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      Air Pollution, Noise, Blue Space, and Green Space and Premature Mortality in Barcelona: A Mega Cohort

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          Abstract

          Introduction: Cities often experience high air pollution and noise levels and lack of natural outdoor environments, which may be detrimental to health. The aim of this study was to evaluate the effects of air pollution, noise, and blue and green space on premature all-cause mortality in Barcelona using a mega cohort approach. Methods: Both men and women of 18 years and above registered on 1 January 2010 by the Sistema d’Informació pel Desenvolupament de la Investigació en Atenció Primària (SIDIAP) and living in the city of Barcelona were included in the cohort and followed up until 31 December 2014 or until death ( n = 2,939,067 person years). The exposure assessment was conducted at the census tract level ( n = 1061). We assigned exposure to long term ambient levels of nitrogen dioxides (NO 2), nitrogen oxides (NO x), particulate matter with aerodynamic diameter less than 2.5 µm (PM 2.5), between 2.5 µm and 10 µm (PM 2.5–10, i.e., coarse particulate matter), less than 10 µm (PM 10) and PM 2.5 light absorption (hereafter referred to as PM 2.5 absorbance) based on land use regressions models. Normalized Difference Vegetation Index (NDVI) was assigned based on remote sensing data, percentage green space and blue space were calculated based on land use maps and modelled road traffic noise was available through the strategic noise map for Barcelona. Results: In this large prospective study ( n = 792,649) in an urban area, we found a decreased risk of all-cause mortality with an increase in green space measured as NDVI (hazard ratio (HR) = 0.92, 95% CI 0.89–0.97 per 0.1) and increased risks of mortality with an increase in exposure to blue space (HR = 1.04, 95% CI 1.01–1.06 per 1%), NO 2 (HR = 1.01, 95% CI 1.00–1.02 per 5 ug/m 3) but no risk with noise (HR = 1.00, 95% CI 0.98–1.02 per 5 dB(A)). The increased risks appeared to be more pronounced in the more deprived areas. Results for NDVI, and to a lesser extent NO 2, remained most consistent after mutual adjustment for other exposures. The NDVI estimate was a little attenuated when NO 2 was included in the model. The study had some limitations including e.g., the assessment of air pollution, noise, green space and socioeconomic status (SES) on census tract level rather than individual level and residual confounding. Conclusion: This large study provides new insights on the relationship between green and blue space, noise and air pollution and premature all-cause mortality.

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          Most cited references33

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          Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project

          Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. We used data from 22 European cohort studies, which created a total study population of 367,251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and between 10 μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. The total study population consisted of 367,251 participants who contributed 5,118,039 person-years at risk (average follow-up 13.9 years), of whom 29,076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m(3) (1.07, 1.01-1.13). Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value. European Community's Seventh Framework Program (FP7/2007-2011). Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project.

            Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM(2.5), PM(2.5) absorbance, PM(10), and PM(coarse) were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R(2)) was 71% for PM(2.5) (range across study areas 35-94%). Model R(2) was higher for PM(2.5) absorbance (median 89%, range 56-97%) and lower for PM(coarse) (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R(2) was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R(2) results were on average 8-11% lower than model R(2). Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE.
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              Air Pollution and Mortality in the Medicare Population.

              Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                30 October 2018
                November 2018
                : 15
                : 11
                : 2405
                Affiliations
                [1 ]ISGlobal, 08003 Barcelona, Spain; mireia.gascon@ 123456isglobal.org (M.G.); mardav92@ 123456gmail.com (D.M.); maria.foraster@ 123456isglobal.org (M.F.); natalie.mueller@ 123456isglobal.org (N.M.); ana.espinosa@ 123456isglobal.org (A.E.); marta.cirach@ 123456isglobal.org (M.C.); H-Khreis@ 123456tti.tamu.edu (H.K.); payam.dadvand@ 123456isglobal.org (P.D.); xavier.basagana@ 123456isglobal.org (X.B.)
                [2 ]Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
                [3 ]CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
                [4 ]ISV Research Group, Research Unit in Primary Care, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17190 Catalonia, Spain; aponjoan@ 123456idiapjgol.info (A.P.); jblanch@ 123456idiapjgol.info (J.B.); mgarcia@ 123456idiapjgol.info (M.d.M.G.-G.); rramos.girona.ics@ 123456gencat.cat (R.R.)
                [5 ]Girona Biomedical Research Institute (IDIBGi), 17190 Catalonia, Spain
                [6 ]Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalonia, Spain
                [7 ]Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
                [8 ]Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH), Texas A&M Transportation Institute (TTI), College Station, TX 77843, USA
                Author notes
                [* ]Correspondence: mark.nieuwenhuijsen@ 123456isglobal.org ; Tel.: +34-608-050-814
                Author information
                https://orcid.org/0000-0003-4537-8472
                https://orcid.org/0000-0001-7001-7674
                Article
                ijerph-15-02405
                10.3390/ijerph15112405
                6265844
                30380717
                f5b2c786-c510-4084-95a1-a2ce3a061e32
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 20 September 2018
                : 27 October 2018
                Categories
                Article

                Public health
                air pollution,green space,blue space,noise,mortality,city,cohort
                Public health
                air pollution, green space, blue space, noise, mortality, city, cohort

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