title: Air Pollution and Mortality in Seven Million Adults: The Dutch Environmental Longitudinal Study (DUELS).
abstract: BACKGROUND
  Long-term exposure to air pollution has been associated with mortality in urban cohort studies. Few studies have investigated this association in large-scale population registries, including non-urban populations.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the associations between long-term exposure to air pollution and nonaccidental and cause-specific mortality in the Netherlands based on existing national databases.
  
  
  METHODS
  We used existing Dutch national databases on mortality, individual characteristics, residence history, neighborhood characteristics, and national air pollution maps based on land use regression (LUR) techniques for particulates with an aerodynamic diameter ≤ 10 μm (PM10) and nitrogen dioxide (NO2). Using these databases, we established a cohort of 7.1 million individuals ≥ 30 years of age. We followed the cohort for 7 years (2004-2011). We applied Cox proportional hazard models adjusting for potential individual and area-specific confounders.
  
  
  RESULTS
  After adjustment for individual and area-specific confounders, for each 10-μg/m3 increase, PM10 and NO2 were associated with nonaccidental mortality [hazard ratio (HR) = 1.08; 95% CI: 1.07, 1.09 and HR = 1.03; 95% CI: 1.02, 1.03, respectively], respiratory mortality (HR = 1.13; 95% CI: 1.10, 1.17 and HR = 1.02; 95% CI: 1.01, 1.03, respectively), and lung cancer mortality (HR = 1.26; 95% CI: 1.21, 1.30 and HR = 1.10 95% CI: 1.09, 1.11, respectively). Furthermore, PM10 was associated with circulatory disease mortality (HR = 1.06; 95% CI: 1.04, 1.08), but NO2 was not (HR = 1.00; 95% CI: 0.99, 1.01). PM10 associations were robust to adjustment for NO2; NO2 associations remained for nonaccidental mortality and lung cancer mortality after adjustment for PM10.
  
  
  CONCLUSIONS
  Long-term exposure to PM10 and NO2 was associated with nonaccidental and cause-specific mortality in the Dutch population of ≥ 30 years of age.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Fischer
authors.forename: Marten
authors.initials: M
authors.lastname: Marra
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Ameling
authors.forename: Gerard
authors.initials: G
authors.lastname: Hoek
authors.forename: Rob
authors.initials: R
authors.lastname: Beelen
authors.forename: Kees
authors.initials: K
authors.lastname: de Hoogh
authors.forename: Oscar
authors.initials: O
authors.lastname: Breugelmans
authors.forename: Hanneke
authors.initials: H
authors.lastname: Kruize
authors.forename: Nicole A H
authors.initials: NA
authors.lastname: Janssen
authors.forename: Danny
authors.initials: D
authors.lastname: Houthuijs
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000633:toxicity*; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009585:Nitrogen Dioxide / Q000633:toxicity*; D052638:Particulate Matter / Q000633:toxicity*; D012044:Regression Analysis; D012140:Respiratory Tract Diseases / Q000401:mortality*
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D009585:Nitrogen Dioxide