Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project

Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollu...

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Veröffentlicht in:THE LANCET PLANETARY HEALTH 2021-09, Vol.5 (9), p.e620-e632
Hauptverfasser: Wolf, Kathrin, Hoffmann, Barbara, Andersen, Zorana J, Atkinson, Richard W, Bauwelinck, Mariska, Bellander, Tom, Brandt, Jørgen, Brunekreef, Bert, Cesaroni, Giulia, Chen, Jie, de Faire, Ulf, de Hoogh, Kees, Fecht, Daniela, Forastiere, Francesco, Gulliver, John, Hertel, Ole, Hvidtfeldt, Ulla Arthur, Janssen, Nicole A H, Jørgensen, Jeanette T, Katsouyanni, Klea, Ketzel, Matthias, Klompmaker, Jochem O, Lager, Anton, Liu, Shuo, MacDonald, Conor J, Magnusson, Patrik K E, Mehta, Amar J, Nagel, Gabriele, Oftedal, Bente, Pedersen, Nancy L, Pershagen, Göran, Raaschou-Nielsen, Ole, Renzi, Matteo, Rizzuto, Debora, Rodopoulou, Sophia, Samoli, Evangelia, van der Schouw, Yvonne T, Schramm, Sara, Schwarze, Per, Sigsgaard, Torben, Sørensen, Mette, Stafoggia, Massimo, Strak, Maciek, Tjønneland, Anne, Verschuren, W M Monique, Vienneau, Danielle, Weinmayr, Gudrun, Hoek, Gerard, Peters, Annette, Ljungman, Petter L S
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container_title THE LANCET PLANETARY HEALTH
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creator Wolf, Kathrin
Hoffmann, Barbara
Andersen, Zorana J
Atkinson, Richard W
Bauwelinck, Mariska
Bellander, Tom
Brandt, Jørgen
Brunekreef, Bert
Cesaroni, Giulia
Chen, Jie
de Faire, Ulf
de Hoogh, Kees
Fecht, Daniela
Forastiere, Francesco
Gulliver, John
Hertel, Ole
Hvidtfeldt, Ulla Arthur
Janssen, Nicole A H
Jørgensen, Jeanette T
Katsouyanni, Klea
Ketzel, Matthias
Klompmaker, Jochem O
Lager, Anton
Liu, Shuo
MacDonald, Conor J
Magnusson, Patrik K E
Mehta, Amar J
Nagel, Gabriele
Oftedal, Bente
Pedersen, Nancy L
Pershagen, Göran
Raaschou-Nielsen, Ole
Renzi, Matteo
Rizzuto, Debora
Rodopoulou, Sophia
Samoli, Evangelia
van der Schouw, Yvonne T
Schramm, Sara
Schwarze, Per
Sigsgaard, Torben
Sørensen, Mette
Stafoggia, Massimo
Strak, Maciek
Tjønneland, Anne
Verschuren, W M Monique
Vienneau, Danielle
Weinmayr, Gudrun
Hoek, Gerard
Peters, Annette
Ljungman, Petter L S
description Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. Long-term air p
doi_str_mv 10.1016/S2542-5196(21)00195-9
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Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Health Effects Institute.</description><identifier>ISSN: 2542-5196</identifier><identifier>EISSN: 2542-5196</identifier><identifier>DOI: 10.1016/S2542-5196(21)00195-9</identifier><identifier>PMID: 34508683</identifier><language>eng</language><publisher>OXFORD: Elsevier Ltd</publisher><subject>Adult ; Air Pollution - adverse effects ; Coronary Disease - chemically induced ; Coronary Disease - epidemiology ; Environmental Exposure - adverse effects ; Environmental Exposure - analysis ; Environmental Sciences ; Environmental Sciences &amp; Ecology ; Humans ; Incidence ; Life Sciences &amp; Biomedicine ; Medicin och hälsovetenskap ; Multicenter Studies as Topic ; Public, Environmental &amp; Occupational Health ; Science &amp; Technology ; Stroke - epidemiology</subject><ispartof>THE LANCET PLANETARY HEALTH, 2021-09, Vol.5 (9), p.e620-e632</ispartof><rights>2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license</rights><rights>Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>133</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000696927000008</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c500t-337d1ddbb39cc28a87a329f3cba98223f629ca8a4d1aaa1fdc40e27161b644c93</citedby><cites>FETCH-LOGICAL-c500t-337d1ddbb39cc28a87a329f3cba98223f629ca8a4d1aaa1fdc40e27161b644c93</cites><orcidid>0000-0002-4605-435X ; 0000-0001-9519-1935 ; 0000-0003-2843-2908 ; 0000-0003-0972-7735 ; 0000-0003-4138-9828 ; 0000-0002-2043-7571 ; 0000-0002-7815-2632 ; 0000-0002-0095-6825 ; 0000-0002-1223-0909 ; 0000-0002-6309-6439 ; 0000-0002-7580-9547 ; 0000-0003-4385-2097 ; 0000-0003-3423-2013 ; 0000-0001-6645-0985 ; 0000-0002-0282-5378 ; 0000-0003-4181-4759 ; 0000-0002-4343-201X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,554,782,786,866,887,2116,27931,27932,39264,39265</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34508683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:147689861$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolf, Kathrin</creatorcontrib><creatorcontrib>Hoffmann, Barbara</creatorcontrib><creatorcontrib>Andersen, Zorana J</creatorcontrib><creatorcontrib>Atkinson, Richard W</creatorcontrib><creatorcontrib>Bauwelinck, Mariska</creatorcontrib><creatorcontrib>Bellander, Tom</creatorcontrib><creatorcontrib>Brandt, Jørgen</creatorcontrib><creatorcontrib>Brunekreef, Bert</creatorcontrib><creatorcontrib>Cesaroni, Giulia</creatorcontrib><creatorcontrib>Chen, Jie</creatorcontrib><creatorcontrib>de Faire, Ulf</creatorcontrib><creatorcontrib>de Hoogh, Kees</creatorcontrib><creatorcontrib>Fecht, Daniela</creatorcontrib><creatorcontrib>Forastiere, Francesco</creatorcontrib><creatorcontrib>Gulliver, John</creatorcontrib><creatorcontrib>Hertel, Ole</creatorcontrib><creatorcontrib>Hvidtfeldt, Ulla Arthur</creatorcontrib><creatorcontrib>Janssen, Nicole A H</creatorcontrib><creatorcontrib>Jørgensen, Jeanette T</creatorcontrib><creatorcontrib>Katsouyanni, Klea</creatorcontrib><creatorcontrib>Ketzel, Matthias</creatorcontrib><creatorcontrib>Klompmaker, Jochem O</creatorcontrib><creatorcontrib>Lager, Anton</creatorcontrib><creatorcontrib>Liu, Shuo</creatorcontrib><creatorcontrib>MacDonald, Conor J</creatorcontrib><creatorcontrib>Magnusson, Patrik K E</creatorcontrib><creatorcontrib>Mehta, Amar J</creatorcontrib><creatorcontrib>Nagel, Gabriele</creatorcontrib><creatorcontrib>Oftedal, Bente</creatorcontrib><creatorcontrib>Pedersen, Nancy L</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Raaschou-Nielsen, Ole</creatorcontrib><creatorcontrib>Renzi, Matteo</creatorcontrib><creatorcontrib>Rizzuto, Debora</creatorcontrib><creatorcontrib>Rodopoulou, Sophia</creatorcontrib><creatorcontrib>Samoli, Evangelia</creatorcontrib><creatorcontrib>van der Schouw, Yvonne T</creatorcontrib><creatorcontrib>Schramm, Sara</creatorcontrib><creatorcontrib>Schwarze, Per</creatorcontrib><creatorcontrib>Sigsgaard, Torben</creatorcontrib><creatorcontrib>Sørensen, Mette</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Strak, Maciek</creatorcontrib><creatorcontrib>Tjønneland, Anne</creatorcontrib><creatorcontrib>Verschuren, W M Monique</creatorcontrib><creatorcontrib>Vienneau, Danielle</creatorcontrib><creatorcontrib>Weinmayr, Gudrun</creatorcontrib><creatorcontrib>Hoek, Gerard</creatorcontrib><creatorcontrib>Peters, Annette</creatorcontrib><creatorcontrib>Ljungman, Petter L S</creatorcontrib><title>Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project</title><title>THE LANCET PLANETARY HEALTH</title><addtitle>LANCET PLANET HEALTH</addtitle><addtitle>Lancet Planet Health</addtitle><description>Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Health Effects Institute.</description><subject>Adult</subject><subject>Air Pollution - adverse effects</subject><subject>Coronary Disease - chemically induced</subject><subject>Coronary Disease - epidemiology</subject><subject>Environmental Exposure - adverse effects</subject><subject>Environmental Exposure - analysis</subject><subject>Environmental Sciences</subject><subject>Environmental Sciences &amp; Ecology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Life Sciences &amp; Biomedicine</subject><subject>Medicin och hälsovetenskap</subject><subject>Multicenter Studies as Topic</subject><subject>Public, Environmental &amp; Occupational Health</subject><subject>Science &amp; Technology</subject><subject>Stroke - 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exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project</title><author>Wolf, Kathrin ; Hoffmann, Barbara ; Andersen, Zorana