Since 1950 the population of the world has more than doubled, and the proportion of people living in cities has increased by a factor of four. In the year 2000 nearly half of the world's population will live in urban areas. Air pollution has always been one of the major nuisances of urban living, but in recent decades the sources of pollution have changed in importance in most of the industrialised world. Earlier they were dominated by individual heating systems, industry and local power plants; now they are mainly related to traffic. Concurrent with this development, the composition of the pollution has changed; it is now dominated by nitrogen oxides, volatile organic compounds and small particles arising from diesel exhaust. Urban Air Pollution - European Aspects was initiated within the European Community COST-Citair programme, in which many of the authors participated. The book presents an up-to-date account of the situation with special reference to European cities. The structure of the book follows by and large the logical chain of events in air pollution, from sources, through dispersion and deposition, to impacts, with additional chapters on experimental or computational techniques and regulatory aspects. The target group is university students at graduate level, but the book should also be useful for technical experts in international, governmental and municipal institutions as well as in private consulting companies and non-governmental organizations.
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Aerosol in Global Atmosphere -- Air Pollution Monitoring and Sustainability -- Aviation and Atmosphere -- Regional Air Quality Stratospheric Pollution -- Air Quality, Surface Transportation Impacts on -- Urban Air Quality: Meteorological Processes -- Urban Air Quality: Sources and Concentrations -- Urban Atmospheric Composition Processes -- Air Pollution Sources, Statistics and Health Effects, Introduction -- Air Quality Guidelines and Standards.
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In: Cole-Hunter , T , Dehlendorff , C , Amini , H , Mehta , A , Lim , Y-H , Jørgensen , J T , Li , S , So , R , Mortensen , L H , Westendorp , R , Hoffmann , B , Bräuner , E V , Ketzel , M , Hertel , O , Brandt , J , Jensen , S S , Christensen , J H , Geels , C , Frohn , L M , Backalarz , C , Simonsen , M K , Loft , S & Andersen , Z J 2021 , ' Long-term exposure to road traffic noise and stroke incidence : a Danish Nurse Cohort study ' , Environmental Health , vol. 20 , no. 1 , 115 . https://doi.org/10.1186/s12940-021-00802-2
BACKGROUND: Road traffic noise has been linked to increased risk of ischemic heart disease, yet evidence on stroke shows mixed results. We examine the association between long-term exposure to road traffic noise and incidence of stroke, overall and by subtype (ischemic or hemorrhagic), after adjustment for air pollution. METHODS: Twenty-five thousand six hundred and sixty female nurses from the Danish Nurse Cohort recruited in 1993 or 1999 were followed for stroke-related first-ever hospital contact until December 31st, 2014. Full residential address histories since 1970 were obtained and annual means of road traffic noise (Lden [dB]) and air pollutants (particulate matter with diameter < 2.5 μm and < 10 μm [PM2.5 and PM10], nitrogen dioxide [NO2], nitrogen oxides [NOx]) were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals [CI]) for the associations of one-, three-, and 23-year running means of Lden preceding stroke (all, ischemic or hemorrhagic), adjusting for stroke risk factors and air pollutants. The World Health Organization and the Danish government's maximum exposure recommendations of 53 and 58 dB, respectively, were explored as potential Lden thresholds. RESULTS: Of 25,660 nurses, 1237 developed their first stroke (1089 ischemic, 148 hemorrhagic) during 16 years mean follow-up. For associations between a 1-year mean of Lden and overall stroke incidence, the estimated HR (95% CI) in the fully adjusted model was 1.06 (0.98-1.14) per 10 dB, which attenuated to 1.01 (0.93-1.09) and 1.00 (0.91-1.09) in models further adjusted for PM2.5 or NO2, respectively. Associations for other exposure periods or separately for ischemic or hemorrhagic stroke were similar. There was no evidence of a threshold association between Lden and stroke. CONCLUSIONS: Long-term exposure to road traffic noise was suggestively positively associated with the risk of overall stroke, although not after adjusting for air pollution.
BACKGROUND: Road traffic noise has been linked to increased risk of ischemic heart disease, yet evidence on stroke shows mixed results. We examine the association between long-term exposure to road traffic noise and incidence of stroke, overall and by subtype (ischemic or hemorrhagic), after adjustment for air pollution. METHODS: Twenty-five thousand six hundred and sixty female nurses from the Danish Nurse Cohort recruited in 1993 or 1999 were followed for stroke-related first-ever hospital contact until December 31st, 2014. Full residential address histories since 1970 were obtained and annual means of road traffic noise (L(den) [dB]) and air pollutants (particulate matter with diameter < 2.5 μm and < 10 μm [PM(2.5) and PM(10)], nitrogen dioxide [NO(2)], nitrogen oxides [NOx]) were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals [CI]) for the associations of one-, three-, and 23-year running means of L(den) preceding stroke (all, ischemic or hemorrhagic), adjusting for stroke risk factors and air pollutants. The World Health Organization and the Danish government's maximum exposure recommendations of 53 and 58 dB, respectively, were explored as potential L(den) thresholds. RESULTS: Of 25,660 nurses, 1237 developed their first stroke (1089 ischemic, 148 hemorrhagic) during 16 years mean follow-up. For associations between a 1-year mean of L(den) and overall stroke incidence, the estimated HR (95% CI) in the fully adjusted model was 1.06 (0.98–1.14) per 10 dB, which attenuated to 1.01 (0.93–1.09) and 1.00 (0.91–1.09) in models further adjusted for PM(2.5) or NO(2), respectively. Associations for other exposure periods or separately for ischemic or hemorrhagic stroke were similar. There was no evidence of a threshold association between L(den) and stroke. CONCLUSIONS: Long-term exposure to road traffic noise was suggestively positively associated with the risk of overall stroke, although not after adjusting for air ...
In: Cole-Hunter , T , Dehlendorff , C , Amini , H , Mehta , A , Lim , Y H , Jørgensen , J T , Li , S , So , R , Mortensen , L H , Westendorp , R , Hoffmann , B , Bräuner , E V , Ketzel , M , Hertel , O , Brandt , J , Jensen , S S , Christensen , J H , Geels , C , Frohn , L M , Backalarz , C , Simonsen , M K , Loft , S & Andersen , Z J 2021 , ' Long-term exposure to road traffic noise and stroke incidence : a Danish Nurse Cohort study ' , Environmental Health , vol. 20 , no. 1 , 115 . https://doi.org/10.1186/s12940-021-00802-2
Background: Road traffic noise has been linked to increased risk of ischemic heart disease, yet evidence on stroke shows mixed results. We examine the association between long-term exposure to road traffic noise and incidence of stroke, overall and by subtype (ischemic or hemorrhagic), after adjustment for air pollution. Methods: Twenty-five thousand six hundred and sixty female nurses from the Danish Nurse Cohort recruited in 1993 or 1999 were followed for stroke-related first-ever hospital contact until December 31st, 2014. Full residential address histories since 1970 were obtained and annual means of road traffic noise (L den [dB]) and air pollutants (particulate matter with diameter < 2.5 μm and < 10 μm [PM 2.5 and PM 10 ], nitrogen dioxide [NO 2 ], nitrogen oxides [NOx]) were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals [CI]) for the associations of one-, three-, and 23-year running means of L den preceding stroke (all, ischemic or hemorrhagic), adjusting for stroke risk factors and air pollutants. The World Health Organization and the Danish government's maximum exposure recommendations of 53 and 58 dB, respectively, were explored as potential L den thresholds. Results: Of 25,660 nurses, 1237 developed their first stroke (1089 ischemic, 148 hemorrhagic) during 16 years mean follow-up. For associations between a 1-year mean of L den and overall stroke incidence, the estimated HR (95% CI) in the fully adjusted model was 1.06 (0.98–1.14) per 10 dB, which attenuated to 1.01 (0.93–1.09) and 1.00 (0.91–1.09) in models further adjusted for PM 2.5 or NO 2 , respectively. Associations for other exposure periods or separately for ischemic or hemorrhagic stroke were similar. There was no evidence of a threshold association between L den and stroke. Conclusions: Long-term exposure to road traffic noise was suggestively positively associated with the risk of overall stroke, although not after adjusting for air pollution.
In: Strak , M , Weinmayr , G , Rodopoulou , S , Chen , J , De Hoogh , K , Andersen , Z J , Atkinson , R , Bauwelinck , M , Bekkevold , T , Bellander , T , Boutron-Ruault , M C , Brandt , J , Cesaroni , G , Concin , H , Fecht , D , Forastiere , F , Gulliver , J , Hertel , O , Hoffmann , B , Hvidtfeldt , U A , Janssen , N A H , Jöckel , K H , Jørgensen , J T , Ketzel , M , Klompmaker , J O , Lager , A , Leander , K , Liu , S , Ljungman , P , Magnusson , P K E , Mehta , A J , Nagel , G , Oftedal , B , Pershagen , G , Peters , A , Raaschou-Nielsen , O , Renzi , M , Rizzuto , D , Van Der Schouw , Y T , Schramm , S , Severi , G , Sigsgaard , T , Sørensen , M , Stafoggia , M , Tjønneland , A , Monique Verschuren , W , Vienneau , D , Wolf , K , Katsouyanni , K , Brunekreef , B , Hoek , G & Samoli , E 2021 , ' Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project : Pooled analysis ' , The BMJ , vol. 374 , n1904 . https://doi.org/10.1136/bmj.n1904
Objective To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. Design Pooled analysis of eight cohorts. Setting Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. Participants 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM 2.5), nitrogen dioxide, ozone, and black carbon. Main outcome measures Deaths due to natural causes and cause specific mortality. Results Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM 2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 μg/m 3 in PM 2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 μg/m 3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM 2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 μg/m 3 an increase of 5 μg/m 3 in PM 2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. Conclusions Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
In: Strak , M , Weinmayr , G , Rodopoulou , S , Chen , J , de Hoogh , K , Andersen , Z J , Atkinson , R , Bauwelinck , M , Bekkevold , T , Bellander , T , Boutron-Ruault , M-C , Brandt , J , Cesaroni , G , Concin , H , Fecht , D , Forastiere , F , Gulliver , J , Hertel , O , Hoffmann , B , Hvidtfeldt , U A , Janssen , N A H , Jockel , K-H , Jorgensen , J , Ketzel , M , Klompmaker , J , Lager , A , Leander , K , Liu , S , Ljungman , P , Magnusson , P K E , Mehta , A J , Nagel , G , Oftedal , B , Pershagen , G , Peters , A , Raaschou-Nielsen , O , Renzi , M , Rizzuto , D , Schouw , Y T V D , Schramm , S , Severi , G , Sigsgaard , T , Sørensen , M , Stafoggia , M , Tjonneland , A , Verschuren , W M M , Vienneau , D , Wolf , K , Katsouyanni , K , Brunekreef , B , Hoek , G & Samoli , E 2021 , ' Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project : pooled analysis ' , B M J , vol. 374 , 1904 . https://doi.org/10.1136/bmj.n1904
OBJECTIVE To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. DESIGN Pooled analysis of eight cohorts. SETTING Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. PARTICIPANTS 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon. MAIN OUTCOME MEASURES Deaths due to natural causes and cause specific mortality. RESULTS Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 mu g/m(3) in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 mu g/m(3) increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 mu g/m(3) an increase of 5 mu g/m(3) in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. CONCLUSIONS Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
