Low-level pollution - health impacts: evidence review

This review explores the existing evidence on the health effects associated with low-level pollution in countries that have levels of ambient air pollution similar to Scotland.


Ahmed, S.M., Mishra, G.D., Moss, K.M., Yang, I.A., Lycett, K., Knibbs, L.D., 2022. Maternal and Childhood Ambient Air Pollution Exposure and Mental Health Symptoms and Psychomotor Development in Children: An Australian Population-Based Longitudinal Study. Environ. Int. 158, 107003. https://doi.org/10.1016/j.envint.2021.107003

Al Ahad, M.A., Demšar, U., Sullivan, F., Kulu, H., 2022. Does Long-Term Air Pollution Exposure Affect Self-Reported Health and Limiting Long Term Illness Disproportionately for Ethnic Minorities in the UK? A Census-Based Individual Level Analysis. Appl. Spat. Anal. Policy 15, 1557–1582. https://doi.org/10.1007/s12061-022-09471-1

Andersson, J., Sundström, A., Nordin, M., Segersson, D., Forsberg, B., Adolfsson, R., Oudin, A., 2023. PM 2.5 and Dementia in a Low Exposure Setting: The Influence of Odor Identification Ability and APOE. J. Alzheimers Dis. 92, 679–689. https://doi.org/10.3233/JAD-220469

Anenberg, S.C., Mohegh, A., Goldberg, D.L., Kerr, G.H., Brauer, M., Burkart, K., Hystad, P., Larkin, A., Wozniak, S., Lamsal, L., 2022. Long-term trends in urban NO2 concentrations and associated paediatric asthma incidence: estimates from global datasets. Lancet Planet. Health 6, e49–e58. https://doi.org/10.1016/S2542-5196(21)00255-2

Bai, L., Benmarhnia, T., Chen, C., Kwong, J.C., Burnett, R.T., van Donkelaar, A., Martin, R.V., Kim, J., Kaufman, J.S., Chen, H., 2022. Chronic Exposure to Fine Particulate Matter Increases Mortality Through Pathways of Metabolic and Cardiovascular Disease: Insights From a Large Mediation Analysis. J. Am. Heart Assoc. 11. https://doi.org/10.1161/JAHA.122.026660

Brauer, M., Brook, J.R., Christidis, T., Chu, Y., Crouse, D.L., Erickson, A., Hystad, P., Li, C., Martin, R.V., Meng, J., Pappin, J., Pinault, L.L., Tjepkema, M., van Donkelaar, A., Weichenthal, S., Burnett, R.T., 2022. Mortality–Air Pollution Associations in Low Exposure Environments (MAPLE): Phase 2.

Brunekreef, B., Strak, M., Chen, J., Andersen, Z.J., Atkinson, R., Carey, I., Cesaroni, G., Forastiere, F., Fecht, D., Gulliver, J., Hertel, O., Hoffmann, B., de Hoogh, K., Houthuijs, D., Hvidtfeldt, U., Klompmaker, J., Krog, N.H., Liu, S., Ljungman, P., Mehta, A., Renzi, M., Rodopoulou, S., Samoli, E., Schwarze, P., Sigsgaard, T., Stafoggia, M., Vienneau, D., Weinmayr, G., Wolf, K., Hoek, G., 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.

Carroll, M., Gao, C.X., Campbell, T.C.H., Smith, C.L., Dimitriadis, C., Berger, E., Maybery, D., Ikin, J., Abramson, M.J., Sim, M.R., McFarlane, A., Smith, K., Guo, Y., 2022. Impacts of coal mine fire-related PM2.5 on the utilisation of ambulance and hospital services for mental health conditions. Atmospheric Pollut. Res. 13, 101415. https://doi.org/10.1016/j.apr.2022.101415

Chastko, K. and Adams, M. (2019) Assessing the accuracy of long-term air pollution estimates produced with temporally adjusted short-term observations from unstructured sampling. Journal of Environmental Management [online]. 240, pp. 249–258.

Christensen, G.M., Li, Z., Pearce, J., Marcus, M., Lah, J.J., Waller, L.A., Ebelt, S., Hüls, A., 2022. The complex relationship of air pollution and neighborhood socioeconomic status and their association with cognitive decline. Environ. Int. 167, 107416. https://doi.org/10.1016/j.envint.2022.107416

Cortes, T.R., I.H. Silveira, B.F.A. de Oliveira, M.L. Bell, and W.L. Junger. ‘Short-Term Association between Ambient Air Pollution and Cardio-Respiratory Mortality in Rio de Janeiro, Brazil’. PLoS ONE 18, no. 2 February (2023). https://doi.org/10.1371/journal.pone.0281499.

