title: Associations between particulate matter elements and early-life pneumonia in seven birth cohorts: results from the ESCAPE and TRANSPHORM projects.
abstract: Evidence for a role of long-term particulate matter exposure on acute respiratory infections is growing. However, which components of particulate matter may be causative remains largely unknown. We assessed associations between eight particulate matter elements and early-life pneumonia in seven birth cohort studies (N total=15,980): BAMSE (Sweden), GASPII (Italy), GINIplus and LISAplus (Germany), INMA (Spain), MAAS (United Kingdom) and PIAMA (The Netherlands). Annual average exposure to copper, iron, potassium, nickel, sulfur, silicon, vanadium and zinc, each respectively derived from particles with aerodynamic diameters ≤ 10 μm (PM10) and 2.5 μm (PM2.5), were estimated using standardized land use regression models and assigned to birth addresses. Cohort-specific associations between these exposures and parental reports of physician-diagnosed pneumonia between birth and two years were assessed using logistic regression models adjusted for host and environmental covariates and total PM10 or PM2.5 mass. Combined estimates were calculated using random-effects meta-analysis. There was substantial within and between-cohort variability in element concentrations. In the adjusted meta-analysis, pneumonia was weakly associated with zinc derived from PM10 (OR: 1.47 (95% CI: 0.99, 2.18) per 20 ng/m(3) increase). No other associations with the other elements were consistently observed. The independent effect of particulate matter mass remained after adjustment for element concentrations. In conclusion, associations between particulate matter mass exposure and pneumonia were not explained by the elements we investigated. Zinc from PM10 was the only element which appeared independently associated with a higher risk of early-life pneumonia. As zinc is primarily attributable to non-tailpipe traffic emissions, these results may suggest a potential adverse effect of non-tailpipe emissions on health.
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany; School of Population and Public Health, University of British Columbia, 2206 East Mall, V6T 1Z3 Vancouver, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Fuertes
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany.
authors.forename: Elaina
authors.initials: E
authors.lastname: MacIntyre
authors.affiliation: Centre for Epidemiology, Institute of Population Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, M13 9PL Manchester, United Kingdom.
authors.forename: Raymond
authors.initials: R
authors.lastname: Agius
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, NL-3584 CM Utrecht, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Beelen
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, NL-3584 CM Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service ASL RME, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Bucci
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service ASL RME, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Cesaroni
authors.affiliation: Centre of Research in Environmental Epidemiology, Doctor Aiguader, 88 E-08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro 3, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cirach
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany; Environmental Science Center, University of Augsburg, Maximilianstraße 3, 86150 Augsburg, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Cyrys
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service ASL RME, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, NL-3584 CM Utrecht, The Netherlands.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Gehring
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, SE-171 77 Stockholm, Sweden.
authors.forename: Olena
authors.initials: O
authors.lastname: Gruzieva
authors.affiliation: Medical Faculty, Heinrich-Heine University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany; IUF-Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: TNO, Netherlands Organization for Applied Scientific Research, Delft, The Netherlands.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jedynska
authors.affiliation: TNO, Netherlands Organization for Applied Scientific Research, Delft, The Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: Keuken
authors.affiliation: IUF-Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Klümper
authors.affiliation: TNO, Netherlands Organization for Applied Scientific Research, Delft, The Netherlands.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Kooter
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, SE-171 77 Stockholm, Sweden.
authors.forename: Michal
authors.initials: M
authors.lastname: Korek
authors.affiliation: IUF-Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Krämer
authors.affiliation: Centre for Epidemiology, Institute of Population Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, M13 9PL Manchester, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Mölter
authors.affiliation: Centre of Research in Environmental Epidemiology, Doctor Aiguader, 88 E-08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro 3, Madrid, Spain.
authors.forename: Mark
authors.initials: M
authors.lastname: Nieuwenhuijsen
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, SE-171 77 Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Pershagen
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service ASL RME, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Porta
authors.affiliation: University of Groningen, University Medical Center Groningen, The Department of Pulmonology, Groningen Research Institute for Asthma and COPD, Hanzeplein 1, NL-9700 RB Groningen, The Netherlands.
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.affiliation: Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, 131 Princess Street, M1 7DN Manchester, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Simpson
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Smit
authors.affiliation: IUF-Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Sugiri
authors.affiliation: Centre of Research in Environmental Epidemiology, Doctor Aiguader, 88 E-08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro 3, Madrid, Spain; IMIM (Hospital del Mar Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, NL-3584 CM Utrecht, The Netherlands.
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany. Electronic address: heinrich@helmholtz-muenchen.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects*; D000397:Air Pollution / Q000009:adverse effects; D002675:Child, Preschool; D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018538:Jupiter; D016015:Logistic Models; D008297:Male; D019216:Metals, Heavy / Q000009:adverse effects*; D010316:Particle Size; D052638:Particulate Matter / Q000009:adverse effects*; D011014:Pneumonia / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000209:etiology; D015032:Zinc / Q000009:adverse effects*
chemical_list: D000393:Air Pollutants; D019216:Metals, Heavy; D052638:Particulate Matter; D015032:Zinc
keywords: Birth cohort; Childhood pneumonia; Elemental composition; Meta-analysis; Particulate matter; Zinc