title: Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard Six Cities study from 1974 to 2009.
abstract: BACKGROUND
  Epidemiologic studies have reported associations between fine particles (aerodynamic diameter ≤ 2.5 µm; PM2.5) and mortality. However, concerns have been raised regarding the sensitivity of the results to model specifications, lower exposures, and averaging time.
  
  
  OBJECTIVE
  We addressed these issues using 11 additional years of follow-up of the Harvard Six Cities study, incorporating recent lower exposures.
  
  
  METHODS
  We replicated the previously applied Cox regression, and examined different time lags, the shape of the concentration-response relationship using penalized splines, and changes in the slope of the relation over time. We then conducted Poisson survival analysis with time-varying effects for smoking, sex, and education.
  
  
  RESULTS
  Since 2001, average PM2.5 levels, for all six cities, were < 18 µg/m3. Each increase in PM2.5 (10 µg/m3) was associated with an adjusted increased risk of all-cause mortality (PM2.5 average on previous year) of 14% [95% confidence interval (CI): 7, 22], and with 26% (95% CI: 14, 40) and 37% (95% CI: 7, 75) increases in cardiovascular and lung-cancer mortality (PM2.5 average of three previous years), respectively. The concentration-response relationship was linear down to PM2.5 concentrations of 8 µg/m3. Mortality rate ratios for PM2.5 fluctuated over time, but without clear trends despite a substantial drop in the sulfate fraction. Poisson models produced similar results.
  
  
  CONCLUSIONS
  These results suggest that further public policy efforts that reduce fine particulate matter air pollution are likely to have continuing public health benefits.
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA. jlepeule@hsph.harvard.edu
authors.forename: Johanna
authors.initials: J
authors.lastname: Lepeule
authors.forename: Francine
authors.initials: F
authors.lastname: Laden
authors.forename: Douglas
authors.initials: D
authors.lastname: Dockery
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D002947:Cities; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology; D052638:Particulate Matter / Q000633:toxicity; D016016:Proportional Hazards Models; D011634:Public Health
chemical_list: D052638:Particulate Matter