The Long-Term Mortality Effects Associated with Exposure to Particles and NOx in the Malmö Diet and Cancer Cohort

Henrik Olstrup, Erin Flanagan, Jan Olov Persson, Ralf Rittner, Hanne Krage Carlsen, Leo Stockfelt, Yiyi Xu, Lars Rylander, Susanna Gustafsson, Mårten Spanne, Daniel Oudin Åström, Gunnar Engström, Anna Oudin

Research output: Contribution to journalArticlepeer-review


In this study, the long-term mortality effects associated with exposure to PM10 (particles with an aerodynamic diameter smaller than or equal to 10 µm), PM2.5 (particles with an aerodynamic diameter smaller than or equal to 2.5 µm), BC (black carbon), and NOx (nitrogen oxides) were analyzed in a cohort in southern Sweden during the period from 1991 to 2016. Participants (those residing in Malmö, Sweden, born between 1923 and 1950) were randomly recruited from 1991 to 1996. At enrollment, 30,438 participants underwent a health screening, which consisted of questionnaires about lifestyle and diet, a clinical examination, and blood sampling. Mortality data were retrieved from the Swedish National Cause of Death Register. The modeled concentrations of PM10, PM2.5, BC, and NOx at the cohort participants’ home addresses were used to assess air pollution exposure. Cox proportional hazard models were used to estimate the associations between long-term exposure to PM10, PM2.5, BC, and NOx and the time until death among the participants during the period from 1991 to 2016. The hazard ratios (HRs) associated with an interquartile range (IQR) increase in each air pollutant were calculated based on the exposure lag windows of the same year (lag0), 1–5 years (lag1–5), and 6–10 years (lag6–10). Three models were used with varying adjustments for possible confounders including both single-pollutant estimates and two-pollutant estimates. With adjustments for all covariates, the HRs for PM10, PM2.5, BC, and NOx in the single-pollutant models at lag1–5 were 1.06 (95% CI: 1.02–1.11), 1.01 (95% CI: 0.95–1.08), 1.07 (95% CI: 1.04–1.11), and 1.11 (95% CI: 1.07–1.16) per IQR increase, respectively. The HRs, in most cases, decreased with the inclusion of a larger number of covariates in the models. The most robust associations were shown for NOx, with statistically significant positive HRs in all the models. An overall conclusion is that road traffic-related pollutants had a significant association with mortality in the cohort.

Original languageEnglish
Article number913
Issue number11
Publication statusPublished - 2023 Nov

Bibliographical note

Funding Information:
This research was funded by Formas under grant agreement number 2017-00898 (How is our health affected by particles from wood burning? A. Oudin), by the European Union’s Horizon 2020 research and innovation program under Grant Agreement No. 814978 (TUBE), and by the Swedish Research Council for Sustainable Development (FORMAS, number 2016–00993; Stockfelt). Open access funding was provided by Lund University.

Publisher Copyright:
© 2023 by the authors.

Subject classification (UKÄ)

  • Environmental Health and Occupational Health

Free keywords

  • air pollution
  • Cox regression
  • hazard ratio
  • long-term exposure
  • nitrogen oxides
  • particles
  • proportional hazard


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