potentially grave implications for human health. We report the first attempt to investigate the association between the daily 3-hour maximum apparent temperature (Tappmax) and respiratory (RD), cardiovascular (CVD), and cerebrovascular (CBD) emergency hospital admissions in Copenhagen, controlling for air pollution. The study period covered 1 January 2002−31 December 2006, stratified in warm and cold periods. A case-crossover design was applied. Susceptibility (effect modification) by age, sex, and socio-economic status was investigated. For an IQR (8°C) increase in the 5-day cumulative average of Tappmax, a 7% (95% CI: 1%, 13%) increase in the RD admission rate was observed in the warm period whereas an inverse association was found with CVD (−8%, 95% CI: −13%, −4%), and none with CBD. There was no association between the 5-day cumulative average of Tappmax during the cold period and any of the cause-specific admissions, except in some susceptible groups: a negative association for RD in the oldest age group and a positive association for CVD in men and the second highest SES group. In conclusion, an increase in Tappmax is associated with a slight increase in RD and decrease in CVD admissions during the warmer months.

Use of the ACDEP trajectory model in the Danish nation-wide Background Monitoring Programme

Abstract The frequently observed eutrophication problems in Danish marine waters are associated with high nutrient loads. This paper outlines how the atmospheric part of the load is determined within the framework of the Danish Background Monitoring Programme. The analyses within the programme are carried out by use of both measurements and model calculations, where the modelling part receives the main focus in this paper. The performed calculations indicate that the atmospheric nitrogen deposition to the Danish marine waters is of comparable size to the river run-off, and in some periods even the dominating contribution to the overall nitrogen input. The model results are shown to be sensitive to the resolution of the meteorological input data for the calculations. Strong improvement of the model performance is the result when meteorological data with much higher temporal and spatial resolution are applied.

Cardiovascular and lung function in relation to outdoor and indoor exposure to fine and ultrafine particulate matter in middle-aged subjects

This cross-sectional study investigated the relationship between exposure to airborne indoor and outdoor particulate matter (PM) and cardiovascular and respiratory health in a population-based sample of 58 residences in Copenhagen, Denmark. Over a 2-day period indoor particle number concentrations (PNC, 10-300 nm) and PM2.5 (aerodynamic diameter<2.5 μm) were monitored for each of the residences in the living room, and outdoor PNC (10-280 nm), PM2.5 and PM10 (aerodynamic diameter<10 μm) were monitored at an urban background station in Copenhagen. In the morning, after the 2-day monitoring period, we measured microvascular function (MVF) and lung function and collected blood samples for biomarkers related to inflammation, in 78 middle-aged residents. Bacteria, endotoxin and fungi were analyzed in material from electrostatic dust fall collectors placed in the residences for 4 weeks. Data were analyzed using linear regression with the generalized estimating equation approach. Statistically significant associations were found between indoor PNC, dominated by indoor use of candles, and lower lung function, the prediabetic marker HbA1c and systemic inflammatory markers observed as changes in leukocyte differential count and expression of adhesion markers on monocytes, whereas C-reactive protein was significantly associated with indoor PM2.5. The presence of indoor endotoxin was associated with lower lung function and expression of adhesion markers on monocytes. An inverse association between outdoor PNC and MVF was also statistically significant. The study suggests that PNC in the outdoor environment may be associated with decreased MVF, while PNC, mainly driven by candle burning, and bioaerosols in the indoor environment may have a negative effect on lung function and markers of systemic inflammation and diabetes.

Out-of-hospital cardiac arrests and outdoor air pollution exposure in Copenhagen, Denmark

Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM10, PM2.5, coarse fraction of PM (PM10-2.5), ultrafine particle proxies, NOx, NO2, O3 and CO in Copenhagen, Denmark, for the period 2000–2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM2.5, lag3 of PM10, lag3 of PM10-2.5, lag3 of NOx and lag4 of CO. An IQR increase of PM2.5 and PM10 was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O3 slightly increased the association between OHCA and PM2.5 and PM10. No susceptible groups were identified.

Residential exposure to outdoor air pollution from livestock operations and perceived annoyance among citizens

Epidemiological studies have shown that residential exposure to livestock odors can affect the health and wellbeing of rural citizens. However, exposure-response models for this relationship have not been developed. One of the main challenges is to identify a compound that can be used as proxy for livestock odor exposure. In this paper we developed models that describe the relationship between long-term averaged outdoor residential ammonia (NH(3)) exposures and livestock odor annoyance experienced by rural residents, and investigated person-related variables associated with annoyance responses. We used emission-based atmospheric dispersion modeling data to estimate household-specific outdoor concentrations and survey data to characterize the study subjects. Binomial and multinomial logistic regressions were used for model development. Residential NH(3) exposure was positively associated with moderate, high and extreme odor annoyance (adjusted odds ratio=10.59; 95% confidence interval: 1.35-83.13, for each unit increase in Log(e)NH(3) exposure). Specific characteristics of the exposed subjects (i.e., age, time per week spent at home, presence of children at home and job) act as co-determinants of odor annoyance responses. Predictive models showed classification accuracies of 67-72%. The results suggest that NH(3) exposure in the residential outdoor environment can be used as a predictor of livestock odor annoyance in population studies.