TY  - JOUR
AB  - BACKGROUND: We evaluated the independent and joint effects of air pollution, land/built environment characteristics, and ambient temperature on all-cause mortality as part of the EXPANSE project. METHODS: We collected data from six administrative cohorts covering Catalonia, Greece, the Netherlands, Rome, Sweden, and Switzerland and three traditional cohorts in Sweden, the Netherlands, and Germany. Participants were linked to spatial exposure estimates derived from hybrid land use regression models and satellite data for: air pollution [fine particulate matter (PM2.5), nitrogen dioxide (NO₂), black carbon (BC), warm season ozone (O3)], land/built environment [normalized difference vegetation index (NDVI), distance to water, impervious surfaces], and ambient temperature (the mean and standard deviation of warm and cool season temperature). We applied Cox proportional hazard models accounting for several cohort-specific individual and area-level variables. We evaluated the associations through single and multiexposure models, and interactions between exposures. The joint effects were estimated using the cumulative risk index (CRI). Cohort-specific hazard ratios (HR) were combined using random-effects meta-analyses. RESULTS: We observed over 3.1 million deaths out of approximately 204 million person-years. In administrative cohorts, increased exposure to PM2.5, NO2, and BC was significantly associated with all-cause mortality (pooled HRs: 1.054, 1.033, and 1.032, respectively). We observed an adverse effect of increased impervious surface and mean season-specific temperature, and a protective effect of increased O3, NDVI, distance to water, and temperature variation on all-cause mortality. The effects of PM2.5 were higher in areas with lower (10th percentile) compared to higher (90th percentile) NDVI levels [pooled HRs: 1.054 (95% confidence interval (CI) 1.030-1.079) vs. 1.038 (95% CI 0.964-1.118)]. A similar pattern was observed for NO2. The CRI of air pollutants (PM2.5 or NO2) plus NDVI and mean warm season temperature resulted in a stronger effect compared to single-exposure HRs: [PM2.5 pooled HR: 1.061 (95% CI 1.021-1.102); NO2 pooled HR: 1.041 (95% CI 1.025-1.057)]. Non-significant effects of similar patterns were observed in traditional cohorts. DISCUSSION: The findings of our study not only support the independent effects of long-term exposure to air pollution and greenness, but also highlight the increased effect when interplaying with other environmental exposures.
AU  - Dimakopoulou, K.*
AU  - Nobile, F.*
AU  - de Bont, J.*
AU  - Wolf, K.
AU  - Vienneau, D.*
AU  - Ibi, D.*
AU  - Coloma, F.*
AU  - Pickford, R.
AU  - Åström, C.*
AU  - Sommar, J.N.*
AU  - Kasdagli, M.I.*
AU  - Souliotis, K.*
AU  - Tsolakidis, A.*
AU  - Tonne, C.*
AU  - Melén, E.*
AU  - Ljungman, P.*
AU  - de Hoogh, K.*
AU  - Vermeulen, R.C.H.*
AU  - Vlaanderen, J.J.*
AU  - Katsouyanni, K.*
AU  - Stafoggia, M.*
AU  - Samoli, E.*
C1  - 70170
C2  - 55203
TI  - Disentangling associations between multiple environmental exposures and all-cause mortality: An analysis of European administrative and traditional cohorts.
JO  - Front. Epidemiol.
