Comparison of associations between mortality and air pollution exposure estimated with a hybrid, a land-use regression and a dispersion model.

Introduction: To characterize air pollution exposure at a fine spatial scale, different exposure assessment methods have been applied. Comparison of associations with health from different exposure methods are scarce. The aim of this study was to evaluate associations of air pollution based on hybrid, land-use regression (LUR) and dispersion models with natural cause and cause-specific mortality.

Methods: We followed a Dutch national cohort of approximately 10.5 million adults aged 29+ years from 2008 until 2012. We used Cox proportional hazard models with age as underlying time scale and adjusted for several potential individual and area-level socio-economic status confounders to evaluate associations of annual average residential NO, PM and BC exposure estimates based on two stochastic models (Dutch LUR, European-wide hybrid) and deterministic Dutch dispersion models.

Results: Spatial variability of PM and BC exposure was smaller for LUR compared to hybrid and dispersion models. NO exposure variability was similar for the three methods. Pearson correlations between hybrid, LUR and dispersion modeled NO and BC ranged from 0.72 to 0.83; correlations for PM were slightly lower (0.61-0.72). In general, all three models showed stronger associations of air pollutants with respiratory disease and lung cancer mortality than with natural cause and cardiovascular disease mortality. The strength of the associations differed between the three exposure models. Associations of air pollutants estimated by LUR were generally weaker compared to associations of air pollutants estimated by hybrid and dispersion models. For natural cause mortality, we found a hazard ratio (HR) of 1.030 (95% confidence interval (CI): 1.019, 1.041) per 10 µg/m for hybrid modeled NO, a HR of 1.003 (95% CI: 0.993, 1.013) per 10 µg/m for LUR modeled NO and a HR of 1.015 (95% CI: 1.005, 1.024) per 10 µg/m for dispersion modeled NO.

Conclusion: Air pollution was positively associated with natural cause and cause-specific mortality, but the strength of the associations differed between the three exposure models. Our study documents that the selected exposure model may contribute to heterogeneity in effect estimates of associations between air pollution and health.