Figures
- FIGURE 1
Study population, exclusions and missing data. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; LLN: lower limit of normal; COPD: chronic obstructive pulmonary disease; NO2: nitrogen dioxide; PM: particulate matter.
- FIGURE 2
Air pollution exposure, a) forced expiratory volume in 1 s (FEV1), b) forced vital capacity (FVC) and c) chronic obstructive pulmonary disease (COPD): comparison with other studies using European Study of Cohorts for Air Pollution Effects (ESCAPE) air pollution estimates. Cohorts included in each study: Adam et al. [5]: European Community Respiratory Health Survey (ECRHS), French Epidemiological Study on Genetics and Environment of Asthma (EGEA), National Survey of Health and Development (NSHD), Study on the Influence of Air Pollution on Lung Function, Inflammation and Aging (SALIA) and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA); de Jong et al. [20]: Lifelines Cohort Study; Schikowski et al. [6]: ECRHS, NSHD, SALIA and SAPALDIA. PM2.5: fine particulate matter with a 50% cut-off aerodynamic diameter <2.5 μm; PM10: particulate matter with a 50% cut-off aerodynamic diameter <10 μm; PMcoarse: coarse particulate matter with diameter 2.5–10 μm; NO2: nitrogen dioxide.
Tables
- TABLE 1
Population characteristics
Lung function (FEV1 and FVC) and NO2 population# Lung function (FEV1 and FVC) and PM population¶ Excluded from analyses due to incomplete data (for lung function and NO2 population) Difference p-value Subjects 299 537 278 228 203 082 Sex Male 47.1 (140 977) 47.2 (131 257) 43.4 (88 187) <0.001 Female 52.9 (158 560) 52.8 (146 971) 56.6 (114 895) Age years 56±8.05 56±8.05 57.3±8.1 <0.001 Age <65 years 83.2 (249 067) 83.1 (231 221) 77.6 (157 526) <0.001 ≥65 years 16.8 (50 470) 16.9 (47 007) 22.4 (45 556) BMI kg·m−2 27.4±4.68 27.4±4.69 27.6±4.97 <0.001 Missing data 3105 BMI Normal (<25 kg·m−2) 33.3 (99 832) 33.3 (92 673) 32.7 (65 350) <0.001 Overweight (25–29.9 kg·m−2) 43.2 (129 271) 43.1 (120 024) 41.4 (82 872) Obese (≥30 kg·m−2) 23.5 (70 434) 23.6 (65 531) 25.9 (51 755) Missing data 3105 Education level A-level, O-level or CSEs 51.3 (153 657) 51.9 (144 504) 61.7 (119 076) <0.001 College, university, NVQ or other professional qualifications 48.7 (145 880) 48.1 (133 724) 38.3 (73 864) Missing data 10 142 Household income <GPB 31 000 44.2 (132 527) 44.6 (124 097) 57.9 (72 891) <0.001 ≥GBP 31 000 55.8 (167 010) 55.4 (154 131) 42.1 (52 993) Missing data 77 198 Smoking status Never-smoker 59.0 (176 817) 58.8 (163 686) 48.4 (96 773) <0.001 Former smoker 38.1 (114 249) 38.3 (106 658) 29.4 (58 842) Current smoker 2.8 (8 471) 2.8 (7 884) 22.2 (44 515) Missing data 2952 Passive smoking exposure at home None 94.7 (283 521) 94.8 (263 679) 93.6 (142 028) <0.001 Any 5.3 (16 016) 5.2 (14 549) 6.4 (9 781) Missing data 51 273 Asthma Never had asthma 89.4 (267 490) 89.3 (248 232) 89.3 (179 670) 0.53 Ever had asthma 10.6 (31 818) 10.7 (29 779) 10.7 (21 498) Missing data 229 217 1914 Occupational status Non-“at-risk” occupation 98.2 (206 506) 98.2 (192 826) 96.4 (112 765) <0.001 “At-risk” occupation 1.8 (3724) 1.8 (3552) 3.6 (4165) Missing data 89 307 81 850 86 152 FEV1 L 2.9±0.78 2.9±0.78 2.6±0.77 <0.001 Missing data 116 641 FVC L 3.8±1.00 3.8±1.00 3.5±0.98 <0.001 Missing data 116 641 FEV1/FVC 0.8±0.07 0.8±0.07 0.8±0.08 <0.001 Missing data 116 641 COPD No 92.7 (276 948) 92.6 (257 089) 87.9 (74 762) <0.001 Yes 7.3 (21 900) 7.4 (20 478) 12.1 (10 267) Missing data 689 661 118 053 Data are presented as n, % (n) or mean±sd, unless otherwise stated. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; NO2: nitrogen dioxide; PM: particulate matter; BMI: body mass index; CSE: Certificate of Secondary Education; NVQ: National Vocational Qualification; COPD: chronic obstructive pulmonary disease. #: descriptive statistics shown are for participants with complete data for FEV1 and FVC, age, sex, BMI, education level, household income, smoking status, passive smoking exposure at home and residential NO2 exposure; ¶: descriptive statistics shown are for participants with complete data for FEV1 and FVC, age, sex, BMI, education level, household income, smoking status, passive smoking exposure at home and residential PM exposure.
