Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard Six Cities study from 1974 to 2009
Open accessAbstract
Background: Epidemiologic studies have reported associations between fine particles (aerodynamic diameter ≤ 2.5 µm; PM2.5) and mortality. However, concerns have been raised regarding the sensitivity of the results to model specifications, lower exposures, and averaging time. Objective: We addressed these issues using 11 additional years of follow-up of the Harvard Six Cities study, incorporating recent lower exposures. Methods: We replicated the previously applied Cox regression, and examined different time lags, the shape of the concentration–response relationship using penalized splines, and changes in the slope of the relation over time. We then conducted Poisson survival analysis with time-varying effects for smoking, sex, and education. Results: Since 2001, average PM2.5 levels, for all six cities, were < 18 µg/m3. Each increase in PM2.5 (10 µg/m3) was associated with an adjusted increased risk of all-cause mortality (PM2.5 average on previous year) of 14% [95% confidence interval (CI): 7, 22], and with 26% (95% CI: 14, 40) and 37% (95% CI: 7, 75) increases in cardiovascular and lung-cancer mortality (PM2.5 average of three previous years), respectively. The concentration–response relationship was linear down to PM2.5 concentrations of 8 µg/m3. Mortality rate ratios for PM2.5 fluctuated over time, but without clear trends despite a substantial drop in the sulfate fraction. Poisson models produced similar results. Conclusions: These results suggest that further public policy efforts that reduce fine particulate matter air pollution are likely to have continuing public health benefits.
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Studies have reported broadly similar effect sizes for ambient particulate matter by smoking status.
“Studies124,159,160 have reported broadly similar effect sizes for ambient particulate matter by smoking status (never, former, and current smokers).”
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- Authors
- Lepeule, J., Laden, F., Dockery, D., & Schwartz, J.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Lepeule, Johanna
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2012-03-28
- Volume
- 120
- Issue
- 7
- Pages
- 965-970
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC3404667
- OpenAlex
- W2029401079
- Cited by
- 983
- References
- 47
- Citations by year
- 2026: 29 · 2025: 43 · 2024: 48 · 2023: 85 · 2022: 82 · 2021: 83 · 2020: 100 · 2019: 86 · 2018: 99 · 2017: 66 · 2016: 86 · 2015: 79 · 2014: 49 · 2013: 32 · 2012: 16
- FWCI
- 38.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/licenses/by/4.0/ (vor, 2102 d)
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- U.S. Environmental Protection Agency (ES000002, R832416)
- National Institute of Environmental Health Sciences (ES000002., P30ES000002)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Physical Sciences › Earth and Planetary Sciences › Atmospheric Science › Atmospheric chemistry and aerosols
- Keywords
- PM2.5, air pollution, mortality, cardiovascular mortality, lung cancer mortality, all-cause mortality, concentration-dependent effects, time delay, time-dependent effects, smoking, air quality policy
- MeSH terms
- Air Pollution, Cities, Humans, Lung Neoplasms, Public Health, Proportional Hazards Models, Particulate Matter
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