Long-term exposure to air pollution and mortality in Scotland: A register-based individual-level longitudinal study

Mary Abed Al Ahad; Urška Demšar; Frank Sullivan; Hill Kulu

doi:10.1016/j.envres.2023.117223

Long-term exposure to air pollution and mortality in Scotland: A register-based individual-level longitudinal study

Environ Res. 2023 Dec 1;238(Pt 2):117223. doi: 10.1016/j.envres.2023.117223. Epub 2023 Oct 2.

Authors

Mary Abed Al Ahad¹, Urška Demšar², Frank Sullivan³, Hill Kulu²

Affiliations

¹ School of Geography and Sustainable Development, University of St Andrews, Scotland, United Kingdom. Electronic address: maaa1@st-andrews.ac.uk.
² School of Geography and Sustainable Development, University of St Andrews, Scotland, United Kingdom.
³ School of Medicine, University of St Andrews, Scotland, United Kingdom.

PMID: 37793592
DOI: 10.1016/j.envres.2023.117223

Abstract

Background: Air pollution is associated with several adverse health outcomes. However, heterogeneity in the size of effect estimates between cohort studies for long-term exposures exist and pollutants like SO₂ and mental/behavioural health outcomes are little studied. This study examines the association between long-term exposure to multiple ambient air pollutants and all-cause and cause-specific mortality from both physical and mental illnesses.

Methods: We used individual-level administrative data from the Scottish-Longitudinal-Study (SLS) on 202,237 individuals aged 17 and older, followed between 2002 and 2017. The SLS dataset was linked to annual concentrations of NO₂, SO₂, and particulate-matter (PM10, PM2.5) pollution at 1 km² spatial resolution using the individuals' residential postcode. We applied survival analysis to assess the association between air pollution and all-cause, cardiovascular, respiratory, cancer, mental/behavioural disorders/suicides, and other-causes mortality.

Results: Higher all-cause mortality was associated with increasing concentrations of PM2.5, PM10, NO₂, and SO₂ pollutants. NO_2, PM10, and PM2.5 were also associated with cardiovascular, respiratory, cancer and other-causes mortality. For example, the mortality hazard from respiratory diseases was 1.062 (95%CI = 1.028-1.096), 1.025 (95%CI = 1.005-1.045), and 1.013 (95%CI = 1.007-1.020) per 1 μg/m³ increase in PM2.5, PM10 and NO₂ pollutants, respectively. In contrast, mortality from mental and behavioural disorders was associated with 1 μg/m³ higher exposure to SO₂ pollutant (HR = 1.042; 95%CI = 1.015-1.069).

Conclusion: This study revealed an association between long-term (16-years) exposure to ambient air pollution and all-cause and cause-specific mortality. The results suggest that policies and interventions to enhance air quality would reduce the mortality hazard from cardio-respiratory, cancer, and mental/behavioural disorders in the long-term.

Keywords: Air pollution; Cardio-respiratory; Mental disorders; Mortality; Scottish longitudinal study.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / toxicity
Air Pollution* / analysis
Cardiovascular Diseases*
Environmental Exposure / analysis
Environmental Pollutants* / analysis
Humans
Longitudinal Studies
Neoplasms* / chemically induced
Nitrogen Dioxide / analysis
Particulate Matter / analysis
Suicide*

Substances

Nitrogen Dioxide
Air Pollutants
Particulate Matter
Environmental Pollutants