Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study

Environment International

Volume 85, December 2015, Pages 5–14

• Malek Bentayeb^{a, ,} ,
• Verene Wagner^a,
• Morgane Stempfelet^a,
• Marie Zins^{b, c},
• Marcel Goldberg^{b, c},
• Mathilde Pascal^a,
• Sophie Larrieu^a,
• Pascal Beaudeau^a,
• Sylvie Cassadou^a,
• Daniel Eilstein^a,
• Laurent Filleul^a,
• Alain Le Tertre^a,
• Sylvia Medina^a,
• Laurence Pascal^a,
• Helene Prouvost^a,
• Philippe Quénel^{a, d},
• Abdelkrim Zeghnoun^a,
• Agnes Lefranc^a

doi:10.1016/j.envint.2015.08.006

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Highlights

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We assessed air quality using deterministic and geostatistical modeling approach.

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We tested several lags of exposure including time-varying exposures.

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We analyzed data of a large French cohort followed-up from 1989 to 2013.

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Long-term exposure to several air pollutants was associated with all-cause mortality.

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Abstract

Introduction

Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France.

Objectives

We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013.

Methods

The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM₁₀, PM_10–2.5, PM_2.5, NO₂, O₃, SO₂, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations.

Results

The cohort recorded 1967 non-accidental deaths. Long-term exposures to baseline PM_2.5, PM_10-25, NO₂ and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 μg/m³, PM_10-25; HR = 1.09;

95% CI: 1.04, 1.15 per 2.2 μg/m³, NO₂: HR = 1.14; 95% CI: 0.99, 1.31 per 19.3 μg/m³ and benzene: HR = 1.10; 95% CI: 1.00, 1.22 per 1.7 μg/m³).The strongest association was found for PM₁₀: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 μg/m³. PM₁₀, PM_10-25 and SO₂ were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality.

Conclusion

Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.

Keywords

• Air pollution;
• Mortality;
• Cohort study;
• Epidemiology;
• France

Corresponding author at: French Institute for Public Health Surveillance (InVS), 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.

Copyright © 2015 Elsevier Ltd. All rights reserved.