Association of long-term exposure to air pollutant mixture and incident cardiovascular disease in a highly polluted region of China

Fuyuan Wen; Bingxiao Li; Han Cao; Pandi Li; Yunyi Xie; Fengxu Zhang; Yuan Sun; Ling Zhang

doi:10.1016/j.envpol.2023.121647

Association of long-term exposure to air pollutant mixture and incident cardiovascular disease in a highly polluted region of China

Environ Pollut. 2023 Jul 1:328:121647. doi: 10.1016/j.envpol.2023.121647. Epub 2023 Apr 14.

Authors

Fuyuan Wen¹, Bingxiao Li¹, Han Cao², Pandi Li¹, Yunyi Xie¹, Fengxu Zhang¹, Yuan Sun¹, Ling Zhang³

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
² Department of Biostatistics, Peking University First Hospital, Beijing, China.
³ Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China. Electronic address: zlilyepi@ccmu.edu.cn.

PMID: 37062405
DOI: 10.1016/j.envpol.2023.121647

Abstract

Despite growing evidence that links long-term air pollution exposure to cardiovascular disease (CVD), the combined effects of air pollutants and particulate matter with an aerodynamic diameter of less than 2.5 μm (PM_2.5) components are still limited. A prospective cohort study was performed based on the Cohort Study on Chronic Disease of the Community Natural Population in the Beijing-Tianjin-Hebei Region (CHCN-BTH) to assess the association of long-term air pollutants with incident CVD and the combined effect of the air pollutants mixture among 26,851 adults. Three-year residential exposure to air pollutants (PM_2.5, O₃, PM₁₀, PM₁, NO₂, SO₂ and CO) and PM_2.5 components [black carbon (BC), NH₄⁺, SO₄^2-, NO₃^- and organic matter (OM)] were calculated based on well-validated models. Proportional hazard models were applied to assess the association of air pollutants with incident CVD. Quantile g-Computation was used to examine the combined effect of the pollutant mixture. During the 56,090 person-years follow-up, 629 participants reported incident CVD. Adjusted hazard ratios with 95% confidence intervals (CIs) of CVD per interquartile range increase in O₃, PM_2.5, PM₁, NO₂, BC, and OM concentrations were 4.52 (95%CI: 2.61, 7.83), 2.39 (95%CI: 1.83, 3.13), 2.37 (95%CI: 1.20, 4.70), 1.36 (95%CI: 1.19, 1.56), 3.84 (95%CI: 2.38, 6.18), and 3.07 (95%CI: 2.01, 4.69), respectively. In multi-pollutant models, the combined effect of air pollutant mixture on incident CVD was 2.37 (95%CI: 2.30, 2.44). PM_2.5 and O₃ contributed 54.3% and 44.5% of the combined effect of the air pollutant mixture, respectively. After using PM_2.5 components instead of PM_2.5 as part of the mixture, OM drove 55.2% of the combined effect. The findings indicated associations of air pollutant mixtures with CVD incidence. PM_2.5 (especially OM) and O₃ might strongly contribute to air pollutant mixtures that lead to incident CVD.

Keywords: Ambient air pollution; Cardiovascular disease; Exposure mixtures; PM(2.5) components; Quantile g-computation.

MeSH terms

Adult
Air Pollutants* / analysis
Air Pollution* / analysis
Cardiovascular Diseases* / chemically induced
Cardiovascular Diseases* / epidemiology
China / epidemiology
Cohort Studies
Environmental Exposure
Humans
Nitrogen Dioxide
Particulate Matter / analysis
Particulate Matter / toxicity
Prospective Studies

Substances

Air Pollutants
Nitrogen Dioxide
Particulate Matter