摘要：Background Air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD), but evidence is sparse and inconsistent. Objectives We examined the association between long-term exposure to low-level air pollution and COPD incidence. Methods Within the ‘Effects of Low-Level Air Pollution: A Study in Europe’ (ELAPSE) study, we pooled data from three cohorts, from Denmark and Sweden, with information on COPD hospital discharge diagnoses. Hybrid land use regression models were used to estimate annual mean concentrations of particulate matter with a diameter < 2.5 µm (PM 2.5 ), nitrogen dioxide (NO 2 ), and black carbon (BC) in 2010 at participants’ baseline residential addresses, which were analysed in relation to COPD incidence using Cox proportional hazards models. Results Of 98,058 participants, 4,928 developed COPD during 16.6 years mean follow-up. The adjusted hazard ratios (HRs) and 95% confidence intervals for associations with COPD incidence were 1.17 (1.06, 1.29) per 5 µg/m 3 for PM 2.5 , 1.11 (1.06, 1.16) per 10 µg/m 3 for NO 2 , and 1.11 (1.06, 1.15) per 0.5 10 −5 m −1 for BC. Associations persisted in subset participants with PM 2.5 or NO 2 levels below current EU and US limit values and WHO guidelines, with no evidence for a threshold. HRs for NO 2 and BC remained unchanged in two-pollutant models with PM 2.5 , whereas the HR for PM 2.5 was attenuated to unity with NO 2 or BC. Conclusions Long-term exposure to low-level air pollution is associated with the development of COPD, even below current EU and US limit values and possibly WHO guidelines. Traffic-related pollutants NO 2 and BC may be the most relevant.
