Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study

Introduction: Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France. Objectives: We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013. Methods: The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM10, PM10-2.5, PM2.3, NO2, O-3, SO2, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations. Results: The cohort recorded 1967 non-accidental deaths. Long-term exposures to baseline PM2.3, Phil(10-25), NO2 and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% Cl: 0.99, 120 per 5.9 mu g/m(3), PM10-25; HR = 1.09; 95%CI: 1.04, 1.15 per 2.2 mu g/m(3), NO2: HR = 1.14; 95% CI: 0.99, 131 per 19.3 mu g/m(3) and benzene: HR= 1.10; 95% CI: 1.00, 122 per 1.7 mu g/m(3)).The strongest association was found for PM10: HR = 1.14; 95% CI: 1.05, 125 per 7.8 mu g/m(3). PM10, PM10-25 and SO2 were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality. Conclusion: Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated-with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample. (C) 2015 Elsevier Ltd. All rights reserved.