VL  - 3
PY  - 2024
SN  - 2674-1199
ER  - 

TY  - JOUR
AB  - BACKGROUND: Many studies reported associations between long-term exposure to environmental factors and mortality; however, little is known on the combined effects of these factors and health. We aimed to evaluate the association between external exposome and all-cause mortality in large administrative and traditional adult cohorts in Europe. METHODS: Data from six administrative cohorts (Catalonia, Greece, Rome, Sweden, Switzerland and the Netherlands, totaling 27,913,545 subjects) and three traditional adult cohorts (CEANS-Sweden, EPIC-NL-the Netherlands, KORA-Germany, totaling 57,653 participants) were included. Multiple exposures were assigned at the residential addresses, and were divided into three a priori defined domains: (1) air pollution [fine particulate matter (PM2.5), nitrogen dioxide (NO₂), black carbon (BC) and warm-season Ozone (warm-O3)]; (2) land/built environment (Normalized Difference Vegetation Index-NDVI, impervious surfaces, and distance to water); (3) air temperature (cold- and warm-season mean and standard deviation). Each domain was synthesized through Principal Component Analysis (PCA), with the aim of explaining at least 80% of its variability. Cox proportional-hazards regression models were applied and the total risk of the external exposome was estimated through the Cumulative Risk Index (CRI). The estimates were adjusted for individual- and area-level covariates. RESULTS: More than 205 million person-years at risk and more than 3.2 million deaths were analyzed. In single-component models, IQR increases of the first principal component of the air pollution domain were associated with higher mortality [HRs ranging from 1.011 (95% CI: 1.005-1.018) for the Rome cohort to 1.076 (1.071-1.081) for the Swedish cohort]. In contrast, lower levels of the first principal component of the land/built environment domain, pointing to reduced vegetation and higher percentage of impervious surfaces, were associated with higher risks. Finally, the CRI of external exposome increased mortality for almost all cohorts. The associations found in the traditional adult cohorts were generally consistent with the results from the administrative ones, albeit without reaching statistical significance. DISCUSSION: Various components of the external exposome, analyzed individually or in combination, were associated with increased mortality across European cohorts. This sets the stage for future research on the connections between various exposure patterns and human health, aiding in the planning of healthier cities.
AU  - Nobile, F.*
AU  - Dimakopoulou, K.*
AU  - Åström, C.*
AU  - Coloma, F.*
AU  - Dadvand, P.*
AU  - de Bont, J.*
AU  - de Hoogh, K.*
AU  - Ibi, D.*
AU  - Katsouyanni, K.*
AU  - Ljungman, P.*
AU  - Melén, E.*
AU  - Nieuwenhuijsen, M.*
AU  - Pickford, R.
AU  - Sommar, J.N.*
AU  - Tonne, C.*
AU  - Vermeulen, R.C.H.*
AU  - Vienneau, D.*
AU  - Vlaanderen, J.J.*
AU  - Wolf, K.
AU  - Samoli, E.*
AU  - Stafoggia, M.*
C1  - 70827
C2  - 55827
TI  - External exposome and all-cause mortality in European cohorts: The EXPANSE project.
JO  - Front. Epidemiol.
VL  - 4
PY  - 2024
SN  - 2674-1199
ER  - 

TY  - JOUR
AB  - INTRODUCTION: Family history of depression and childhood maltreatment are established risk factors for depression. However, how these factors are interrelated and jointly influence depression risk is not well understood. The present study investigated (i) if childhood maltreatment is associated with a family history of depression (ii) if family history and childhood maltreatment are associated with increased lifetime and current depression, and whether both factors interact beyond their main effects, and (iii) if family history affects lifetime and current depression via childhood maltreatment. METHODS: Analyses were based on a subgroup of the first 100,000 participants of the German National Cohort (NAKO), with complete information (58,703 participants, mean age = 51.2 years, 53% female). Parental family history of depression was assessed via self-report, childhood maltreatment with the Childhood Trauma Screener (CTS), lifetime depression with self-reported physician's diagnosis and the Mini-International Neuropsychiatric Interview (MINI), and current depressive symptoms with the depression scale of the Patient Health Questionnaire (PHQ-9). Generalized linear models were used to test main and interaction effects. Mediation was tested using causal mediation analyses. RESULTS: Higher frequencies of the childhood maltreatment measures were found in subjects reporting a positive family history of depression. Family history and childhood maltreatment were independently associated with increased depression. No statistical interactions of family history and childhood maltreatment were found for the lifetime depression measures. For current depressive symptoms (PHQ-9 sum score), an interaction was found, with stronger associations of childhood maltreatment and depression in subjects with a positive family history. Childhood maltreatment was estimated to mediate 7%-12% of the effect of family history on depression, with higher mediated proportions in subjects whose parents had a depression onset below 40 years. Abuse showed stronger associations with family history and depression, and higher mediated proportions of family history effects on depression than neglect. DISCUSSION: The present study confirms the association of childhood maltreatment and family history with depression in a large population-based cohort. While analyses provide little evidence for the joint effects of both risk factors on depression beyond their individual effects, results are consistent with family history affecting depression via childhood maltreatment to a small extent.
