Article Text

Long-term associations of outdoor air pollution with mortality in Great Britain
  1. Paul Elliott1,
  2. Gavin Shaddick1,2,
  3. Jonathan C Wakefield1,3,
  4. Cornelis de Hoogh1,
  5. David J Briggs1
  1. 1
    Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, UK
  2. 2
    Department of Mathematical Sciences, University of Bath, UK
  3. 3
    Departments of Statistics and Biostatistics, University of Washington, USA
  1. Professor P Elliott, Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Faculty of Medicine, St Mary’s Campus, Imperial College London, Norfolk Place, London W2 1PG, UK; p.elliott{at}


Background: Recent studies have indicated long-term effects on mortality of particulate and sulphur dioxide (SO2) pollution, but uncertainties remain over the size of any effects, potential latency and generalisability.

Methods: A small area study was performed across electoral wards in Great Britain of mean annual black smoke (BS) and SO2 concentrations (from 1966) and subsequent all-cause and cause-specific mortality using random effect models within a Bayesian framework adjusted for social deprivation and urban/rural classification. Different latencies and changes in associations over time were assessed.

Results: Significant associations were found between BS and SO2 concentrations and mortality. The effects were stronger for respiratory illness than other causes of mortality for the most recent exposure periods (shorter latency times) and most recent mortality period (lower pollutant concentrations). In pooled analysis across four sequential 4 year mortality periods (1982–98), adjusted excess relative risk for respiratory mortality was 3.6% (95% CI 2.6% to 4.5%) per 10 μg/m3 BS and 13.2% (95% CI 11.5% to 14.9%) per 10 ppb SO2, and in the most recent period (1994–8) it was 19.3% (95% CI 5.1% to 35.7%) and 21.7% (95% CI 2.9% to 38.5%), respectively.

Conclusions: These findings add to the evidence that air pollution has long-term effects on mortality and point to continuing public health risks even at the relatively lower levels of BS and SO2 that now occur. They therefore have importance for policies on public health protection through regulation and control of air pollution.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials


  • The Small Area Health Statistics Unit is funded by a grant from the Department of Health, Department of Environment, Food and Rural Affairs, Environment Agency, Scottish Executive, Welsh Assembly Government and the Northern Ireland Department of Health, Social Services and Public Safety. The funders approved the study design and commented on the results. Data analysis, interpretation and reporting were the sole responsibility of the authors. The views expressed in this publication are those of the authors and not necessarily those of the funding bodies.

  • Competing interests: None.

  • Abbreviations:
    American Cancer Society
    black smoke
    particulate matter
    sulphur dioxide

Linked Articles