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Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer
So R, Andersen ZJ, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Rodopoulou S et al.. Environment international, 2022-04-12
Topic: Risk, prevention and care in population studies
Background The association between long-term exposure to air pollution and mortality from cardiorespiratory diseases is well established, yet the evidence for other diseases remains limited. Objectives To examine the associations of long-term exposure to air pollution with mortality from diabetes, dementia, psychiatric disorders, chronic kidney disease (CKD), asthma, acute lower respiratory infection (ALRI), as well as mortality from all-natural and cardiorespiratory causes in the Danish nationwide administrative cohort. Methods We followed all residents aged ≥ 30 years (3,083,227) in Denmark from 1 January 2000 until 31 December 2017. Annual mean concentrations of fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), black carbon (BC), and ozone (warm season) were estimated using European-wide hybrid land-use regression models (100 m × 100 m) and assigned to baseline residential addresses. We used Cox proportional hazard models to evaluate the association between air pollution and mortality, accounting for demographic and socioeconomic factors. We additionally applied indirect adjustment for smoking and body mass index (BMI). Results During 47,023,454 person-years of follow-up, 803,881 people died from natural causes. Long-term exposure to PM 2.5 (mean: 12.4 µg/m 3 ), NO 2 (20.3 µg/m 3 ), and/or BC (1.0 × 10 -5 /m) was statistically significantly associated with all studied mortality outcomes except CKD. A 5 µg/m 3 increase in PM 2.5 was associated with higher mortality from all-natural causes (hazard ratio 1.11; 95% confidence interval 1.09-1.13), cardiovascular disease (1.09; 1.07-1.12), respiratory disease (1.11; 1.07-1.15), lung cancer (1.19; 1.15-1.24), diabetes (1.10; 1.04-1.16), dementia (1.05; 1.00-1.10), psychiatric disorders (1.38; 1.27-1.50), asthma (1.13; 0.94-1.36), and ALRI (1.14; 1.09-1.20). Associations with long-term exposure to ozone (mean: 80.2 µg/m 3 ) were generally negative but became significantly positive for several endpoints in two-pollutant models. Generally, associations were attenuated but remained significant after indirect adjustment for smoking and BMI. Conclusion Long-term exposure to PM 2.5 , NO 2 , and/or BC in Denmark were associated with mortality beyond cardiorespiratory diseases, including diabetes, dementia, psychiatric disorders, asthma, and ALRI.
Key findings
- Results During 47,023,454 person-years of follow-up, 803,881 people died from natural causes.
- Long-term exposure to PM 2.5 (mean: 12.4 µg/m 3 ), NO 2 (20.3 µg/m 3 ), and/or BC (1.0 × 10 -5 /m) was statistically significantly associated with all studied mortality outcomes except CKD.
- A 5 µg/m 3 increase in PM 2.5 was associated with higher mortality from all-natural causes (hazard ratio 1.11; 95% confidence interval 1.09-1.13), cardiovascular disease (1.09; 1.07-1.12), respiratory disease (1.11; 1.07-1.15), lung cancer (1.19; 1.15-1.24), diabetes (1.10; 1.04-1.16), dementia (1.05; 1.00-1.10), psychiatric disorders (1.38; 1.27-1.50), asthma (1.13; 0.94-1.36), and ALRI (1.14; 1.09-1.20).
- Associations with long-term exposure to ozone (mean: 80.2 µg/m 3 ) were generally negative but became significantly positive for several endpoints in two-pollutant models.
- Generally, associations were attenuated but remained significant after indirect adjustment for smoking and BMI.
Why it matters
This Danish cohort study found that long-term exposure to certain air pollutants was statistically significantly associated with mortality from several causes, including dementia. It reports an association between air pollution and death from dementia but does not test or report any treatment, cure, or prevention for Alzheimer's disease.
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Study details
- Participants803,881
- Evidence strengthModerate
How this study scored 57/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Environment international) |
| Journal's citation record | 3 / 4 | Environment International: journal h-index 335 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 803,881 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 94 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 15.7 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 3 / 6 | Cited 7.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 3 / 4 | Cited 60 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Amar Jayant Mehta: h-index 38 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 17 institution(s) in 10 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 35544998) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 57 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1016/j.envint.2022.107241
- PubMed: 35544998
- Original source →
- Free full text: Environment International →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
So, R., Andersen, Z. J., Chen, J., Stafoggia, M., de Hoogh, K., Katsouyanni, K., et al. (2022). Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer. Environment international. https://doi.org/10.1016/j.envint.2022.107241
Vancouver
So R, Andersen ZJ, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, et al. Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer. Environment international. 2022. doi:10.1016/j.envint.2022.107241. PMID: 35544998.
BibTeX
@article{so2022-35544998,
author = {So, R. and Andersen, Z. J. and Chen, J. and Stafoggia, M. and de Hoogh, K. and Katsouyanni, K. and Vienneau, D. and Rodopoulou, S. and others},
title = {{Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer}},
journal = {Environment international},
year = {2022},
doi = {10.1016/j.envint.2022.107241},
pmid = {35544998},
url = {https://doi.org/10.1016/j.envint.2022.107241}
}
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