OBJECTIVE: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. DESIGN: Pooled analysis of eight cohorts. SETTING: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. PARTICIPANTS: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM(2.5)), nitrogen dioxide, ozone, and black carbon. MAIN OUTCOME MEASURES: Deaths due to natural causes and cause specific mortality. RESULTS: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM(2.5), nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m(3) in PM(2.5) was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m(3) increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM(2.5), nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m(3) an increase of 5 µg/m(3) in PM(2.5) was associated with 29.6% (14% to 47.4%) increase in natural deaths. CONCLUSIONS: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
In: Strak , M , Weinmayr , G , Rodopoulou , S , Chen , J , de Hoogh , K , Andersen , Z J , Atkinson , R , Bauwelinck , M , Bekkevold , T , Bellander , T , Boutron-Ruault , M-C , Brandt , J , Cesaroni , G , Concin , H , Fecht , D , Forastiere , F , Gulliver , J , Hertel , O , Hoffmann , B , Hvidtfeldt , U A , Janssen , N A H , Jöckel , K-H , Jørgensen , J T , Ketzel , M , Klompmaker , J O , Lager , A , Leander , K , Liu , S , Ljungman , P , Magnusson , P K E , Mehta , A J , Nagel , G , Oftedal , B , Pershagen , G , Peters , A , Raaschou-Nielsen , O , Renzi , M , Rizzuto , D , van der Schouw , Y T , Schramm , S , Severi , G , Sigsgaard , T , Sørensen , M , Stafoggia , M , Tjønneland , A , Verschuren , W M M , Vienneau , D , Wolf , K , Katsouyanni , K , Brunekreef , B , Hoek , G & Samoli , E 2021 , ' Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project : pooled analysis ' , BMJ (Clinical research ed.) , vol. 374 , n1904 . https://doi.org/10.1136/bmj.n1904
OBJECTIVE: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. DESIGN: Pooled analysis of eight cohorts. SETTING: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. PARTICIPANTS: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon. MAIN OUTCOME MEASURES: Deaths due to natural causes and cause specific mortality. RESULTS: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. CONCLUSIONS: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
International audience ; Objective To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. Design Pooled analysis of eight cohorts. Setting Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. Participants 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM 2.5), nitrogen dioxide, ozone, and black carbon. Main outcome measures Deaths due to natural causes and cause specific mortality. Results Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM 2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 μg/m 3 in PM 2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 μg/m 3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM 2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 μg/m 3 an increase of 5 μg/m 3 in PM 2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. Conclusions Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
International audience ; Objective To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. Design Pooled analysis of eight cohorts. Setting Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. Participants 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM 2.5), nitrogen dioxide, ozone, and black carbon. Main outcome measures Deaths due to natural causes and cause specific mortality. Results Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM 2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 μg/m 3 in PM 2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 μg/m 3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM 2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 μg/m 3 an increase of 5 μg/m 3 in PM 2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. Conclusions Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
International audience ; Objective To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. Design Pooled analysis of eight cohorts. Setting Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. Participants 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM 2.5), nitrogen dioxide, ozone, and black carbon. Main outcome measures Deaths due to natural causes and cause specific mortality. Results Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM 2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 μg/m 3 in PM 2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 μg/m 3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM 2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 μg/m 3 an increase of 5 μg/m 3 in PM 2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. Conclusions Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
International audience ; Objective To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. Design Pooled analysis of eight cohorts. Setting Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. Participants 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM 2.5), nitrogen dioxide, ozone, and black carbon. Main outcome measures Deaths due to natural causes and cause specific mortality. Results Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM 2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 μg/m 3 in PM 2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 μg/m 3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM 2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 μg/m 3 an increase of 5 μg/m 3 in PM 2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. Conclusions Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.