@article{de99cd691c764f70bf6c1721e76b45dd,
title = "All-cause mortality and long-term exposure to low level air pollution in the {\textquoteleft}45 and up study{\textquoteright} cohort, Sydney, Australia, 2006–2015",
abstract = " Background: Epidemiological studies show that long-term exposure to ambient air pollution reduces life expectancy. Most studies have been in environments with relatively high concentrations such as North America, Europe and Asia. Associations at the lower end of the concentration-response function are not well defined. Objectives: We assessed associations between all-cause mortality and exposure to annual average particulate matter <2.5 μm (PM 2.5 ) and nitrogen dioxide (NO 2 ) in Sydney, Australia, where concentrations are relatively low. Methods: The {\textquoteleft}45 and Up Study{\textquoteright} comprises a prospective longitudinal cohort from the state of New South Wales, Australia with 266,969 participants linked to death registry data. We analyzed data for the participants who resided in Sydney at baseline questionnaire (n = 75,268). Exposures to long-term pollution were estimated using annual averages from a chemical transport model (PM 2.5 ), and a satellite-based land-use regression model (NO 2 ). Socio-demographic information was extracted from the baseline questionnaire. Cox proportional hazard models were applied to estimate associations, while adjusting for covariates. Results: In our cohort mean annual PM 2.5 was 4.5 μg/m 3 and mean NO 2 was 17.8 μg/m 3 . The mortality rate was 4.4% over the 7 years of follow up. Models that adjusted for individual-level and area-level risk factors resulted in a detrimental non statistically significant hazard ratio (HR) of 1.05 (95% CI: 0.98–1.12) per 1 μg/m 3 increase in PM 2.5 , and 1.03 (95% CI: 0.98–1.07) per 5 μg/m 3 increase in NO 2 . Conclusions: We found evidence that low-level air pollution exposure was associated with increased risk of mortality in this cohort of adults aged 45 years and over, even at the relatively low concentrations seen in Sydney. However, a clear determination of the association with mortality is difficult because the results were sensitive to some covariates. Our findings are supportive of emerging evidence that exposure to low levels of air pollution reduces life expectancy. ",
keywords = "All-cause mortality, Fine particulate matter, Gaseous pollutants, Low concentration, Survival model, Prospective Studies, Risk Assessment, Humans, Middle Aged, Mortality, Male, Air Pollution/adverse effects, New South Wales/epidemiology, Air Pollutants/adverse effects, Aged, 80 and over, Female, Aged, Longitudinal Studies, Environmental Exposure/adverse effects",
author = "Hanigan, {Ivan C.} and Rolfe, {Margaret I.} and Knibbs, {Luke D.} and Farhad Salimi and Cowie, {Christine T.} and Jane Heyworth and Marks, {Guy B.} and Yuming Guo and Martin Cope and Adrian Bauman and Bin Jalaludin and Morgan, {Geoffrey G.}",
note = "Funding Information: IH, FS and LK were supported by The Centre for Air Pollution, Energy and Health Research (CAR). CAR ( www.car-cre.org.au ) is an Australian National Health and Medical Research Council (NHMRC) funded Centre for Research Excellence ( APP1030259 ). YG was supported by the Career Development Fellowship of NHMRC (# APP1107107 ). Funding Information: Informed consent was obtained from all survey participants. The study presented in this paper was approved by the NSW Population & Health Services Research Ethics Committee AU RED Reference: HREC/15/CIPHS/4, Cancer Institute NSW reference number: 2015/02/575 for Sub-study 2 [Air Pollution, Traffic Exposures and Mortality and Morbidity in Older Australians (APTEMA) Study], under the overarching project titled {\textquoteleft}Understanding the impact of the social, economic and environmental factors on the health of Australians in mid - later life; where are the opportunities for prevention?{\textquoteright} (NHMRC grant 402,810). Thanks go to Associate Professor Philayrath Phongsavan at The University of Sydney for coordination of the data cleaning. Funding Information: This research was completed using data collected through the {\textquoteleft}45 and Up Study{\textquoteright} ( www.saxinstitute.org.au ). The {\textquoteleft}45 and Up Study{\textquoteright} is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; NSW Government Family & Community Services – Ageing, Carers and the Disability Council NSW; and the Australian Red Cross Blood Service. We thank the many thousands of people participating in the 45 and Up Study. Publisher Copyright: {\textcopyright} 2019 The Authors",
year = "2019",
month = may,
doi = "10.1016/j.envint.2019.02.044",
language = "English",
volume = "126",
pages = "762--770",
journal = "Environment International",
issn = "0160-4120",
publisher = "Elsevier Limited",
}
