Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE)

Official website of the project: www.elapseproject.eu

Studies have consistently found associations between long-term exposure to outdoor air pollution and a range of morbidity and mortality endpoints. Recent evaluations by the World Health Organization and the Global Burden of Disease study have suggested that these associations may be non-linear and persist at very low concentrations. Uncertainty about the shape of the concentration response function exists especially for the low and high end of the concentration distribution, partly related to the scarcity of observations in the low range. In the current project (Effects of Low-Level Air Pollution: A Study in Europe, ELAPSE) we focus on analyses contributing to knowledge about spatially resolved air pollution concentrations at the low end of the exposure distribution, defined as less than current EU Limit Values for PM2.5, NO2 and Ozone.

We address the issue of health effects at low air pollution levels by performing targeted analyses of all-cause and cause-specific mortality and morbidity endpoints within 11 selected cohorts of the ESCAPE study and, in addition, in 7 recent large European administrative cohorts. The analysis focusses on the pollutants PM2.5, NO2, and O3, but it will also exploit the rich data of black carbon (BC) available for the ESCAPE study with high spatial resolution. The state-of-the-art exposure assessment combining satellite and ground-based measurements with chemistry transport modeling and land use regression modeling characterizes fine-scale intra-urban as well as between-city air pollution contrasts. By combining ESCAPE cohorts and 7 large administrative cohorts in one study, we substantially increase sample size while utilizing in-depth individual characterization. The project also addresses research questions regarding the shape of the exposure-response function at low levels, development of correction methods for exposure measurement error, the analysis of co-occurring pollutants, and indirect approaches for confounder control. It will provide highly relevant information for future air quality regulations.


  • To estimate long-term exposure to PM2.5, NO2, O3 and Black Carbon of the pooled ESCAPE cohort and seven large European administrative cohorts by developing state-of-the-art hybrid models  combining satellite and ground-based measurements with chemistry transport modeling and land use regression modeling.
  • To investigate the association of long-term exposure to PM2.5, NO2, Black Carbon and O3 with natural and cause-specific mortality, coronary and cerebrovascular events, respiratory morbidity, and lung cancer incidence.
  • To investigate shape of the exposure-response function, the impact of different methods for exposure measurement error, the role of co-occurring pollutants, and the effect of indirect approaches for confounder control in administrative cohorts.

Study design

Analysis of the pooled ESCAPE cohort of 11 individual cohorts, of seven administrative cohorts and subsequent meta-analyses.

Study area

Regions of Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden, and Switzerland.

Study population

380.000 participants in the pooled ESCAPE cohort, >35 million participants in the administrative cohorts

Project partners Bert Brunekreef (coordinator), Institute for Risk Assessment Sciences (IRAS), Utrecht University, the Netherlands, and ELAPSE consortium
Team at hhu Frauke Hennig, Anna Buschka, Barbara Hoffmann (PI)
Funding Health Effects Institute (2016-2022)
Duration 1.1.2016 – 31.3.2022

Main report

Brunekreef et al., 2021. Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM2.5, BC, NO2, and O3: An Analysis of European Cohorts in the ELAPSE Project. HEI Research Report 208.

For individual journal articles, please visit the ELAPSE website.

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