title: The association of air pollution and greenness with mortality and life expectancy in Spain: A small-area study.
abstract: Air pollution exposure has been associated with an increase in mortality rates, but few studies have focused on life expectancy, and most studies had restricted spatial coverage. A limited body of evidence is also suggestive for a beneficial association between residential exposure to greenness and mortality, but the evidence for such an association with life expectancy is still very scarce.
  
  
  
  To investigate the association of exposure to air pollution and greenness with mortality and life expectancy in Spain.
  
  
  
  Mortality data from 2148 small areas (average population of 20,750 inhabitants, and median population of 7672 inhabitants) covering Spain for years 2009-2013 were obtained. Average annual levels of PM10, PM2.5, NO2and O3were derived from an air quality forecasting system at 4×4km resolution. The normalized difference vegetation index (NDVI) was used to assess greenness in each small area. Air pollution and greenness were linked to standardized mortality rates (SMRs) using Poisson regression and to life expectancy using linear regression. The models were adjusted for socioeconomic status and lung cancer mortality rates (as a proxy for smoking), and accounted for spatial autocorrelation.
  
  
  
  The increase of 5μg/m3in PM10, NO2and O3or of 2μg/m3in PM2.5concentration resulted in a loss of life in years of 0.90 (95% credibility interval CI: 0.83, 0.98), 0.13 (95% CI: 0.09, 0.17), 0.20years (95% CI: 0.16, 0.24) and 0.64 (0.59, 0.70), respectively. Similar associations were found in the SMR analysis, with stronger associations for PM2.5and PM10, which were associated with an increased mortality risk of 3.7% (95% CI: 3.5%, 4.0%) and 5.7% (95% CI: 5.4%, 6.1%). For greenness, a protective effect on mortality and longer life expectancy was only found in areas with lower socioeconomic status.
  
  
  
  Air pollution concentrations were associated to important reductions in life expectancy. The reduction of air pollution should be a priority for public health.
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: de Keijzer
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Agis
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Ambrós
authors.affiliation: Barcelona Supercomputing Center (BSC), Earth Sciences Department, C/Jordi Girona 29, Edificio Nexus II, 08034 Barcelona, Spain.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Arévalo
authors.affiliation: Barcelona Supercomputing Center (BSC), Earth Sciences Department, C/Jordi Girona 29, Edificio Nexus II, 08034 Barcelona, Spain; Environmental Modelling Laboratory, Technical University of Catalonia (UPC), Avda. Diagonal 647, Edificio H, Oficina 10.23, 08028 Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Baldasano
authors.affiliation: Dipartimento Tematico Sistemi Previsionali, Qualità dell'aria, ARPA Piemonte, Via Pio VII 9, 10135 Turin, TO, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bande
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Barrera-Gómez
authors.affiliation: Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, Universitat Pompeu Fabra, C/Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain; Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), C/Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain; Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma de Madrid, 28049 Madrid, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Benach
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cirach
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Payam
authors.initials: P
authors.lastname: Dadvand
authors.affiliation: Dipartimento Tematico Sistemi Previsionali, Qualità dell'aria, ARPA Piemonte, Via Pio VII 9, 10135 Turin, TO, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Ghigo
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Èrica
authors.initials: È
authors.lastname: Martinez-Solanas
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Mark
authors.initials: M
authors.lastname: Nieuwenhuijsen
authors.affiliation: Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency (ARPA Piemonte), Via Pio VII 9, 10135 Turin, TO, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Cadum
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain. Electronic address: xavier.basagana@isglobal.org.
authors.forename: Xavier
authors.initials: X
authors.lastname: Basagaña
mesh_terms: D000397:Air Pollution / Q000032:analysis*; D004777:Environment; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009026:Mortality; D052638:Particulate Matter / Q000032:analysis; D012424:Rural Population; D017062:Small-Area Analysis; D013030:Spain / Q000453:epidemiology; D014505:Urban Population
chemical_list: D052638:Particulate Matter
keywords: Air pollution; Greenness; Mortality; NO(2); Ozone; Particulate matter