Health studies have found associations between long-term concentrations of outdoor air pollution and an increased risk of admission to hospital or death from a range of diseases. The World Health Organisation have expressed concern that these associations may persist at pollutant concentrations below current European and US limit values. To investigate possible health effects associated with low air pollution levels, the US Health Effects Institute have funded a collaboration of European researchers to undertake analyses of deaths and other indicators of disease. Patients registered in CPRD in 2010 will be linked to modelled concentrations of air pollutants (fine particles, black carbon (soot), nitrogen dioxide and ozone; vehicular non-tailpipe pollution (Cu, Fe, Zn) and secondary inorganic aerosol; and fine particle concentrations derived from satellite monitoring). Patients who die, or receive their first diagnosis of cardiovascular disease, dementia, or lung cancer or diabetes mortality in the period 2011-2017, will be identified from primary care records, hospital admissions and mortality records. The relationship between concentrations of pollution and risk of disease/death accounting for lifestyle factors such as smoking will be determined. Results from the analyses of the CPRD data will be combined with results from similar analyses in other European centres and will provide policy makers with new information to assess the health impact of low concentrations of ambient pollution and evaluate regulatory measures.
The objective of this study, part of a European-wide multi-centre project, is to investigate associations between long-term concentrations of outdoor air pollution and health, with particular focus on the shape of the concentration-response relationship at low pollutant concentrations. If associations are observed at low levels, then these findings will have important implications for public health because of the very large populations exposed. Concentrations of fine particles, black carbon, nitrogen dioxide, ozone and vehicular non-tailpipe pollution (Cu, Fe, Zn) and secondary inorganic aerosol will be estimated at 100m grid resolution across England for 2010 using statistically derived (land use regression) models and satellite monitoring. Using patients registered in CPRD throughout 2010, all disease related and cardiorespiratory deaths and incident cardiovascular, dementia and lung cancer during 2011-2017 will be determined from primary care, hospital admissions and death records. Cox proportional hazard models controlling for age, gender, BMI, smoking status and socioeconomic status will be used to estimate the hazard associated with pollutant concentrations. The shape of the concentration response function will be assessed using non-parametric spline functions. The hazard ratios will be combined with those from the other cohorts in the project in an European-wide meta-analyses to improve precision of the effect estimates.
Mortality
- Coronary and cerebrovascular disease incidence
- Lung cancer incidence
- Dementia incidence
- Diabetes mortality
Richard Atkinson - Chief Investigator - St George's, University of London
Richard Atkinson - Corresponding Applicant - St George's, University of London
Iain Carey - Collaborator - St George's, University of London
John Gulliver - Collaborator - Imperial College London
Fay Hosking - Collaborator - St George's, University of London
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation