Mortality endpoints ( version 29-06-2012 ) Tentative title : Effects of long-term exposure to air pollution on natural cause and cardiovascular mortality

Background In the cohort studies assessing effects of long-term exposure to air pollution on mortality, it has generally been found that effects were stronger for cardiovascular causes of death than for other causes of death (excluding respiratory disease and lung cancer) (Beelen et al, 2009; Beelen et al. 2008; Nafstad et al. 2004; Pope et al. 2002; Laden et al. 2006; Ostro et al. 2011). A recent study from the US in higher educated men did not find any association between PM2.5 and cardiovascular disease mortality (Puett et al. 2011). Studies have evaluated the broad category of all cardiovascular diseases combined, for reasons of cohort size or the limitations of death certificates to define causes of death more specifically. In some of the US studies, cardio-pulmonary mortality was analysed – combining cardiovascular and respiratory disease (Pope et al. 2002). In ESCAPE we will analyse natural cause, cardiovascular and respiratory mortality separately. Studies in the US have mostly reported associations with PM2.5 (Brook et al. 2010). Studies in Europe have also reported associations between long-term exposure to NO2 or NOx and cardiovascular mortality, including studies in the Netherlands (Beelen et al. 2008), France (Filleul et al. 2005) and Norway (Nafstad et al. 2004).