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Original article
Long-term exposure to NO2 and PM10 and all-cause and cause-specific mortality in a prospective cohort of women
  1. Joachim Heinrich1,
  2. Elisabeth Thiering1,
  3. Peter Rzehak1,2,
  4. Ursula Krämer3,
  5. Matthias Hochadel1,4,
  6. Knut M Rauchfuss5,
  7. Ulrike Gehring1,6,
  8. H-Erich Wichmann1,2
  1. 1Helmholtz Zentrum München—German Research Center for Environment and Health, Institute of Epidemiology I, Neuherberg, Germany
  2. 2Ludwig-Maximilians-University of Munich, Institute of Medical Informatics, Biometrics and Epidemiology, Chair of Epidemiology, Munich, Germany
  3. 3IUF Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
  4. 4Institut für Herzinfarktforschung at the University of Heidelberg, Ludwigshafen, Heidelberg, Germany
  5. 5Department of Environmental Health, Toxicology, Epidemiology, North Rhine-Westphalia State Environment Agency (LANUV-NRW), Essen, Germany
  6. 6Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
  1. Correspondence to Dr Joachim Heinrich, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology I, Ingolstädter Landstraße 1, Neuherberg D-85764, Germany; heinrich{at}


We assessed whether long-term exposure to air pollution is associated with all-cause and cause-specific mortality during a period of declining particulate matter concentrations.

Approximately 4800 women aged 55 years from North Rhine-Westphalia, Germany, were followed for up to 18 years. Exposure to air pollution was assessed in two ways: (1) using the distance between the residential address and the nearest major road, as calculated from Geographic Information System data and (2) calculating 1-year average particulate matter concentrations below 10 µm (PM10) and nitrogen dioxide (NO2) levels using data from the nearest air-monitoring station data to the subjects’ residences. Ninety-two per cent of all subjects lived in the same community during the entire follow-up period. Associations between mortality and exposure were assessed using Cox's proportional hazards models, including confounder adjustment.

Sixteen per cent of women passed away during the follow-up period. An increase of 7 μg/m3 PM10 (IQR) was associated with an increased HR for all-cause (HR 1.15, 95% CI (1.04 to 1.27)), cardiopulmonary (HR 1.39, 95% CI (1.17 to 1.64)), and lung cancer mortality (HR 1.84, 95% CI (1.23 to 2.74)). An increase of 16 μg/m3 (IQR) NO2 exposure was associated with all-cause (HR 1.18, 95% CI (1.07 to 1.30)) and cardiopulmonary mortality (HR 1.55, 95% CI (1.30 to 1.84)). The association between cardiopulmonary mortality and PM10 was reduced for the extended follow-up period, during which PM10 concentrations (but not NO2 concentrations) were lower. Living close to a major road was associated with an increased relative risk for all-cause, cardiopulmonary and respiratory mortality. These associations were temporally stable.

Long-term exposure to ambient PM10 and NO2 was associated with increased mortality rates.

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