Dominici, F., Zanobetti, A., Schwartz, J., Braun, D., Sabath, B., Wu, X., 2019. Assessing Adverse Health Effects of Long- Term Exposure to Low Levels of Ambient Air Pollution: Implementation of Causal Inference Methods.

Dominski, F.H., Lorenzetti Branco, J.H., Buonanno, G., Stabile, L., Gameiro da Silva, M., Andrade, A., 2021. Effects of air pollution on health: A mapping review of systematic reviews and meta-analyses. Environ. Res. 201, 111487. https://doi.org/10.1016/j.envres.2021.111487

Evangelopoulos, D., Chatzidiakou, L., Walton, H., Katsouyanni, K., Kelly, F.J., Quint, J.K., Jones, R.L., Barratt, B., 2021. Personal exposure to air pollution and respiratory health of COPD patients in London. Eur. Respir. J. 58. https://doi.org/10.1183/13993003.03432-2020

Goria, S., Pascal, M., Corso, M., Le Tertre, A., 2021. Short-term exposure to air pollutants increases the risk of hospital admissions in patients with Parkinson’s disease – A multicentric study on 18 French areas. Atmos. Environ. 264. https://doi.org/10.1016/j.atmosenv.2021.118668

Grant, A., Leung, G., Aubin, M.-J., Kergoat, M.-J., Li, G., Freeman, E.E., 2021. Fine Particulate Matter and Age-Related Eye Disease: The Canadian Longitudinal Study on Aging. Invest. Ophthalmol. Vis. Sci. 62, 7. https://doi.org/10.1167/iovs.62.10.7

Health Effects Institute. 2020. State of Global Air 2020. Data source: Global Burden of Disease Study 2019. IHME, 2020. https://www.stateofglobalair.org/data/#/air/table

Health Effects Institute, 2014. 14-3 Assessing Health Effects of Long-term Exposure to Low Levels of Ambient Air Pollution [WWW Document]. Health Eff. Inst. URL https://www.healtheffects.org/research/funding/rfa/14-3-assessing-health-effects-long-term-exposure-low-levels-ambient-air-pollution (accessed 4.14.23).

Hüls, A., Van Cor, S., Christensen, G.M., Li, Z., Liu, Y., Shi, L., Pearce, J.L., Bayakly, R., Lash, T.L., Ward, K., Switchenko, J.M., 2023. Environmental, social and behavioral risk factors in association with spatial clustering of childhood cancer incidence. Spat. Spatio-Temporal Epidemiol. 45, 100582. https://doi.org/10.1016/j.sste.2023.100582

Iglesias-Vázquez, L., Binter, A.-C., Canals, J., Hernández-Martínez, C., Voltas, N., Ambròs, A., Fernández-Barrés, S., Pérez-Crespo, L., Guxens, M., Arija, V., 2022. Maternal exposure to air pollution during pregnancy and child’s cognitive, language, and motor function: ECLIPSES study. Environ. Res. 212, 113501. https://doi.org/10.1016/j.envres.2022.113501

Kriit, H.K., B. Forsberg, D.O. Åström, and A. Oudin. ‘Annual Dementia Incidence and Monetary Burden Attributable to Fine Particulate Matter (PM2.5) Exposure in Sweden’. Environmental Health: A Global Access Science Source 20, no. 1 (2021). https://doi.org/10.1186/s12940-021-00750-x.

Kusters, M.S.W., E. Essers, R. Muetzel, A. Ambrós, H. Tiemeier, and M. Guxens. ‘Air Pollution Exposure during Pregnancy and Childhood, Cognitive Function, and Emotional and Behavioral Problems in Adolescents’. Environmental Research 214 (2022). https://doi.org/10.1016/j.envres.2022.113891.

