External exposome and all-cause mortality in European cohorts: the EXPANSE project

Federica Nobile; Konstantina Dimakopoulou; Christofer Åström; Fabián Coloma; Payam Dadvand; Jeroen de Bont; Kees de Hoogh; Dorina Ibi; Klea Katsouyanni; Petter Ljungman; Erik Melén; Mark Nieuwenhuijsen; Regina Pickford; Johan Nilsson Sommar; Cathryn Tonne; Roel C H Vermeulen; Danielle Vienneau; Jelle J Vlaanderen; Kathrin Wolf; Evangelia Samoli; Massimo Stafoggia

doi:10.3389/fepid.2024.1327218

External exposome and all-cause mortality in European cohorts: the EXPANSE project

Federica Nobile^*, Konstantina Dimakopoulou, Christofer Åström, Fabián Coloma, Payam Dadvand, Jeroen de Bont, Kees de Hoogh, Dorina Ibi, Klea Katsouyanni, Petter Ljungman, Erik Melén, Mark Nieuwenhuijsen, Regina Pickford, Johan Nilsson Sommar, Cathryn Tonne, Roel C H Vermeulen, Danielle Vienneau, Jelle J Vlaanderen, Kathrin Wolf, Evangelia SamoliMassimo Stafoggia

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Many studies reported associations between long-term exposure to environmental factors and mortality; however, little is known on the combined effects of these factors and health. We aimed to evaluate the association between external exposome and all-cause mortality in large administrative and traditional adult cohorts in Europe.

METHODS: Data from six administrative cohorts (Catalonia, Greece, Rome, Sweden, Switzerland and the Netherlands, totaling 27,913,545 subjects) and three traditional adult cohorts (CEANS-Sweden, EPIC-NL-the Netherlands, KORA-Germany, totaling 57,653 participants) were included. Multiple exposures were assigned at the residential addresses, and were divided into three a priori defined domains: (1) air pollution [fine particulate matter (PM 2.5), nitrogen dioxide (NO₂), black carbon (BC) and warm-season Ozone (warm-O 3)]; (2) land/built environment (Normalized Difference Vegetation Index-NDVI, impervious surfaces, and distance to water); (3) air temperature (cold- and warm-season mean and standard deviation). Each domain was synthesized through Principal Component Analysis (PCA), with the aim of explaining at least 80% of its variability. Cox proportional-hazards regression models were applied and the total risk of the external exposome was estimated through the Cumulative Risk Index (CRI). The estimates were adjusted for individual- and area-level covariates.

RESULTS: More than 205 million person-years at risk and more than 3.2 million deaths were analyzed. In single-component models, IQR increases of the first principal component of the air pollution domain were associated with higher mortality [HRs ranging from 1.011 (95% CI: 1.005-1.018) for the Rome cohort to 1.076 (1.071-1.081) for the Swedish cohort]. In contrast, lower levels of the first principal component of the land/built environment domain, pointing to reduced vegetation and higher percentage of impervious surfaces, were associated with higher risks. Finally, the CRI of external exposome increased mortality for almost all cohorts. The associations found in the traditional adult cohorts were generally consistent with the results from the administrative ones, albeit without reaching statistical significance.

DISCUSSION: Various components of the external exposome, analyzed individually or in combination, were associated with increased mortality across European cohorts. This sets the stage for future research on the connections between various exposure patterns and human health, aiding in the planning of healthier cities.

Original language	English
Article number	1327218
Number of pages	13
Journal	Frontiers in Epidemiology
Volume	4
DOIs	https://doi.org/10.3389/fepid.2024.1327218
Publication status	Published - 28 May 2024

Bibliographical note

Publisher Copyright:
2024 Nobile, Dimakopoulou, Åström, Coloma, Dadvand, de Bont, de Hoogh, Ibi, Katsouyanni, Ljungman, Melén, Nieuwenhuijsen, Pickford, Sommar, Tonne, Vermeulen, Vienneau, Vlaanderen, Wolf, Samoli and Stafoggia.

