title: Cross-sectional associations between air pollution and chronic bronchitis: an ESCAPE meta-analysis across five cohorts.
abstract: BACKGROUND
  This study aimed to assess associations of outdoor air pollution on prevalence of chronic bronchitis symptoms in adults in five cohort studies (Asthma-E3N, ECRHS, NSHD, SALIA, SAPALDIA) participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE) project.
  
  
  METHODS
  Annual average particulate matter (PM(10), PM(2.5), PM(absorbance), PM(coarse)), NO(2), nitrogen oxides (NO(x)) and road traffic measures modelled from ESCAPE measurement campaigns 2008-2011 were assigned to home address at most recent assessments (1998-2011). Symptoms examined were chronic bronchitis (cough and phlegm for ≥3 months of the year for ≥2 years), chronic cough (with/without phlegm) and chronic phlegm (with/without cough). Cohort-specific cross-sectional multivariable logistic regression analyses were conducted using common confounder sets (age, sex, smoking, interview season, education), followed by meta-analysis.
  
  
  RESULTS
  15 279 and 10 537 participants respectively were included in the main NO(2) and PM analyses at assessments in 1998-2011. Overall, there were no statistically significant associations with any air pollutant or traffic exposure. Sensitivity analyses including in asthmatics only, females only or using back-extrapolated NO(2) and PM10 for assessments in 1985-2002 (ECRHS, NSHD, SALIA, SAPALDIA) did not alter conclusions. In never-smokers, all associations were positive, but reached statistical significance only for chronic phlegm with PM(coarse) OR 1.31 (1.05 to 1.64) per 5 µg/m(3) increase and PM(10) with similar effect size. Sensitivity analyses of older cohorts showed increased risk of chronic cough with PM(2.5abs) (black carbon) exposures.
  
  
  CONCLUSIONS
  Results do not show consistent associations between chronic bronchitis symptoms and current traffic-related air pollution in adult European populations.
authors.affiliation: Department of Epidemiology & Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Yutong
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany.
authors.forename: Tamara
authors.initials: T
authors.lastname: Schikowski
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Adam
authors.affiliation: Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Buschka
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Anne-Elie
authors.initials: AE
authors.lastname: Carsin
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and Environmental epidemiology team, Villejuif, France. Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Jacquemin
authors.affiliation: Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marcon
authors.affiliation: INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and Environmental epidemiology team, Villejuif, France. Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
authors.forename: Margaux
authors.initials: M
authors.lastname: Sanchez
authors.affiliation: Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vierkötter
authors.affiliation: Department of Epidemiology & Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Zaina
authors.initials: Z
authors.lastname: Al-Kanaani
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Beelen
authors.affiliation: German Research Centre for Environmental Health, Institutes of Epidemiology I and II, Neuherberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Birk
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cirach
authors.affiliation: Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Nutrition, Hormones, and Women's Health team, Villejuif, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: French Institute for Public Health Surveillance, Saint-Maurice, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Declercq
authors.affiliation: Department of Epidemiology & Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Kees
authors.initials: K
authors.lastname: de Hoogh
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Centre for Environmental Policy, Imperial College London, London, UK.
authors.forename: Audrey
authors.initials: A
authors.lastname: de Nazelle
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Regina E
authors.initials: RE
authors.lastname: Ducret-Stich
authors.affiliation: Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Neuroscience, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Valeria Ferretti
authors.affiliation: Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umea University, Umea, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Forsberg
authors.affiliation: Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Gerbase
authors.affiliation: MRC Unit for Lifelong Health and Ageing at UCL, Institute of Epidemiology and Health Care, University College London, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.affiliation: German Research Centre for Environmental Health, Institutes of Epidemiology I and II, Neuherberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Hoek
authors.affiliation: Department of Epidemiology & Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Jarvis
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Dirk
authors.initials: D
authors.lastname: Keidel
authors.affiliation: MRC Unit for Lifelong Health and Ageing at UCL, Institute of Epidemiology and Health Care, University College London, London, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Kuh
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Martina S
authors.initials: MS
authors.lastname: Ragettli
authors.affiliation: Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranzi
authors.affiliation: Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Rochat
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.affiliation: Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Sugiri
authors.affiliation: INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and Environmental epidemiology team, Villejuif, France. Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
authors.forename: Sofia
authors.initials: S
authors.lastname: Temam
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Tsai
authors.affiliation: INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and Environmental epidemiology team, Villejuif, France. Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
authors.forename: Raphaëlle
authors.initials: R
authors.lastname: Varraso
authors.affiliation: INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and Environmental epidemiology team, Villejuif, France. Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Kauffmann
authors.affiliation: Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Krämer
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Nino
authors.initials: N
authors.lastname: Künzli
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Probst-Hensch
authors.affiliation: Department of Epidemiology & Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Hansell
mesh_terms: D000397:Air Pollution / Q000009:adverse effects; D029481:Bronchitis, Chronic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004784:Environmental Monitoring; D014943:Global Health; D006801:Humans; D015994:Incidence; D012307:Risk Factors