Long-Term Exposure to Traffic-Related Air Pollution and the Risk of Coronary Heart Disease Hospitalization and Mortality

By Gan, Wen Qi; Koehoorn, Mieke et al. | Environmental Health Perspectives, April 2011 | Go to article overview

Long-Term Exposure to Traffic-Related Air Pollution and the Risk of Coronary Heart Disease Hospitalization and Mortality


Gan, Wen Qi, Koehoorn, Mieke, Davies, Hugh W., Demers, Paul A., Tamburic, Lillian, Brauer, Michael, Environmental Health Perspectives


BACKGROUND: Epidemiologic studies have demonstrated that exposure to road traffic is associated with adverse cardiovascular outcomes.

OBJECTIVES: We aimed to identify specific traffic-related air pollutants that are associated with the risk of coronary heart disease (CHD) morbidity and mortality to support evidence-based environmental policy making.

METHODS: This population-based cohort study included a 5-year exposure period and a 4-year follow-up period. All residents 45-85 years of age who resided in Metropolitan Vancouver during the exposure period and without known CHD at baseline were included in this study (n = 452,735). Individual exposures to traffic-related air pollutants including black carbon, fine particles [aerodynamic diameter [less than or equal to] 2.5 [micro]m ([PM.sub.2.5])], nitrogen dioxide ([NO.sub.2]), and nitric oxide were estimated at residences of the subjects using land-use regression models and integrating changes in residences during the exposure period. CHD hospitalizations and deaths during the follow-up period were identified from provincial hospitalization and death registration records.

RESULTS: An interquartile range elevation in the average concentration of black carbon (0.94 x [10.sup.-5]/m filter absorbance, equivalent to approximately 0.8 [micro]g/[m.sup.3] elemental carbon) was associated with a 3% increase in CHD hospitalization (95% confidence interval, 1-5%) and a 6% increase in CHD mortality (3-9%) after adjusting for age, sex, preexisting comorbidity, neighborhood socioeconomic status, and copollutants ([PM.sub.2.5] and [NO.sub.2]). There were clear linear exposure--response relationships between black carbon and coronary events.

CONCLUSIONS: Long-term exposure to traffic-related fine particulate air pollution, indicated by black carbon, may partly explain the observed associations between exposure to road traffic and adverse cardiovascular outcomes.

KEY WORDS: air pollution, cohort studies, coronary heart disease, particulate matter, vehicle emissions. Environ Health Perspect 119:501-507 (2011). doi:10.1289/ehp.1002511 [Online 16 November 2010]

A number of epidemiologic studies have demonstrated tha long-term exposure to road traffic as indicated by residential proximity to major roadways or residential traffic intensity is associated with adverse cardiovascular outcomes including coronary artery atherosclerosis (Hoffmann et al. 2007), deep vein thrombosis (Baccarelli et al. 2009), fatal and nonfatal coronary events (Kan et al. 2008; Tonne et al. 2007), and cardiopulmonary mortality (Gchring et al. 2006; Hoek et al. 2002). In a previous analysis of this population-based cohort, Gan et al. (2010) observed that living close to road traffic was associated with an increased risk of coronary heart disease (CHD) mortality and that change in residential proximity to road traffic was associated with an altered risk of CHD mortality: moving close to traffic was associated with an increased risk, whereas moving away from traffic was associated with a decreased risk. In addition to exposure to traffic noise (Selander et al. 2009), residential proximity to toad traffic may reflect exposure to multiple traffic-related air pollutants (Brauer et al. 2003; Kunzli et al. 2000; Zhu et al. 2002). Identifying traffic-related air pollutants responsible for adverse cardiovascular outcomes is important for evidence-based environmental policy making and cost-effective air pollution intervention.

Metropolitan Vancouver, located on the west coast of Canada, has relatively low levels of air pollution compared with other metropolitan areas. For example, in this region, the annual average concentration of fine particles [aerodynamic diameter [less than or equal to] 2.5 [micro]m ([PM.sub.2.5])] is 5 [micro]g/[m.sup.3] (Brauer et al. 2008), in contrast to 8.7 [micro]g/[m.sup.3] in Toronto, Canada (Jerrett et al. 2009), 14.0 [micro]g/[m.s.up. …

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