Historic air pollution exposure and long-term mortality risks in England and Wales: prospective longitudinal cohort study

Abstract

IntroductionLong-term air pollution exposure contributes to mortality but there are few studies examining effects of very long-term (>25 years) exposures.MethodsThis study investigated modelled air pollution concentrations at residence for 1971, 1981, 1991 (black smoke (BS) and SO2) and 2001 (PM10) in relation to mortality up to 2009 in 367 658 members of the longitudinal survey, a 1% sample of the English Census. Outcomes were all-cause (excluding accidents), cardiovascular (CV) and respiratory mortality.ResultsBS and SO2 exposures remained associated with mortality decades after exposure—BS exposure in 1971 was significantly associated with all-cause (OR 1.02 (95% CI 1.01 to 1.04)) and respiratory (OR 1.05 (95% CI 1.01 to 1.09)) mortality in 2002–2009 (ORs expressed per 10 μg/m3). Largest effect sizes were seen for more recent exposures and for respiratory disease. PM10 exposure in 2001 was associated with all outcomes in 2002–2009 with stronger associations for respiratory (OR 1.22 (95% CI 1.04 to 1.44)) than CV mortality (OR 1.12 (95% CI 1.01 to 1.25)). Adjusting PM10 for past BS and SO2 exposures in 1971, 1981 and 1991 reduced the all-cause OR to 1.16 (95% CI 1.07 to 1.26) while CV and respiratory associations lost significance, suggesting confounding by past air pollution exposure, but there was no evidence for effect modification. Limitations include limited information on confounding by smoking and exposure misclassification of historic exposures.ConclusionsThis large national study suggests that air pollution exposure has long-term effects on mortality that persist decades after exposure, and that historic air pollution exposures influence current estimates of associations between air pollution and mortality.

Life course of place: A longitudinal study of mental health and place

“…Beyond local social context, the only other aspects of place that have been examined in a long-term life-course framework are the influence of air pollution (Elliott et al, 2007) and residing in a rural context (Jokela et al, 2009). Hansell et al (2016, for example, combined data from members of the England and Wales Longitudinal Study with data on air pollution concentrations at residence in 1971, 1981, 1991 and 2001 to examine the contribution of long-term air pollution exposure to mortality (all-cause [excluding accidents], cardiovascular and respiratory mortality).…”

“…Hansell et al. (), for example, combined data from members of the England and Wales Longitudinal Study with data on air pollution concentrations at residence in 1971, 1981, 1991 and 2001 to examine the contribution of long‐term air pollution exposure to mortality (all‐cause [excluding accidents], cardiovascular and respiratory mortality). The authors found that associations with air pollution persisted decades after exposure, emphasising that circumstances in earlier life can have implications for health much later in life.…”

Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China

“…In England, black smoke levels dropped from 42.7 μg/m 3 in 1971 to 11.8 μg/m 3 in 2001. 30 London's annual mean PM 2.5 has held at an around 20 μg/m 3 . Recent average PM 2.5 levels in Los Angeles are near the WHO goal at 10 μg/m 3 .…”

Progress with air quality management in the 60 years since the UK clean Air Act, 1956. Lessons, failures, challenges and opportunities

“…The number of deaths has subsequently been a subject of some debate with 12,000 excess deaths and some 100,000 cases of respiratory illness being suggested. Recent work by Hansell et al [3] suggests that exposure to high air pollution concentrations carries a long-term risk to health. The smog of 1952 was a catastrophe with a very high increase in respiratory mortality and morbidity.…”