- TABLE 2
Pollutant descriptive statistics and correlation matrix#
Subjects n Mean±sd μg·m−3 Minimum μg·m−3 Maximum μg·m−3 IQR μg·m−3 Pearson correlation coefficients PM2.5 PM10 PMcoarse NO2 PM2.5 278 228 9.94±1.04 8.17 19.89 1.27 1 0.53 0.21 0.87 PM10 278 228 16.18±1.90 11.78 31.39 1.77 1 0.81 0.50 PMcoarse 278 228 6.41±0.90 5.57 12.82 0.77 1 0.19 NO2 299 537 26.31±7.49 12.93 108.49 9.70 1 IQR: interquartile range; PM2.5: fine particulate matter with a 50% cut-off aerodynamic diameter <2.5 μm; PM10: particulate matter with a 50% cut-off aerodynamic diameter <10 μm; PMcoarse: coarse particulate matter with diameter 2.5–10 μm; NO2: nitrogen dioxide. #: descriptive statics shown are for participants with complete data for forced expiratory volume in 1 s, forced vital capacity, age, sex, body mass index, education level, household income, smoking status and passive smoking exposure at home.
- TABLE 3
Associations of lung function and ambient air pollution exposure#
Subjects n FEV1 (mL) β (95% CI) FVC (mL) β (95% CI) FEV1/FVC β (95% CI) PM2.5 per 5 μg·m−3 278 228 −83.13 (−92.50– −73.75) −62.62 (−73.91– −51.32) −9.68 (−10.81– −8.56) PM10 per 10 μg·m−3 278 228 −94.41 (−104.59– −84.22) −122.95 (−135.22– −110.68) −0.34 (−1.56–0.89) PMcoarse per 5 μg·m−3 278 228 −68.61 (−79.37– −57.85) −96.69 (−109.65– −83.73) 1.34 (0.04–2.63) NO2 per 10 μg·m−3 299 537 −33.85 (−36.34– −31.36) −33.47 (−36.47– −30.46) −2.27 (−2.57– −1.96) Bold type represents statistical significance. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; PM2.5: fine particulate matter with a 50% cut-off aerodynamic diameter <2.5 μm; PM10: particulate matter with a 50% cut-off aerodynamic diameter <10 μm; PMcoarse: coarse particulate matter with diameter 2.5–10 μm; NO2: nitrogen dioxide. #: adjusted for age (continuous), age-squared, sex, height, body mass index (kg·m−2), household income (<GBP 31 000/≥GBP 31 000), education level (lower vocational or less/higher vocational or more), smoking status (never/former/current) and passive smoking exposure at home (none/any).