Latham, R.M., Kieling, C., Arseneault, L., Botter-Maio Rocha, T., Beddows, A., Beevers, S.D., Danese, A., De Oliveira, K., Kohrt, B.A., Moffitt, T.E., Mondelli, V., Newbury, J.B., Reuben, A., Fisher, H.L., 2021. Childhood exposure to ambient air pollution and predicting individual risk of depression onset in UK adolescents. J. Psychiatr. Res. 138, 60–67. https://doi.org/10.1016/j.jpsychires.2021.03.042

Lee, D., Robertson, C., Ramsay, C., Gillespie, C., Napier, G., 2019. Estimating the health impact of air pollution in Scotland, and the resulting benefits of reducing concentrations in city centres. Spat. Spatio-Temporal Epidemiol. 29, 85–96. https://doi.org/10.1016/j.sste.2019.02.003

Li, D., Xie, J., Wang, L., Sun, Y., Hu, Y., Tian, Y., 2023. Genetic susceptibility and lifestyle modify the association of long-term air pollution exposure on major depressive disorder: a prospective study in UK Biobank. BMC Med. 21, 67. https://doi.org/10.1186/s12916-023-02783-0

Li, Y., Xie, T., Cardoso Melo, R.D., de Vries, M., Lakerveld, J., Zijlema, W., Hartman, C.A., 2023. Longitudinal effects of environmental noise and air pollution exposure on autism spectrum disorder and attention-deficit/hyperactivity disorder during adolescence and early adulthood: The TRAILS study. Environ. Res. 227, 115704. https://doi.org/10.1016/j.envres.2023.115704

Liu, C., Wang, B., Liu, S., Li, S., Zhang, K., Luo, B., Yang, A., 2021. Type 2 diabetes attributable to PM2.5: A global burden study from 1990 to 2019. Environ. Int. 156, 106725. https://doi.org/10.1016/j.envint.2021.106725

Lukina, A.O., Burstein, B., Szyszkowicz, M., 2022. Urban air pollution and emergency department visits related to central nervous system diseases. PLOS ONE 17, e0270459. https://doi.org/10.1371/journal.pone.0270459

Min, J., Lee, W., Bell, M.L., Kim, Y., Heo, S., Kim, G.E., Kim, J.H., Yun, J.Y., Kim, S.I., Schwartz, J., Ha, E., 2023. Hospital admission risks and excess costs for neurological symptoms attributable to long-term exposure to fine particulate matter in New York State, USA. Environ. Res. 229, 115954. https://doi.org/10.1016/j.envres.2023.115954

Mok, P.L.H., Antonsen, S., Agerbo, E., Brandt, J., Geels, C., Christensen, J.H., Frohn, L.M., Pedersen, C.B., Webb, R.T., 2021. Exposure to ambient air pollution during childhood and subsequent risk of self-harm: A national cohort study. Prev. Med. 152, 106502. https://doi.org/10.1016/j.ypmed.2021.106502

Mortamais, M., Gutierrez, L.-A., de Hoogh, K., Chen, J., Vienneau, D., Carrière, I., Letellier, N., Helmer, C., Gabelle, A., Mura, T., Sunyer, J., Benmarhnia, T., Jacquemin, B., Berr, C., 2021. Long-term exposure to ambient air pollution and risk of dementia: Results of the prospective Three-City Study. Environ. Int. 148, 106376. https://doi.org/10.1016/j.envint.2020.106376

Muhsin, H.A., Steingrimsson, S., Oudin, A., Åström, D.O., Carlsen, H.K., 2022. Air pollution and increased number of psychiatric emergency room visits: A case-crossover study for identifying susceptible groups. Environ. Res. 204, 112001. https://doi.org/10.1016/j.envres.2021.112001

Newbury, J.B., Arseneault, L., Caspi, A., Moffitt, T.E., Odgers, C.L., Belsky, D.W., Sugden, K., Williams, B., Ambler, A.P., Matthews, T., Fisher, H.L., 2022. Association between genetic and socioenvironmental risk for schizophrenia during upbringing in a UK longitudinal cohort. Psychol. Med. 52, 1527–1537. https://doi.org/10.1017/S0033291720003347

Parra, K.L., Alexander, G.E., Raichlen, D.A., Klimentidis, Y.C., Furlong, M.A., 2022. Exposure to air pollution and risk of incident dementia in the UK Biobank. Environ. Res. 209, 112895. https://doi.org/10.1016/j.envres.2022.112895

Petrowski, K., Bührer, S., Strauß, B., Decker, O., Brähler, E., 2021. Examining air pollution (PM10), mental health and well-being in a representative German sample. Sci. Rep. 11. https://doi.org/10.1038/s41598-021-93773-w

