Long-Term Effect of Outdoor Air Pollution on Mortality and Morbidity: A 12-Year Follow-Up Study for Metropolitan France

Int J Environ Res Public Health. 2018 Nov 8;15(11):2487. doi: 10.3390/ijerph15112487.


Background: Short-term effects of air pollution are documented more than long-term effects.

Objective: We investigated 12-year impacts of ambient air pollutants on cardiovascular and respiratory morbidity and mortality at the departmental level in metropolitan France.

Methods: Daily air pollution data at 2-km resolution, including concentrations of particulate matter of 10 µm or 2.5 µm in diameter or less (PM10 and PM2.5), nitrogen dioxide (NO₂), and ozone (O₃), were accrued from the CHIMERE database for 1999 and 2000. Simultaneously, morbidity (hospitalizations) and mortality data were collected in 2012 using the ESPS (Enquête Santé et Protection Sociale/Health, Health Care and Insurance Survey) survey data and the CepiDc (Centre d'Épidémiologie sur les Causes Médicales de Décès/French Epidemiology Centre on Medical Causes of Death) database. Based on Poisson regression analyses, the long-term effect was estimated. A higher risk of all-cause mortality was observed using CépiDc database, with a relative risk of 1.024 (95% CI: 1.022, 1.026) and 1.029 (95% CI: 1.027, 1.031) for a 10 µg/m³ increase in PM2.5 and PM10, respectively. Mortality due to cardiovascular and respiratory diseases likewise exhibited long-term associations with both PM2.5 and PM10. Using ESPS survey data, a significant risk was observed for both PM2.5 and PM10 in all-cause mortality and all-cause morbidity. Although a risk for higher all-cause mortality and morbidity was also present for NO₂, the cause-specific relative risk due to NO₂ was found to be lesser, as compared to PM. Nevertheless, cardiovascular and respiratory morbidity were related to NO₂, along with PM2.5 and PM10. However, the health effect of O₃ was seen to be substantially lower in comparison to the other pollutants.

Conclusion: Our study confirmed that PM has a long-term impact on mortality and morbidity. Exposure to NO₂ and O₃ could also lead to increased health risks.

Keywords: air pollution; cardiovascular diseases; morbidity; mortality; respiratory diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants / adverse effects
  • Air Pollutants / analysis
  • Air Pollution / adverse effects*
  • Air Pollution / analysis
  • Follow-Up Studies
  • France / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Morbidity*
  • Mortality*
  • Nitrogen Dioxide / adverse effects
  • Nitrogen Dioxide / analysis
  • Ozone / adverse effects
  • Ozone / analysis
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis
  • Regression Analysis
  • Risk


  • Air Pollutants
  • Particulate Matter
  • Ozone
  • Nitrogen Dioxide