AU  - Streit, F.*
AU  - Völker, M.P.*
AU  - Klinger-König, J.*
AU  - Zillich, L.*
AU  - Frank, J.*
AU  - Reinhard, I.*
AU  - Foo, J.C.*
AU  - Witt, S.H.*
AU  - Sirignano, L.*
AU  - Becher, H.*
AU  - Obi, N.*
AU  - Riedel, O.*
AU  - Do, S.*
AU  - Castell, S.*
AU  - Hassenstein, M.J.*
AU  - Karch, A.*
AU  - Stang, A.*
AU  - Schmidt, B.*
AU  - Schikowski, T.*
AU  - Stahl-Pehe, A.*
AU  - Brenner, H.*
AU  - Perna, L.*
AU  - Greiser, K.H.*
AU  - Kaaks, R.*
AU  - Michels, K.B.*
AU  - Franzke, C.W.*
AU  - Peters, A.
AU  - Fischer, B.*
AU  - Konzok, J.*
AU  - Mikolajczyk, R.*
AU  - Führer, A.*
AU  - Keil, T.*
AU  - Fricke, J.*
AU  - Willich, S.N.*
AU  - Pischon, T.*
AU  - Völzke, H.*
AU  - Meinke-Franze, C.*
AU  - Loeffler, M.*
AU  - Wirkner, K.*
AU  - Berger, K.*
AU  - Grabe, H.J.*
AU  - Rietschel, M.*
C1  - 70403
C2  - 55607
TI  - The interplay of family history of depression and early trauma: Associations with lifetime and current depression in the German national cohort (NAKO).
JO  - Front. Epidemiol.
VL  - 3
PY  - 2023
SN  - 2674-1199
ER  - 

TY  - JOUR
AB  - Future projection of the temperature-related health burden, including mortality and hospital admissions, is a growing field of research. These studies aim to provide crucial information for decision-makers considering existing health policies as well as integrating targeted adaptation strategies to evade the health burden. However, this field of research is still overshadowed by large uncertainties. These uncertainties exist to an extent in the future climate and population models used by such studies but largely in the disparities in underlying assumptions. Existing studies differ in the factors incorporated for projection and strategies for considering the future adaptation of the population to temperature. These differences exist to a great degree because of a lack of robust evidence as well as gaps in the field of climate epidemiology that still require extensive input from the research community. This narrative review summarizes the current status of projection studies of temperature-attributable health burden, the guiding assumptions behind them, the common grounds, as well as the differences. Overall, the review aims to highlight existing evidence and knowledge gaps as a basis for designing future studies on temperature-attributable health burden estimation. Finding a robust methodology for projecting the future health burden could be a milestone for climate epidemiologists as this would largely benefit the world when applying this technique to project the climate-attributable cause-specific health burden and adapt our existing health policies accordingly.
AU  - Rai, M.
AU  - Breitner-Busch, S.
AU  - Zhang, S.
AU  - Rappold, A.G.*
AU  - Schneider, A.E.
C1  - 68757
C2  - 54967
TI  - Achievements and gaps in projection studies on the temperature-attributable health burden: Where should we be headed?
JO  - Front. Epidemiol.
VL  - 2
PY  - 2022
SN  - 2674-1199
ER  -