Funding

Project funded by the European Union's Horizon 2020 research and innovation programme (No 874627). The KORA study was initiated and financed by the Helmholtz Zentrum M\u00FCnchen \u2013 German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Data collection in the KORA study is done in cooperation with the University Hospital of Augsburg. Acknowledgments

Funders	Funder number
Bundesministerium für Bildung und Forschung
Deutsches Forschungszentrum für Gesundheit und Umwelt, Helmholtz Zentrum München
Horizon 2020	874627

Keywords

air pollution
air temperature
environment
exposome
green space
mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3389/fepid.2024.1327218Licence: CC BY

fepid-04-1327218Final published version, 2.88 MBLicence: CC BY

Cite this

Nobile, F., Dimakopoulou, K., Åström, C., Coloma, F., Dadvand, P., de Bont, J., de Hoogh, K., Ibi, D., Katsouyanni, K., Ljungman, P., Melén, E., Nieuwenhuijsen, M., Pickford, R., Sommar, J. N., Tonne, C., Vermeulen, R. C. H., Vienneau, D., Vlaanderen, J. J., Wolf, K., ... Stafoggia, M. (2024). External exposome and all-cause mortality in European cohorts: the EXPANSE project. Frontiers in Epidemiology, 4, Article 1327218. https://doi.org/10.3389/fepid.2024.1327218

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abstract = "BACKGROUND: Many studies reported associations between long-term exposure to environmental factors and mortality; however, little is known on the combined effects of these factors and health. We aimed to evaluate the association between external exposome and all-cause mortality in large administrative and traditional adult cohorts in Europe.METHODS: Data from six administrative cohorts (Catalonia, Greece, Rome, Sweden, Switzerland and the Netherlands, totaling 27,913,545 subjects) and three traditional adult cohorts (CEANS-Sweden, EPIC-NL-the Netherlands, KORA-Germany, totaling 57,653 participants) were included. Multiple exposures were assigned at the residential addresses, and were divided into three a priori defined domains: (1) air pollution [fine particulate matter (PM 2.5), nitrogen dioxide (NO₂), black carbon (BC) and warm-season Ozone (warm-O 3)]; (2) land/built environment (Normalized Difference Vegetation Index-NDVI, impervious surfaces, and distance to water); (3) air temperature (cold- and warm-season mean and standard deviation). Each domain was synthesized through Principal Component Analysis (PCA), with the aim of explaining at least 80% of its variability. Cox proportional-hazards regression models were applied and the total risk of the external exposome was estimated through the Cumulative Risk Index (CRI). The estimates were adjusted for individual- and area-level covariates. RESULTS: More than 205 million person-years at risk and more than 3.2 million deaths were analyzed. In single-component models, IQR increases of the first principal component of the air pollution domain were associated with higher mortality [HRs ranging from 1.011 (95% CI: 1.005-1.018) for the Rome cohort to 1.076 (1.071-1.081) for the Swedish cohort]. In contrast, lower levels of the first principal component of the land/built environment domain, pointing to reduced vegetation and higher percentage of impervious surfaces, were associated with higher risks. Finally, the CRI of external exposome increased mortality for almost all cohorts. The associations found in the traditional adult cohorts were generally consistent with the results from the administrative ones, albeit without reaching statistical significance.DISCUSSION: Various components of the external exposome, analyzed individually or in combination, were associated with increased mortality across European cohorts. This sets the stage for future research on the connections between various exposure patterns and human health, aiding in the planning of healthier cities.",

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Nobile, F, Dimakopoulou, K, Åström, C, Coloma, F, Dadvand, P, de Bont, J, de Hoogh, K , Ibi, D, Katsouyanni, K, Ljungman, P, Melén, E, Nieuwenhuijsen, M, Pickford, R, Sommar, JN, Tonne, C, Vermeulen, RCH, Vienneau, D, Vlaanderen, JJ, Wolf, K, Samoli, E & Stafoggia, M 2024, 'External exposome and all-cause mortality in European cohorts: the EXPANSE project', Frontiers in Epidemiology, vol. 4, 1327218. https://doi.org/10.3389/fepid.2024.1327218

TY - JOUR

T1 - External exposome and all-cause mortality in European cohorts

T2 - the EXPANSE project

AU - Nobile, Federica

AU - Dimakopoulou, Konstantina

AU - Åström, Christofer

AU - Coloma, Fabián

AU - Dadvand, Payam

AU - de Bont, Jeroen

AU - de Hoogh, Kees

AU - Ibi, Dorina

AU - Katsouyanni, Klea

AU - Ljungman, Petter

AU - Melén, Erik

AU - Nieuwenhuijsen, Mark

AU - Pickford, Regina

AU - Sommar, Johan Nilsson

AU - Tonne, Cathryn

AU - Vermeulen, Roel C H

AU - Vienneau, Danielle

AU - Vlaanderen, Jelle J

AU - Wolf, Kathrin

AU - Samoli, Evangelia

AU - Stafoggia, Massimo

N1 - Publisher Copyright: 2024 Nobile, Dimakopoulou, Åström, Coloma, Dadvand, de Bont, de Hoogh, Ibi, Katsouyanni, Ljungman, Melén, Nieuwenhuijsen, Pickford, Sommar, Tonne, Vermeulen, Vienneau, Vlaanderen, Wolf, Samoli and Stafoggia.