- TABLE 4
Associations of chronic obstructive pulmonary disease and ambient air pollution exposure#
Cases/non-cases n/n OR (95% CI) PM2.5 per 5 μg·m−3 20 478/257 089 1.52 (1.42–1.62) PM10 per 10 μg·m−3 20 478/257 089 1.08 (1.00–1.16) PMcoarse per 5 μg·m−3 20 478/257 089 0.99 (0.91–1.07) NO2 per 10 μg·m−3 21 900/276 948 1.12 (1.10–1.14) Bold type represents statistical significance. PM2.5: fine particulate matter with a 50% cut-off aerodynamic diameter <2.5 μm; PM10: particulate matter with a 50% cut-off aerodynamic diameter <10 μm; PMcoarse: coarse particulate matter with diameter 2.5–10 μm; NO2: nitrogen dioxide. #: adjusted for age (continuous), sex, body mass index (kg·m−2), household income (<GBP 31 000/≥GBP 31 000), education level (lower vocational or less/higher vocational or more), smoking status (never/former/current) and passive smoking exposure at home (none/any).
- TABLE 5
Lung function subgroup analyses for fine particulate matter with diameter <2.5 μm (PM2.5) and nitrogen dioxide (NO2)#
FEV1 mL FVC mL FEV1/FVC PM2.5 per 5 μg·m−3 NO2 per 10 μg·m−3 PM2.5 per 5 μg·m−3 NO2 per 10 μg·m−3 PM2.5 per 5 μg·m−3 NO2 per 10 μg·m−3 β (95% CI) Interaction p-value β (95% CI) Interaction p-value β (95% CI) Interaction p-value β (95% CI) Interaction p-value β (95% CI) Interaction p-value β (95% CI) Interaction p-value Sex <0.001 <0.001 <0.001 <0.001 0.928 0.883 Male −102.32 (−118.16– −86.48) −41.22 (−45.44– −37.00) −78.48 (−97.42– −59.54) −40.85 (−45.89– −35.81) −9.52 (−11.25– −7.80) −2.27 (−2.73– −1.80) Female −68.14 (−78.68– −57.59) −28.01 (−30.82– −25.21) −50.47 (−63.28– −37.67) −27.66 (−31.06– −24.26) −9.79 (−11.26– −8.32) −2.25 (−2.65– −1.86) Age 0.574 0.113 0.187 0.014 <0.001 <0.001 <65 years −83.63 (−93.85– −73.40) −32.55 (−37.27– −31.83) −65.06 (−77.40– −52.71) −34.86 (−38.15– −31.58) −8.92 (−10.11– −7.73) −2.04 (−2.36– −1.72) ≥65 years −85.32 (−108.62– −62.01) −31.64 (−37.82– −25.47) −54.05 (−81.85– −26.25) −27.41 (−34.78– −20.05) −13.73 (−16.91– −10.54) −3.50 (−4.35– −2.65) Obesity 0.068 0.003 0.460 0.082 0.005 0.005 Non-obese −78.68 (−89.31– −68.04) −31.69 (−34.51– −28.87) −58.93 (−71.78– −46.08) −31.65 (−35.05– −28.24) −9.07 (−10.36– −7.79) −2.07 (−2.41– −1.73) Obese −95.53 (−115.24– −75.82) −40.36 (−45.68– −35.04) −76.78 (−100.30– −53.27) −40.78 (−47.12– −34.45) −10.99 (−13.32– −8.67) −2.61 (−3.24– −1.98) Smoking status 0.388 <0.001 <0.001 <0.001 <0.001 <0.001 Never-smoker −84.49 (−96.74– −72.25) −38.11 (−41.37– −34.85) −76.56 (−91.51– −61.60) −41.89 (−45.87– −37.91) −6.91 (−8.35– −5.47) −1.61 (−2.00– −1.23) Current or past smoker −87.08 (−101.61– −72.55) −30.42 (−34.28– −26.56) −49.66 (−66.87– −32.46) −24.42 (−28.99– −19.85) −13.80 (−15.59– −12.00) −3.31 (−3.79– −2.83) Household income <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <GBP 31 000 −78.85 (−93.56– −64.13) −35.76 (−39.79– −31.73) −95.83 (−112.86– −78.79) −46.92 (−51.58– −42.25) −13.70 (−15.49– −11.91) −3.46 (−3.96– −2.97) ≥GBP 31 000 −39.12 (−52.30– −25.94) −21.81 (−25.24– −18.37) −31.69 (−46.76– −16.62) −22.15 (−26.08– −18.23) −6.38 (−7.82– −4.95) −1.41 (−1.78– −1.03) Asthma status 0.002 0.033 0.094 0.319 0.013 0.113 Never had asthma −84.84 (−94.61– −75.08) −33.93 (−36.53– −31.33) −63.17 (−75.10– −51.24) −33.21 (−36.38– −30.04) −9.78 (−10.92– −8.64) −2.27 (−2.57– −1.96) Ever had asthma −70.01 (−99.76– −40.26) −33.13 (−41.08– −25.17) −54.57 (−89.32– −19.81) −34.12 (−43.40– −24.85) −9.25 (−13.30– −5.21) −2.43 (−3.51– −1.34) Occupational status 0.001 <0.001 0.002 <0.001 0.431 0.594 Non-“at-risk” occupation −71.88 (−83.25– −60.51) −30.88 (−33.87– −27.89) −57.95 (−71.67– −44.24) −32.20 (−35.81– −28.59) −6.94 (−8.25– −5.62) −1.57 (−1.92– −1.22) “At-risk” occupation −183.85 (−271.13– −96.56) −77.71 (−101.86– −53.57) −192.19 (−296.36– −88.01) −91.28 (−120.11– −62.46) −9.18 (−19.57–1.20) −1.81 (−4.71–1.09) FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity. #: adjusted for age (continuous), age-squared, sex, height, body mass index (kg·m−2), household income (<GBP 31 000/≥GBP 31 000), education level (lower vocational or less/higher vocational or more), smoking status (never/former/current) and passive smoking exposure at home (none/any).
- TABLE 6
Chronic obstructive pulmonary disease subgroup analyses for fine particulate matter with diameter <2.5 μm (PM2.5) and nitrogen dioxide (NO2)#
PM2.5 per 5 μg·m−3 NO2 per 10 μg·m−3 Cases/non-cases OR (95% CI) Interaction p-value Cases/non-cases OR (95% CI) Interaction p-value Sex 0.024 0.101 Male 10 615/120 233 1.40 (1.27–1.54) 11 279/129 269 1.10 (1.07–1.13) Female 9863/136 856 1.64 (1.49–1.81) 10 621/147 679 1.13 (1.10–1.16) Age 0.128 0.260 <65 years 16 685/214 004 1.49 (1.38–1.60) 17 854/230 661 1.11 (1.09–1.13) ≥65 years 3793/43 085 1.64 (1.40–1.92) 4046/46 287 1.13 (1.09–1.18) Obesity 0.002 0.002 Non-obese 16 508/195 722 1.44 (1.34–1.56) 17 646/210 967 1.10 (1.08–1.12) Obese 3970/61 367 1.80 (1.55–2.09) 4254/65 981 1.17 (1.12–1.22) Smoking status 0.009 0.181 Never-smoker 10 574/152 753 1.39 (1.26–1.53) 11 319/165 120 1.10 (1.07–1.13) Current or past smoker 9904/104 336 1.69 (1.53–1.85) 10 581/111 828 1.14 (1.11–1.17) Household income <0.001 <0.001 <GBP 31 000 10 090/113 656 1.85 (1.69–2.04) 10 700/121 462 1.19 (1.15–1.22) ≥ GBP 31 000 10 388/143 433 1.25 (1.14–1.38) 11 200/155 486 1.06 (1.03–1.09) Asthma status <0.001 <0.001 Never had asthma 14 484/233 176 1.66 (1.53–1.79) 15 510/251 382 1.14 (1.12–1.17) Ever had asthma 5967/23 729 1.24 (1.08–1.42) 6362/25 371 1.06 (1.02–1.10) Occupational status 0.742 0.725 Non-“at-risk” occupation 13 512/178 876 1.37 (1.26–1.49) 14 354/191 700 1.09 (1.06–1.11) “At-risk” occupation 381/3161 1.46 (0.89–2.39) 399/3314 1.11 (0.97–1.27) Data are presented as n/n, unless otherwise stated. #: adjusted for age (continuous), sex, body mass index (kg·m−2), household income (<GBP 31 000/≥GBP 31 000), education level (lower vocational or less/higher vocational or more), smoking status (never/former/current) and passive smoking exposure at home (none/any).
Supplementary Material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
Supplementary material ERJ-02140-2018.Supplement
