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Environment
Original article
Traffic pollution and the incidence of cardiorespiratory outcomes in an adult cohort in London
  1. I M Carey1,
  2. H R Anderson2,
  3. R W Atkinson1,
  4. S Beevers2,
  5. D G Cook1,
  6. D Dajnak2,
  7. J Gulliver3,
  8. F J Kelly2
  1. 1Population Health Research Institute, St George's University of London, London, UK
  2. 2MRC-PHE Centre for Environment and Health, King's College London, London, UK
  3. 3UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College, London, UK
  1. Correspondence to Dr IM Carey, Population Health Research Institute, St George's University of London, London SW17 0RE, UK; i.carey{at}sgul.ac.uk

Abstract

Objectives The epidemiological evidence for adverse health effects of long-term exposure to air and noise pollution from traffic is not coherent. Further, the relative roles of background versus near traffic pollution concentrations in this process are unclear. We investigated relationships between modelled concentrations of air and noise pollution from traffic and incident cardiorespiratory disease in London.

Methods Among 211 016 adults aged 40–79 years registered in 75 Greater London practices between 2005 and 2011, the first diagnosis for a range of cardiovascular and respiratory outcomes were identified from primary care and hospital records. Annual baseline concentrations for nitrogen oxide (NOx), particulate matter with a median aerodynamic diameter <2.5 μm (PM2.5) attributable to exhaust and non-exhaust sources, traffic intensity and noise were estimated at 20 m2 resolution from dispersion models, linked to clinical data via residential postcode. HRs were adjusted for confounders including smoking and area deprivation.

Results The largest observed associations were between traffic-related air pollution and heart failure (HR=1.10 for 20 μg/m3 change in NOx, 95% CI 1.01 to 1.21). However, no other outcomes were consistently associated with any of the pollution indicators, including noise. The greater variations in modelled air pollution from traffic between practices, versus within, hampered meaningful fine spatial scale analyses.

Conclusions The associations observed with heart failure may suggest exacerbatory effects rather than underlying chronic disease. However, the overall failure to observe wider associations with traffic pollution may reflect that exposure estimates based on residence inadequately represent the relevant pattern of personal exposure, and future studies must address this issue.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/oemed-2015-103531

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    Footnotes

    • Contributors HRA, RWA, DGC and FJK conceived the study. SB, DD and JG provided the exposure data and assisted with the linkage process. IMC helped oversee the extraction of the clinical records, designed and undertook the analysis. All authors contributed to the development of the project methodology, interpretation of the results and drafting of the paper.

    • Funding This work was funded under the cross research council Environmental Exposure and Health Initiative with funds from the Natural Environment Research Council, the Medical Research Council, and the Department of Health [Grant number NE/I0078571]. Clinical Practice Research Datalink is owned by the Secretary of State of the UK Department of Health and operates within the MHRA. Clinical Practice Research Datalink has received funding from the MHRA, Wellcome Trust, Medical Research Council, NIHR Health Technology Assessment programme, Innovative Medicine Initiative, UK Department of Health, Technology Strategy Board, Seventh Framework Programme EU, various universities, contract research organisations, and pharmaceutical companies.

    • Disclaimer The views expressed in this paper are those of the authors and do not reflect the official policy or position of the Medicines and Healthcare Products Regulatory Agency (MHRA).

    • Competing interests None declared.

    • Ethics approval This study was approved by the Independent Scientific Advisory Committee (ISAC) evaluation of protocols of research involving CPRD data.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement A full list of Read and ICD-10 codes used is available from the corresponding author.