Unit:
Τομέας Κοινωνικής Ιατρικής - Ψυχιατρικής και ΝευρολογίαςLibrary of the School of Health Sciences
Dissertation committee:
Κλέα Κατσουγιάννη, Αντωνία Τριχοπούλου, Χριστίνα Μπάμια
Original Title:
Επίδραση της μακροχρόνιας έκθεσης σε ατμοσφαιρική ρύπανση, σχετιζόμενη με κυκλοφοριακή κίνηση, στη νοσηρότητα και τη θνησιμότητα από καρδιαγγειακά νοσήματα, στο Λεκανοπέδιο της Αττικής
Summary:
Several studies have provided evidence of the adverse effects of short
term exposures to air pollution on cardiovascular morbidity and mortality. The
corresponding studies related to long term exposures are fewer, have mostly
been implemented at the US or Northern Europe. Most of them report an adverse
association between air pollution and the incidence of and mortality from
cardiovascular diseases. However, some publications report no relationship
between long term exposure to air pollution and cardiovascular disease.
Older studies have used estimates of exposure to pollution based on
measurements from fixed air pollution monitoring sites, thus attributing the
same exposure estimate to all subjects in the same area. In recent
publications, researchers try to individualize the exposure estimation to air
pollution, more frequently by applying land use regression models.
Our objective was to evaluate the effects of long term exposure to
traffic-related air pollution on the incidence of and mortality from
cardiovascular disease (CVD) in a Greek cohort in the Attica area.
We used data from the European Prospective Investigation on Nutrition
and Cancer (EPIC) for 2752 subjects followed from 1997 to 2011, whose residence
was in 10 municipalities of the Greater Athens area. Air pollution exposure
estimation was based on a spatio-temporal land use regression (LUR) model
linking geo-coded
residential addresses to long-term average PM10 and NO2 concentrations. The
incidence of and mortality from cardiovascular events, myocardial infarction
and stroke were considered as health outcomes. For the statistical analysis,
Cox proportional hazards models were used, adjusting for the potential
confounding effects of several demographic and socioeconomic factors.
We found an association between PM10 exposure with the incidence of
total cardiovascular events (HR for 10μg/m3 increase in exposure to PM10: 1.43,
p-value: 0.056), more pronounced among younger subjects (HR for 10μg/m3
increase in exposure to PM10 for subjects aged 50 years old at enrollment:
1.98, p-value: 0.038), as well as the incidence of ischemic heart disease
events among women (HR for 10μg/m3 increase in exposure to PM10: 2.28, p-value:
0.079). All other associations examined with cardiovascular incidence outcomes,
separately by gender and by age group, were in the same direction even though
not all of them were found statistically significant. Weaker or null
associations were observed with NO2 exposure, for the same outcomes. NO2 was
positively related to the incidence of cardiovascular disease in women but the
association was statistically significant only for ischaemic heart disease
incidence (HR for 10μg/m3 increase in exposure to NO2: 1.59, p-value: 0.034).
Long term exposure to PM10 and NO2 was associated with mortality from
cardiovascular diseases and more specifically, from ischaemic heart disease.
In conclusion, our study adds to the evidence that exposure to
particulate matter has long-term adverse effects on the incidence of and
mortality from cardiovascular disease. It is one of the very few studies
performed in southern Europe and the first in the Greater Athens area and in
Greece generally, in a densely populated, highly polluted area with warm
climate.
Keywords:
Air pollution, Long term, Cardiovascular disease, Morbidity, Mortality
Number of references:
207
File:
File access is restricted.
document.pdf
2 MB
File access is restricted.
