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HEI study in Europe finds evidence of health effects at lower levels of air pollution

A major new Health Effects Institute (HEI) report presents a study examining associations between exposures to relatively low levels of air pollution and several health outcomes among participants in 22 European cohorts.

In the report, the investigators describe the development of new exposure models for all of Europe for four pollutants: fine particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2), and ozone (O3), as well as PM2.5 particle composition.

Bert Brunekreef at the Institute for Risk Assessment Sciences, Utrecht University, the Netherlands, and colleagues reported that exposure to PM2.5, BC, and NO2 showed significant associations of air pollution exposure with natural-cause, cardiovascular, respiratory, and lung cancer mortality. They also reported that they did not find positive associations between O3 and all causes of death examined.

The shape of the associations with natural cause mortality showed steeper slopes at lower exposures, with no evidence of concentrations below which no associations were found for PM2.5, BC, and NO2.

This study contributes evidence of significant associations between exposures to relatively low levels of air pollution over many years and several important health outcomes.

The study was funded through the HEI program Assessing Health Effects of Long-Term Exposure to Low Levels of Ambient Air Pollution (RFA 14-3). Two North American studies were also funded by this program, examining low levels of ambient air pollution in the United States and Canada. Initial results were published in 2019 and Phase 2 results are under review.

The Health Effects Institute is a nonprofit corporation chartered in 1980 as an independent research organization to provide high-quality, impartial, and relevant science on the effects of air pollution on health. HEI typically receives balanced funding from the US Environmental Protection Agency and the worldwide motor vehicle industry.


  • Brunekreef B, Strak M, Chen J, Andersen ZJ, Atkinson R, Bauwelinck M, et al. (2021) Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM2.5, BC, NO2, and O3: An Analysis of European Cohorts in the ELAPSE Project. Research Report 208. Boston, MA: Health Effects Institute.


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