Qiu, X., Danesh-Yazdi, M., Wei, Y., Di, Q., Just, A., Zanobetti, A., Weisskopf, M., Dominici, F., Schwartz, J., 2022. Associations of short-term exposure to air pollution and increased ambient temperature with psychiatric hospital admissions in older adults in the USA: a case–crossover study. Lancet Planet. Health 6, e331–e341. https://doi.org/10.1016/S2542-5196(22)00017-1

Ren, B., He, Q., Ma, J., Zhang, G., 2023. A preliminary analysis of global neonatal disorders burden attributable to PM2.5 from 1990 to 2019. Sci. Total Environ. 870, 161608. https://doi.org/10.1016/j.scitotenv.2023.161608

Reuben, A., Arseneault, L., Beddows, A., Beevers, S.D., Moffitt, T.E., Ambler, A., Latham, R.M., Newbury, J.B., Odgers, C.L., Schaefer, J.D., Fisher, H.L., 2021. Association of Air Pollution Exposure in Childhood and Adolescence with Psychopathology at the Transition to Adulthood. JAMA Netw. Open 4. https://doi.org/10.1001/jamanetworkopen.2021.7508

So, R., Andersen, Z.J., Chen, J., Stafoggia, M., de Hoogh, K., Katsouyanni, K., Vienneau, D., Rodopoulou, S., Samoli, E., Lim, Y.-H., Jørgensen, J.T., Amini, H., Cole-Hunter, T., Mahmood Taghavi Shahri, S., Maric, M., Bergmann, M., Liu, S., Azam, S., Loft, S., Westendorp, R.G.J., Mortensen, L.H., Bauwelinck, M., Klompmaker, J.O., Atkinson, R., Janssen, N.A.H., Oftedal, B., Renzi, M., Forastiere, F., Strak, M., Thygesen, L.C., Brunekreef, B., Hoek, G., Mehta, A.J., 2022. Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer. Environ. Int. 164, 107241. https://doi.org/10.1016/j.envint.2022.107241

So, R., Chen, J., Stafoggia, M., de Hoogh, K., Katsouyanni, K., Vienneau, D., Samoli, E., Rodopoulou, S., Loft, S., Lim, Y.-H., Westendorp, R.G.J., Amini, H., Cole-Hunter, T., Bergmann, M., Shahri, S.M.T., Zhang, J., Maric, M., Mortensen, L.H., Bauwelinck, M., Klompmaker, J.O., Atkinson, R.W., Janssen, N.A.H., Oftedal, B., Renzi, M., Forastiere, F., Strak, M., Brunekreef, B., Hoek, G., Andersen, Z.J., 2023. Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study. Environ. Res. 224, 115552. https://doi.org/10.1016/j.envres.2023.115552

Soares, A.R., Silva, C., 2022. Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades. Atmosphere 13, 434. https://doi.org/10.3390/atmos13030434

Starling, A.P., Wood, C., Liu, C., Kechris, K., Yang, I.V., Friedman, C., Thomas, D.S.K., Peel, J.L., Adgate, J.L., Magzamen, S., Martenies, S.E., Allshouse, W.B., Dabelea, D., 2022. Ambient air pollution during pregnancy and DNA methylation in umbilical cord blood, with potential mediation of associations with infant adiposity: The Healthy Start study. Environ. Res. 214. https://doi.org/10.1016/j.envres.2022.113881

The Air Quality Standards Regulations 2010 [WWW Document], n.d. URL https://www.legislation.gov.uk/uksi/2010/1001/contents/made (accessed 7.7.23).

Thompson, R., Smith, R.B., Karim, Y.B., Shen, C., Drummond, K., Teng, C., Toledano, M.B., 2023. Air pollution and human cognition: A systematic review and meta-analysis. Sci. Total Environ. 859, 160234. https://doi.org/10.1016/j.scitotenv.2022.160234

UKHSA, 2022. Statement on the differential toxicity of particulate matter according to source or constituents: 2022 [WWW Document]. GOV.UK. URL https://www.gov.uk/government/publications/particulate-air-pollution-health-effects-of-exposure/statement-on-the-differential-toxicity-of-particulate-matter-according-to-source-or-constituents-2022 (accessed 6.22.23).

