TY - JOUR
TI - Investigating the association between long-term exposure to air pollution and greenness with mortality from neurological, cardio-metabolic and chronic obstructive pulmonary diseases in Greece
AU - Kasdagli, M.-I.
AU - Katsouyanni, K.
AU - de Hoogh, K.
AU - Lagiou, P.
AU - Samoli, E.
JO - Environmental Pollution
PY - 2022
VL - 292
TODO - null
SP - null
PB - Elsevier Ireland Ltd
SN - 0269-7491
TODO - 10.1016/j.envpol.2021.118372
TODO - Diagnosis;  Economics;  Land use;  Nitrogen oxides;  Pulmonary diseases, Cause-specific mortality;  Chronic obstructive pulmonary disease;  Confidence interval;  Ecological studies;  Greenness;  Long term exposure;  Normalized difference vegetation index;  PM 2.5;  Relative risks;  Synergistic effect, Air pollution, black carbon;  nitrogen dioxide;  ozone, atmospheric pollution;  autocorrelation;  census;  diabetes;  health risk;  mortality;  pollution exposure;  regression analysis;  respiratory disease;  spatial analysis, air pollutant;  air pollution;  Article;  cardiovascular disease;  cerebrovascular disease;  chronic obstructive lung disease;  concentration (parameter);  diabetes mellitus;  disease association;  Greece;  human;  ischemic heart disease;  land use;  long term exposure;  medical research;  metabolic disorder;  mortality;  mortality rate;  mortality risk;  neurologic disease;  particulate matter 2.5;  Poisson regression;  prediction;  regression model;  socioeconomics;  spatial autocorrelation analysis;  vegetation;  adverse event;  air pollutant;  environmental exposure;  epidemiology;  Greece;  particulate matter, Greece, Air Pollutants;  Air Pollution;  Environmental Exposure;  Greece;  Humans;  Particulate Matter;  Pulmonary Disease, Chronic Obstructive
TODO - Long-term exposure to air pollution has been associated with increased natural-cause mortality, but the evidence on diagnoses-specific mortality outcomes is limited. Few studies have examined the potential synergistic effects of exposure to pollutants and greenness. We investigated the association between exposure to air pollution and greenness with nervous system related mortality, cardiometabolic and chronic obstructive pulmonary diseases (COPD) mortality in Greece, using an ecological study design. We collected socioeconomic and mortality data for 1035 municipal units from the 2011 Census. Annual PM2.5, NO2, BC and O3 concentrations for 2010 were predicted at 100 × 100 m grids by hybrid land use regression models. The normalized difference vegetation index (NDVI) was used for greenness. We applied single and two-exposure Poisson regression models on standardized mortality rates accounting for spatial autocorrelation. We assessed interactions between pollutants and greenness. An interquartile range increase in PM2.5, NO2 and BC was associated with increased risk in mortality from diseases of the nervous system (relative risk (RR): 1.14, 95% confidence interval (CI): 1.01, 1.28); 1.03 (95% CI: 0.99, 1.07); 1.05 (95% CI: 1.00, 1.10) respectively) and from cerebrovascular disease (RR: 1.14, 95% CI: 1.10, 1.18); 1.02 (95% CI: 1.01, 1.04); 1.02 (95% CI: 1.00, 1.04) respectively). PM2.5 was associated with ischemic heart disease mortality (RR: 1.05, 95% CI: 1.01, 1.10). We estimated inverse associations for all outcomes with O3 and for mortality from diseases of the nervous system or COPD with greenness. Estimates were mostly robust to co-exposure adjustment. Interactions were identified between NDVI and O3 or PM2.5 on mortality from the diseases of the nervous system, with higher effect estimates in greener areas. Our findings support the adverse effects of air pollution and the beneficial role of greenness on cardiovascular and nervous system related mortality. Further research is needed on diabetes mellitus. © 2021 Elsevier Ltd
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