Associations of long-term exposure to ambient PM2.5 with mortality in Chinese adults: A pooled analysis of cohorts in the China-PAR project

Xueli Yang; Fengchao Liang; Jianxin Li; Jichun Chen; Fangchao Liu; Keyong Huang; Jie Cao; Shufeng Chen; Qingyang Xiao; Xiaoqing Liu; Chong Shen; Ling Yu; Fanghong Lu; Xianping Wu; Xigui Wu; Ying Li; Liancheng Zhao; Dongsheng Hu; Jianfeng Huang; Xiangfeng Lu; Yang Liu; Dongfeng Gu

doi:10.1016/j.envint.2020.105589

Associations of long-term exposure to ambient PM_2.5 with mortality in Chinese adults: A pooled analysis of cohorts in the China-PAR project

Environ Int. 2020 May:138:105589. doi: 10.1016/j.envint.2020.105589. Epub 2020 Mar 5.

Authors

Xueli Yang¹, Fengchao Liang², Jianxin Li², Jichun Chen², Fangchao Liu², Keyong Huang², Jie Cao², Shufeng Chen², Qingyang Xiao³, Xiaoqing Liu⁴, Chong Shen⁵, Ling Yu⁶, Fanghong Lu⁷, Xianping Wu⁸, Xigui Wu², Ying Li², Liancheng Zhao², Dongsheng Hu⁹, Jianfeng Huang², Xiangfeng Lu², Yang Liu¹⁰, Dongfeng Gu¹¹

Affiliations

¹ Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health; Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China.
² Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
³ School of Environment, Tsinghua University, Beijing 100084, China.
⁴ Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou 510080, China.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
⁶ Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350014, China.
⁷ Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China.
⁸ Sichuan Center for Disease Control and Prevention, Chengdu 610041, China.
⁹ Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen 518060, China.
¹⁰ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. Electronic address: yang.liu@emory.edu.
¹¹ Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Medical School, Southern University of Science and Technology, Shenzhen 518055, China. Electronic address: gudongfeng@cashq.ac.cn.

Abstract

Background: The concentration-response relationship between mortality and long-term exposure to fine particulate matter (PM_2.5) has not been fully elucidated, especially at high levels of PM_2.5 concentrations.

Objective: We aimed to evaluate chronic effects of ambient PM_2.5 exposure on deaths among Chinese adults in high-exposure settings.

Methods: Participants of the Prediction for Atherosclerotic cardiovascular disease Risk in China (China-PAR) project were included from four prospective cohorts among Chinese adults aged ≥18 years old. The overall follow-up rate of the four cohorts was 93.4% until the recent follow-up survey that ended in 2015. The average of satellite-based PM_2.5 concentrations during 2000-2015 at 1-km spatial resolution was assigned to each participant according to individual residence addresses. Based on the pooled analysis of individual data from the four cohorts, a Cox proportional hazards model was used to estimate the hazard ratio (HR) and corresponding 95% confidence intervals (95% CIs) for the association of PM_2.5 exposure with mortality after multivariate adjustment.

Results: A total of 116,821 participants were eligible in the final analysis. During a mean of 7.7 years of follow-up, 6,395 non-accidental deaths and 2,507 cardio-metabolic deaths occurred. The mean of PM_2.5 concentration was 64.9 μg/m³ ranging from 31.2 μg/m³ to 97.0 μg/m³. For each 10 μg/m³ increment in PM_2.5, the HR was 1.11 (95% CI: 1.08-1.14) for non-accidental mortality and 1.22 (95% CI: 1.16-1.27) for cardio-metabolic mortality. In addition, a weak exponential curve for the concentration-response association between mortality and PM_2.5 was observed among Chinese adults.

Conclusions: Our study provided important evidence of the long-term effects of PM_2.5 exposure on deaths among Chinese adults. The findings expand our knowledge on concentration-response relationship in high-exposure environments, which is essential to address the urgent challenge of reducing the disease burden attributable to PM_2.5 exposure in rapidly industrializing countries such as China.

Keywords: Cohort study; Concentration-response relationship; Long-term exposure; Mortality; Satellite-based PM(2.5).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Air Pollutants* / analysis
Air Pollution* / adverse effects
China / epidemiology
Environmental Exposure / analysis
Humans
Mortality
Particulate Matter / analysis
Proportional Hazards Models
Prospective Studies

Substances

Air Pollutants
Particulate Matter

Grants and funding

R01 ES032140/ES/NIEHS NIH HHS/United States