J ; Atkinson, Richard W ; Bauwelinck, Mariska ; Bellander, Tom ; Brandt, Jørgen ; Brunekreef, Bert ; Cesaroni, Giulia ; Chen, Jie ; de Faire, Ulf ; de Hoogh, Kees ; Fecht, Daniela ; Forastiere, Francesco ; Gulliver, John ; Hertel, Ole ; Hvidtfeldt, Ulla Arthur ; Janssen, Nicole A H ; Jørgensen, Jeanette T ; Katsouyanni, Klea ; Ketzel, Matthias ; Klompmaker, Jochem O ; Lager, Anton ; Liu, Shuo ; MacDonald, Conor J ; Magnusson, Patrik K E ; Mehta, Amar J ; Nagel, Gabriele ; Oftedal, Bente ; Pedersen, Nancy L ; Pershagen, Göran ; Raaschou-Nielsen, Ole ; Renzi, Matteo ; Rizzuto, Debora ; Rodopoulou, Sophia ; Samoli, Evangelia ; van der Schouw, Yvonne T ; Schramm, Sara ; Schwarze, Per ; Sigsgaard, Torben ; Sørensen, Mette ; Stafoggia, Massimo ; Strak, Maciek ; 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Giulia</au><au>Chen, Jie</au><au>de Faire, Ulf</au><au>de Hoogh, Kees</au><au>Fecht, Daniela</au><au>Forastiere, Francesco</au><au>Gulliver, John</au><au>Hertel, Ole</au><au>Hvidtfeldt, Ulla Arthur</au><au>Janssen, Nicole A H</au><au>Jørgensen, Jeanette T</au><au>Katsouyanni, Klea</au><au>Ketzel, Matthias</au><au>Klompmaker, Jochem O</au><au>Lager, Anton</au><au>Liu, Shuo</au><au>MacDonald, Conor J</au><au>Magnusson, Patrik K E</au><au>Mehta, Amar J</au><au>Nagel, Gabriele</au><au>Oftedal, Bente</au><au>Pedersen, Nancy L</au><au>Pershagen, Göran</au><au>Raaschou-Nielsen, Ole</au><au>Renzi, Matteo</au><au>Rizzuto, Debora</au><au>Rodopoulou, Sophia</au><au>Samoli, Evangelia</au><au>van der Schouw, Yvonne T</au><au>Schramm, Sara</au><au>Schwarze, Per</au><au>Sigsgaard, Torben</au><au>Sørensen, Mette</au><au>Stafoggia, Massimo</au><au>Strak, Maciek</au><au>Tjønneland, Anne</au><au>Verschuren, W M Monique</au><au>Vienneau, Danielle</au><au>Weinmayr, Gudrun</au><au>Hoek, Gerard</au><au>Peters, Annette</au><au>Ljungman, Petter L S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project</atitle><jtitle>THE LANCET PLANETARY HEALTH</jtitle><stitle>LANCET PLANET HEALTH</stitle><addtitle>Lancet Planet Health</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>5</volume><issue>9</issue><spage>e620</spage><epage>e632</epage><pages>e620-e632</pages><issn>2542-5196</issn><eissn>2542-5196</eissn><abstract>Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Health Effects Institute.</abstract><cop>OXFORD</cop><pub>Elsevier Ltd</pub><pmid>34508683</pmid><doi>10.1016/S2542-5196(21)00195-9</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-4605-435X</orcidid><orcidid>https://orcid.org/0000-0001-9519-1935</orcidid><orcidid>https://orcid.org/0000-0003-2843-2908</orcidid><orcidid>https://orcid.org/0000-0003-0972-7735</orcidid><orcidid>https://orcid.org/0000-0003-4138-9828</orcidid><orcidid>https://orcid.org/0000-0002-2043-7571</orcidid><orcidid>https://orcid.org/0000-0002-7815-2632</orcidid><orcidid>https://orcid.org/0000-0002-0095-6825</orcidid><orcidid>https://orcid.org/0000-0002-1223-0909</orcidid><orcidid>https://orcid.org/0000-0002-6309-6439</orcidid><orcidid>https://orcid.org/0000-0002-7580-9547</orcidid><orcidid>https://orcid.org/0000-0003-4385-2097</orcidid><orcidid>https://orcid.org/0000-0003-3423-2013</orcidid><orcidid>https://orcid.org/0000-0001-6645-0985</orcidid><orcidid>https://orcid.org/0000-0002-0282-5378</orcidid><orcidid>https://orcid.org/0000-0003-4181-4759</orcidid><orcidid>https://orcid.org/0000-0002-4343-201X</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Air Pollution - adverse effects
Coronary Disease - chemically induced
Coronary Disease - epidemiology
Environmental Exposure - adverse effects
Environmental Exposure - analysis
Environmental Sciences
Environmental Sciences & Ecology
Humans
Incidence
Life Sciences & Biomedicine
Medicin och hälsovetenskap
Multicenter Studies as Topic
Public, Environmental & Occupational Health
Science & Technology
Stroke - epidemiology
title Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project
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