Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: the Life-GAP projectDepartment of Environmental Science, Aarhus University, Roskilde, Denmark.
Department of Environmental Science, Aarhus University, Roskilde, Denmark.
Department of Environmental Science, Aarhus University, Roskilde, Denmark.
Department of Respiratory Medicine and Sleep, Landspitali – the National University Hospital of Iceland, Reykjavik, Iceland; Medical Faculty, University of Iceland, Iceland.
Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Institute of Psychology, Jagiellonian University, Krakow, Poland; Health and Quality of Life in a Green and Sustainable Environment”, Strategic Research and Innovation Program for the Development of MU – Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
Department of Public Health, Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.
Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Show others and affiliations
2025 (English)In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 270, article id 120938Article in journal (Refereed) Published
Abstract [en]
Background: Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive. Objective: We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study.
Methods: We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990–2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes.
Results: The analysis included 1675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00–1.35; 2000: RR 1.24, 95% CI: 0.98–1.57; 1990–2000: RR 1.17, 95% CI: 0.97–1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00–2.01; 2000: RR 2.20, 95% CI: 1.43–3.38; 1990–2000: RR 1.44, 95% CI: 1.04–2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows.
Conclusion: Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.
Place, publisher, year, edition, pages
Elsevier, 2025. Vol. 270, article id 120938
Keywords [en]
Air pollution, Emergency room visits, Green space, Hay fever, Hospital admissions, Longitudinal study
National Category
Respiratory Medicine and Allergy Occupational Health and Environmental Health Public Health, Global Health and Social Medicine
Identifiers
URN: urn:nbn:se:umu:diva-236009DOI: 10.1016/j.envres.2025.120938ISI: 001422201300001PubMedID: 39862954Scopus ID: 2-s2.0-85216216569OAI: oai:DiVA.org:umu-236009DiVA, id: diva2:1943616
Funder
The Research Council of Norway, 300765NordForsk, 75007: NordicWelfAir2025-03-112025-03-112025-03-11Bibliographically approved