ELAPSE: "Effects of Low-Level Air Pollution: a Study in Europe" (2016-2019)

Official website of the project

Study objectives:
As our main hypothesis we will investigate if long-term exposure to low concentrations of outdoor air pollution is related to adverse health effects. We will define ‘low’ using various cut-points defined by current EU, US and WHO limit values, air quality standards and guidelines, respectively. We will specifically test whether the exposure-response functions deviate significantly from linearity at low exposures.

Specific objectives:

  • To estimate long-term average exposure to PM2.5, NO2, O3 and Black Carbon by developing new hybrid models that combine monitoring data, land-use, satellite observations and dispersion models of the pooled ESCAPE cohort and six large administrative cohorts.

  • To investigate the shape of the relationship between long-term exposure to PM2.5, NO2, Black Carbon and O3 and three broad health effect categories
    (a) natural and cause-specific mortality;
    (b) coronary and cerebrovascular events; and
    (c) lung cancer incidence
    using a number of different methods to characterize the exposure response function (linear, non-linear, threshold).

  • To investigate in the context of objective 2 the variability of the exposure-response function across population and different exposure assessment methods; as well as 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:

Longitudinal analyses of event incidence. ESCAPE cohorts will be pooled and administrative cohorts will be analyzed separately. Meta-analysis techniques will be used to combine the estimates subsequently.

Study population:
Ten selected well-characterized cohorts from the ESCAPE study
plus one additional Danish cohort and seven large European administrative cohorts. Helmholtz Zentrum München brings into ELAPSE the KORA cohort.

Study area:
Eleven European countries participate in ELAPSE, thereof cities and regions from Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Norway, Sweden, Switzerland, and the UK.

Funding period:
2016 - 2019

Current status:



Institute for Risk Assessment Sciences (IRAS), Utrecht University, the Netherlands: Bert Brunekreef (project coordination)
Partner Helmholtz Zentrum München - Institute of Epidemiology: Annette Peters, Kathrin Wolf, Alexandra Schneider, Josef Cyrys.


Collaboration with 14 partners from 10 European countries.


Health Effects Institute: 4954-RFA14-3/16-5.


Helmholtz Zentrum München, German Research Center for Environmental Health

Institute of Epidemiology
Dr. Annette Peters

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