Wang, Y., Crowe, M., Knibbs, L.D., Fuller-Tyszkiewicz, M., Mygind, L., Kerr, J.A., Wake, M., Olsson, C.A., Enticott, P.G., Peters, R.L., Daraganova, G., Mavoa, S., Lycett, K., 2023. Greenness modifies the association between ambient air pollution and cognitive function in Australian adolescents, but not in mid-life adults. Environ. Pollut. 324, 121329. https://doi.org/10.1016/j.envpol.2023.121329

Willocks, L.J., Bhaskar, A., Ramsay, C.N., Lee, D., Brewster, D.H., Fischbacher, C.M., Chalmers, J., Morris, G., Scott, E.M., 2012. Cardiovascular disease and air pollution in Scotland: no association or insufficient data and study design? BMC Public Health 12, 227. https://doi.org/10.1186/1471-2458-12-227

Wu, J., Grande, G., Stafoggia, M., Ljungman, P., Laukka, E.J., Eneroth, K., Bellander, T., Rizzuto, D., 2022. Air pollution as a risk factor for Cognitive Impairment no Dementia (CIND) and its progression to dementia: A longitudinal study. Environ. Int. 160. https://doi.org/10.1016/j.envint.2021.107067

Yang, B.-Y., Fan, S., Thiering, E., Seissler, J., Nowak, D., Dong, G.-H., Heinrich, J., 2020. Ambient air pollution and diabetes: A systematic review and meta-analysis. Environ. Res. 180, 108817. https://doi.org/10.1016/j.envres.2019.108817

Yap, Christina, Iain J. Beverland, Mathew R. Heal, Geoffrey R. Cohen, Chris Robertson, Deborah E. J. Henderson, Neil S. Ferguson, Carole L. Hart, George Morris, and Raymond M. Agius. ‘Association between Long-Term Exposure to Air Pollution and Specific Causes of Mortality in Scotland’. Occupational and Environmental Medicine 69, no. 12 (1 December 2012): 916–24. https://doi.org/10.1136/oemed-2011-100600.

Yim, S.H.L., Huang, T., Ho, J.M.W., Lam, A.S.M., Yau, S.T.Y., Yuen, T.W.H., Dong, G.H., Tsoi, K.K.F., Sung, J.J.Y., 2022. Rise and fall of lung cancers in relation to tobacco smoking and air pollution: A global trend analysis from 1990 to 2012. Atmos. Environ. 269, 118835. https://doi.org/10.1016/j.atmosenv.2021.118835

Zhang, X., Liu, S.H., Geron, M., Mathilda Chiu, Y.-H., Gershon, R., Ho, E., Huddleston, K., Just, A.C., Kloog, I., Coull, B.A., Enlow, M.B., Wright, R.O., Wright, R.J., 2022. Prenatal exposure to PM2.5 and childhood cognition: Accounting for between-site heterogeneity in a pooled analysis of ECHO cohorts in the Northeastern United States. Environ. Res. 214. https://doi.org/10.1016/j.envres.2022.114163

Zhao, H., Zhang, X., Wang, W., Shi, J., Lai, W., Li, Y., Zhang, C., Guo, L., Gong, J., Li, L., Lu, C., 2023. Global, regional, and national burden of ambient and household PM2.5-related neonatal disorders, 1990–2019. Ecotoxicol. Environ. Saf. 252, 114560. https://doi.org/10.1016/j.ecoenv.2023.114560

Zhao, N., Pinault, L., Toyib, O., Vanos, J., Tjepkema, M., Cakmak, S., 2021. Long-term ozone exposure and mortality from neurological diseases in Canada. Environ. Int. 157, 106817. https://doi.org/10.1016/j.envint.2021.106817

Zhao, Q., Kress, S., Markevych, I., Berdel, D., von Berg, A., Gappa, M., Koletzko, S., Bauer, C.-P., Schulz, H., Standl, M., Heinrich, J., Schikowski, T., 2021. Air pollution during infancy and lung function development into adolescence: The GINIplus/LISA birth cohorts study. Environ. Int. 146, 106195. https://doi.org/10.1016/j.envint.2020.106195

Ziou, M., Gao, C.X., Wheeler, A.J., Zosky, G.R., Stephens, N., Knibbs, L.D., Williamson, G.J., Melody, S.M., Venn, A.J., Dalton, M.F., Dharmage, S.C., Johnston, F.H., 2023. Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life. Sci. Total Environ. 883, 163580. https://doi.org/10.1016/j.scitotenv.2023.163580


Email: andrew.taylor2@gov.scot

Back to top