PY - 2024/5/28

Y1 - 2024/5/28

N2 - BACKGROUND: Many studies reported associations between long-term exposure to environmental factors and mortality; however, little is known on the combined effects of these factors and health. We aimed to evaluate the association between external exposome and all-cause mortality in large administrative and traditional adult cohorts in Europe.METHODS: Data from six administrative cohorts (Catalonia, Greece, Rome, Sweden, Switzerland and the Netherlands, totaling 27,913,545 subjects) and three traditional adult cohorts (CEANS-Sweden, EPIC-NL-the Netherlands, KORA-Germany, totaling 57,653 participants) were included. Multiple exposures were assigned at the residential addresses, and were divided into three a priori defined domains: (1) air pollution [fine particulate matter (PM 2.5), nitrogen dioxide (NO₂), black carbon (BC) and warm-season Ozone (warm-O 3)]; (2) land/built environment (Normalized Difference Vegetation Index-NDVI, impervious surfaces, and distance to water); (3) air temperature (cold- and warm-season mean and standard deviation). Each domain was synthesized through Principal Component Analysis (PCA), with the aim of explaining at least 80% of its variability. Cox proportional-hazards regression models were applied and the total risk of the external exposome was estimated through the Cumulative Risk Index (CRI). The estimates were adjusted for individual- and area-level covariates. RESULTS: More than 205 million person-years at risk and more than 3.2 million deaths were analyzed. In single-component models, IQR increases of the first principal component of the air pollution domain were associated with higher mortality [HRs ranging from 1.011 (95% CI: 1.005-1.018) for the Rome cohort to 1.076 (1.071-1.081) for the Swedish cohort]. In contrast, lower levels of the first principal component of the land/built environment domain, pointing to reduced vegetation and higher percentage of impervious surfaces, were associated with higher risks. Finally, the CRI of external exposome increased mortality for almost all cohorts. The associations found in the traditional adult cohorts were generally consistent with the results from the administrative ones, albeit without reaching statistical significance.DISCUSSION: Various components of the external exposome, analyzed individually or in combination, were associated with increased mortality across European cohorts. This sets the stage for future research on the connections between various exposure patterns and human health, aiding in the planning of healthier cities.

AB - BACKGROUND: Many studies reported associations between long-term exposure to environmental factors and mortality; however, little is known on the combined effects of these factors and health. We aimed to evaluate the association between external exposome and all-cause mortality in large administrative and traditional adult cohorts in Europe.METHODS: Data from six administrative cohorts (Catalonia, Greece, Rome, Sweden, Switzerland and the Netherlands, totaling 27,913,545 subjects) and three traditional adult cohorts (CEANS-Sweden, EPIC-NL-the Netherlands, KORA-Germany, totaling 57,653 participants) were included. Multiple exposures were assigned at the residential addresses, and were divided into three a priori defined domains: (1) air pollution [fine particulate matter (PM 2.5), nitrogen dioxide (NO₂), black carbon (BC) and warm-season Ozone (warm-O 3)]; (2) land/built environment (Normalized Difference Vegetation Index-NDVI, impervious surfaces, and distance to water); (3) air temperature (cold- and warm-season mean and standard deviation). Each domain was synthesized through Principal Component Analysis (PCA), with the aim of explaining at least 80% of its variability. Cox proportional-hazards regression models were applied and the total risk of the external exposome was estimated through the Cumulative Risk Index (CRI). The estimates were adjusted for individual- and area-level covariates. RESULTS: More than 205 million person-years at risk and more than 3.2 million deaths were analyzed. In single-component models, IQR increases of the first principal component of the air pollution domain were associated with higher mortality [HRs ranging from 1.011 (95% CI: 1.005-1.018) for the Rome cohort to 1.076 (1.071-1.081) for the Swedish cohort]. In contrast, lower levels of the first principal component of the land/built environment domain, pointing to reduced vegetation and higher percentage of impervious surfaces, were associated with higher risks. Finally, the CRI of external exposome increased mortality for almost all cohorts. The associations found in the traditional adult cohorts were generally consistent with the results from the administrative ones, albeit without reaching statistical significance.DISCUSSION: Various components of the external exposome, analyzed individually or in combination, were associated with increased mortality across European cohorts. This sets the stage for future research on the connections between various exposure patterns and human health, aiding in the planning of healthier cities.

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KW - air temperature

KW - environment

KW - exposome

KW - green space

KW - mortality

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DO - 10.3389/fepid.2024.1327218

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JO - Frontiers in Epidemiology

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External exposome and all-cause mortality in European cohorts: the EXPANSE project

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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