Risk of Nonaccidental and Cardiovascular Mortality in Relation to Long-term Exposure to Low Concentrations of Fine Particulate Matter: A Canadian National-Level Cohort Study

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Abstract

Background: Few cohort studies have evaluated the risk of mortality associated with long-term exposure to fine particulate matter [≤ 2.5 μm in aerodynamic diameter (PM _2.5)]. This is the first national-level cohort study to investigate these risks in Canada.

Objective: We investigated the association between long-term exposure to ambient PM _2.5 and cardiovascular mortality in nonimmigrant Canadian adults.

Methods: We assigned estimates of exposure to ambient PM _2.5 derived from satellite observations to a cohort of 2.1 million Canadian adults who in 1991 were among the 20% of the population mandated to provide detailed census data. We identified deaths occurring between 1991 and 2001 through record linkage. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for available individual-level and contextual covariates using both standard Cox proportional survival models and nested, spatial random-effects survival models.

Results: Using standard Cox models, we calculated HRs of 1.15 (95% CI: 1.13, 1.16) from nonaccidental causes and 1.31 (95% CI: 1.27, 1.35) from ischemic heart disease for each 10-μg/m ³ increase in concentrations of PM _2.5. Using spatial random-effects models controlling for the same variables, we calculated HRs of 1.10 (95% CI: 1.05, 1.15) and 1.30 (95% CI: 1.18, 1.43), respectively. We found similar associations between nonaccidental mortality and PM _2.5 based on satellite-derived estimates and ground-based measurements in a subanalysis of subjects in 11 cities.

Conclusions: In this large national cohort of nonimmigrant Canadians, mortality was associated with long-term exposure to PM _2.5. Associations were observed with exposures to PM _2.5 at concentrations that were predominantly lower (mean, 8.7 μg/m ³; interquartile range, 6.2 μg/m ³) than those reported previously.

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Most cited references 30

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Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease.

C Arden Pope, Richard T Burnett, George D Thurston … (2004)

Epidemiologic studies have linked long-term exposure to fine particulate matter air pollution (PM) to broad cause-of-death mortality. Associations with specific cardiopulmonary diseases might be useful in exploring potential mechanistic pathways linking exposure and mortality. General pathophysiological pathways linking long-term PM exposure with mortality and expected patterns of PM mortality with specific causes of death were proposed a priori. Vital status, risk factor, and cause-of-death data, collected by the American Cancer Society as part of the Cancer Prevention II study, were linked with air pollution data from United States metropolitan areas. Cox Proportional Hazard regression models were used to estimate PM-mortality associations with specific causes of death. Long-term PM exposures were most strongly associated with mortality attributable to ischemic heart disease, dysrhythmias, heart failure, and cardiac arrest. For these cardiovascular causes of death, a 10-microg/m3 elevation in fine PM was associated with 8% to 18% increases in mortality risk, with comparable or larger risks being observed for smokers relative to nonsmokers. Mortality attributable to respiratory disease had relatively weak associations. Fine particulate air pollution is a risk factor for cause-specific cardiovascular disease mortality via mechanisms that likely include pulmonary and systemic inflammation, accelerated atherosclerosis, and altered cardiac autonomic function. Although smoking is a much larger risk factor for cardiovascular disease mortality, exposure to fine PM imposes additional effects that seem to be at least additive to if not synergistic with smoking.

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Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults.

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Time-series, cross-sectional, and prospective cohort studies have observed associations between mortality and particulate air pollution but have been limited by ecologic design or small number of subjects or study areas. The present study evaluates effects of particulate air pollution on mortality using data from a large cohort drawn from many study areas. We linked ambient air pollution data from 151 U.S. metropolitan areas in 1980 with individual risk factor on 552,138 adults who resided in these areas when enrolled in a prospective study in 1982. Deaths were ascertained through December, 1989. Exposure to sulfate and fine particulate air pollution, which is primarily from fossil fuel combustion, was estimated from national data bases. The relationships of air pollution to all-cause, lung cancer, and cardiopulmonary mortality was examined using multivariate analysis which controlled for smoking, education, and other risk factors. Although small compared with cigarette smoking, an association between mortality and particulate air pollution was observed. Adjusted relative risk ratios (and 95% confidence intervals) of all-cause mortality for the most polluted areas compared with the least polluted equaled 1.15 (1.09 to 1.22) and 1.17 (1.09 to 1.26) when using sulfate and fine particulate measures respectively. Particulate air pollution was associated with cardiopulmonary and lung cancer mortality but not with mortality due to other causes. Increased mortality is associated with sulfate and fine particulate air pollution at levels commonly found in U.S. cities. The increase in risk is not attributable to tobacco smoking, although other unmeasured correlates of pollution cannot be excluded with certainty.

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International statistical classification of diseases and related health problems. Tenth revision.

G Brämer (1988)

The International Classification of Diseases has, under various names, been for many decades the essential tool for national and international comparability in public health. This statistical tool has been customarily revised every 10 years in order to keep up with the advances of medicine. At first intended primarily for the classification of causes of death, its scope has been progressively widening to include coding and tabulation of causes of morbidity as well as medical record indexing and retrieval. The ability to exchange comparable data from region to region and from country to country, to allow comparison from one population to another and to permit study of diseases over long periods, is one of the strengths of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD). WHO has been responsible for the organization, coordination and execution of activities related to ICD since 1948 (Sixth Revision of the ICD) and is now proceeding with the Tenth Revision. For the first time in its history the ICD will be based on an alphanumeric coding scheme and will have to function as a core classification from which a series of modules can be derived, each reaching a different degree of specificity and adapted to a particular specialty or type of user. It is proposed that the chapters on external causes of injury and poisoning, and factors influencing health status and contact with health services, which were supplementary classifications in ICD-9, should form an integral part of ICD-10. The title of ICD has been amended to "International Statistical Classification of Diseases and Related Health Problems"', but the abbreviation "ICD" will be retained.(ABSTRACT TRUNCATED AT 250 WORDS)

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Author and article information

Journal

Journal ID (nlm-ta): Environ Health Perspect

Journal ID (iso-abbrev): Environ. Health Perspect

Journal ID (publisher-id): EHP

Title: Environmental Health Perspectives

Publisher: National Institute of Environmental Health Sciences

ISSN (Print): 0091-6765

ISSN (Electronic): 1552-9924

Publication date (Electronic): 07 February 2012

Publication date (Print): May 2012

Volume: 120

Issue: 5

Pages: 708-714

Affiliations

[1 ]Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada

[2 ]Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada

[3 ]Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada

[4 ]Department of Medicine, McGill University, Montreal, Quebec, Canada

[5 ]Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

[6 ]School of Public Health, University of California–Berkeley, Berkeley, California, USA

[7 ]Department of Economics, Brigham Young University, Provo, Utah, USA

[8 ]School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada

[9 ]Air Quality Research Division, Environment Canada, Downsview, Ontario, Canada

[10 ]Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, USA

Author notes

Address correspondence to D.L. Crouse, Health Canada, Room 155, Environmental Health Centre, 50 Columbine Dr., Ottawa, ON Canada K1A 0K9. Telephone: (613) 952-4789. Fax: (613) 941-3883. E-mail: daniel.crouse@ 123456hc-sc.gc.ca

Article

Publisher ID: ehp.1104049

DOI: 10.1289/ehp.1104049

PMC ID: 3346774

PubMed ID: 22313724

SO-VID: ea1c407b-0e8f-4864-8915-6bc2c008687d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 08 June 2011

Date accepted : 07 February 2012

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