Long-Term Exposure to Ambient Air Pollution and Lower Respiratory Tract Infection in Adults: Danish Nationwide Evidence

BACKGROUND: Long-term exposure to air pollution has been linked with acute lower respiratory infections (ALRIs) in children, but the evidence in adults is still mixed and sparse. We aimed to examine the association between long-term exposure to air pollution and incident ALRIs in adults.

METHOD: We followed all Danish residents aged 30 or older (N=3,083,227) for the first-ever hospital contact (in-, outpatient, or emergency) for ALRIs (and pneumonia or influenza separately) from 2000 to 2018. Long-term exposure to air pollution was defined as annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC), which were modeled using hybrid land-use regression models and assigned to baseline residential addresses. Cox regression models were used to assess the association between air pollution and incidence of ALRIs in total, pneumonia, and influenza.

RESULTS: During 16 years' mean follow-up, there were 322,035, 309,092 and 11,977 incident cases of ALRIs, pneumonia, and influenza, respectively. We detected positive associations of air pollution and incident ALRIs, with hazard ratios (95% confidence interval) of 1.08 (1.07, 1.09) per 10 μg/m3 for NO2, 1.07 (1.06, 1.08) per 0.5 10-5 m-1 for BC, and 1.04 (1.03, 1.04) per 2 μg/m3 for PM2.5. We detected similar associations with pneumonia, but no detected association with influenza.

CONCLUSION: Long-term exposure to air pollution may contribute to an increased risk of contracting ALRIs, particularly pneumonia, that require hospital care. Associations persisted for all major pollutants (PM2.5, NO2 and BC) even at exposure lower than the current EU limits and WHO guideline.