title: Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study.
abstract: BACKGROUND
  Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France.
  
  
  OBJECTIVE
  We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013.
  
  
  METHODS
  The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM10, PM10–2.5, PM2.5, NO2, O3, SO2, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations.
  
  
  RESULTS
  The cohort recorded 1967 non-accidental deaths. Long-term exposures to b aseline PM2.5, PM10-25, NO2 and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 μg/m3, PM10-25; HR=1.09; 95% CI: 1.04, 1.15 per 2.2 μg/m3, NO2: HR=1.14; 95% CI: 0.99, 1.31 per 19.3 μg/m3 and benzene: HR=1.10; 95% CI: 1.00, 1.22 per 1.7 μg/m3).The strongest association was found for PM10: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 μg/m3. PM10, PM10-25 and SO2 were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality.
  
  
  CONCLUSIONS
  Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France. Electronic address: m.bentayeb@invs.sante.fr.
authors: Malek
authors: M
authors: Bentayeb
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Verene
authors: V
authors: Wagner
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Morgane
authors: M
authors: Stempfelet
authors: Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif, France; Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France.
authors: Marie
authors: M
authors: Zins
authors: Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif, France; Versailles St-Quentin University, UMS 011, F-94807 Villejuif, France.
authors: Marcel
authors: M
authors: Goldberg
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Mathilde
authors: M
authors: Pascal
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Sophie
authors: S
authors: Larrieu
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Pascal
authors: P
authors: Beaudeau
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Sylvie
authors: S
authors: Cassadou
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Daniel
authors: D
authors: Eilstein
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Laurent
authors: L
authors: Filleul
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Alain
authors: A
authors: Le Tertre
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Sylvia
authors: S
authors: Medina
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Laurence
authors: L
authors: Pascal
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Helene
authors: H
authors: Prouvost
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France; School of Public Health (EHESP/SPC) - IRSET Inserm UMR 1085, Rennes, France.
authors: Philippe
authors: P
authors: Quénel
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Abdelkrim
authors: A
authors: Zeghnoun
authors: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors: Agnes
authors: A
authors: Lefranc
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000032:analysis*; D001554:Benzene / Q000032:analysis; D002318:Cardiovascular Diseases / Q000401:mortality*; D004781:Environmental Exposure / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D009585:Nitrogen Dioxide / Q000032:analysis; D010126:Ozone / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis*; D016016:Proportional Hazards Models; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012307:Risk Factors; D013458:Sulfur Dioxide / Q000032:analysis; D011795:Surveys and Questionnaires
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D013458:Sulfur Dioxide; D010126:Ozone; D001554:Benzene; D009585:Nitrogen Dioxide
keywords: Air pollution; Cohort study; Epidemiology; France; Mortality