Single- and two-pollutant concentration-response functions for PM2.5 and NO2 for quantifying mortality burden in health impact assessments

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• dc.contributor.author Chen, Xuan
• dc.contributor.author Gehring, Ulrike
• dc.contributor.author Dyer, Georgia M. C.
• dc.contributor.author Khomenko, Sasha
• dc.contributor.author de Hoogh, Kees
• dc.contributor.author Tonne, Cathryn
• dc.contributor.author Tatah, Lambed
• dc.contributor.author Vermeulen, Roel
• dc.contributor.author Khreis, Haneen
• dc.contributor.author Nieuwenhuijsen, Mark J.
• dc.contributor.author Hoek, Gerard
• dc.date.accessioned 2025-01-16T12:28:04Z
• dc.date.available 2025-01-16T12:28:04Z
• dc.date.issued 2024
• dc.description.abstract Objective: Health Impact Assessments (HIAs) for air pollutant mixtures are challenging because risk estimates are primarily derived from single-pollutant models. Combining risk estimates from multiple pollutants requires new approaches, as a simple addition of single pollutant risk estimates from correlated air pollutants may result in double counting. We investigated approaches applying concentration-response functions (CRFs) from single- and two-pollutant models in HIAs, focusing on long-term exposure to particulate matter with a diameter less than 2.5 μm (PM2.5) and nitrogen dioxide (NO2) and their associations with all-cause mortality. Methods: A systematic literature search of MEDLINE and EMBASE identified cohort studies employing single- and two-pollutant models of long-term exposure to PM2.5 and NO2 with all-cause mortality. Pooled CRFs were calculated through random-effects meta-analyses of risk estimates from single- and two-pollutant models. Coefficient differences were calculated by comparing single- and two-pollutant model estimates. Four approaches to estimating population-attributable fractions (PAFs) were compared: PM2.5 or NO2 single-pollutant models to represent the mixture, the sum of single-pollutant models, the sum of two-pollutant models and the sum of single-pollutant models from a larger body of evidence adjusted by coefficient difference. Results: Seventeen papers reported both single and two-pollutant estimates. Pooled hazard ratios (HRs) for mortality from single- and two-pollutant models were 1.053 (95% confidence interval: 1.034-1.071) and 1.035 (1.014-1.057), respectively, for a 5 μg/m3 increase in PM2.5. HRs for a 10 μg/m3 increase in NO2 were 1.032 (1.014-1.049) and 1.024 (1.000-1.049) for single- and two-pollutant models, respectively. The average coefficient difference between single- and two-pollutant models was 0.017 for PM2.5 and 0.007 for NO2. Combined PAFs for the PM2.5-NO2 mixture using joint HRs from single- and two-pollutant model CRFs were 0.09 and 0.06, respectively. Conclusion: Utilizing CRFs from two-pollutant models or applying the coefficient difference to a more extensive evidence base seems to mitigate the potential overestimation of mixture health impacts from adding single-pollutant CRFs.
• dc.description.sponsorship We acknowledge support from the Urban Burden of Disease Estimation for Policy Making (UBDPolicy) 2023–2026 Horizon Europe project (grant number 101094639); the Spanish Ministry of Science and Innovation and State Research Agency through the grant CEX2018-000806-S funded by MCIN/AEI/10.13039/501100011033, and the Ayudas para la Formación de Profesorado Universitario (FPU) 2020–2024 doctoral funding (FPU19/05210); support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya programme; support from Centro de Investigación Biomédica en red (CIBER) Epidemiología y Salud Pública.
• dc.format.mimetype application/pdf
• dc.identifier.citation Chen X, Gehring U, Dyer GMC, Khomenko S, de Hoogh K, Tonne C, et al. Single- and two-pollutant concentration-response functions for PM2.5 and NO2 for quantifying mortality burden in health impact assessments. Environ Res. 2024 Dec 15;263(Pt 3):120215. DOI: 10.1016/j.envres.2024.120215
• dc.identifier.doi http://dx.doi.org/10.1016/j.envres.2024.120215
• dc.identifier.issn 0013-9351
• dc.identifier.uri http://hdl.handle.net/10230/69160
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Environ Res. 2024 Dec 15;263(Pt 3):120215
• dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101094639
• dc.rights © 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Air pollution
• dc.subject.keyword Concentration-response functions
• dc.subject.keyword Health impact assessment
• dc.title Single- and two-pollutant concentration-response functions for PM2.5 and NO2 for quantifying mortality burden in health impact assessments
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion