Dynamic association of ambient air pollution with incidence and mortality of pulmonary hypertension: A multistate trajectory analysis

Hui Shi; Lan Chen; Shiyu Zhang; Rui Li; Yinglin Wu; Hongtao Zou; Chongjian Wang; Miao Cai; Hualiang Lin

doi:10.1016/j.ecoenv.2023.115126

Dynamic association of ambient air pollution with incidence and mortality of pulmonary hypertension: A multistate trajectory analysis

Ecotoxicol Environ Saf. 2023 Jun 12:262:115126. doi: 10.1016/j.ecoenv.2023.115126. Online ahead of print.

Authors

Hui Shi¹, Lan Chen¹, Shiyu Zhang¹, Rui Li¹, Yinglin Wu¹, Hongtao Zou¹, Chongjian Wang², Miao Cai¹, Hualiang Lin³

Affiliations

¹ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
² Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
³ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address: linhualiang@mail.sysu.edu.cn.

Abstract

Background: There is little evidence regarding the association between ambient air pollution and incidence and the mortality of pulmonary hypertension (PH).

Methods: We included 494,750 participants at baseline in the UK Biobank study. Exposures to PM_2.5, PM₁₀, NO₂, and NO_x were estimated at geocoded participants' residential addresses, utilizing pollution data provided by UK Department for Environment, Food and Rural Affairs (DEFRA). The outcomes were the incidence and mortality of PH. We used multivariate multistate models to investigate the impacts of various ambient air pollutants on both incidence and mortality of PH.

Results: During a median follow-up of 11.75 years, 2517 participants developed incident PH, and 696 died. We observed that all ambient air pollutants were associated with increased incidence of PH with different magnitudes, with adjusted hazard ratios (HRs) [95% confidence intervals (95% CIs)] for each interquartile range (IQR) increase of 1.73 (1.65, 1.81) for PM_2.5, 1.70 (1.63, 1.78) for PM₁₀, 1.42 (1.37, 1.48) for NO₂, and 1.35 (1.31, 1.40) for NO_x. Furthermore, PM_2.5, PM₁₀, NO₂ and NO₂ influenced the transition from PH to death, and the corresponding HRs (95% CIs) were 1.35 (1.25, 1.45), 1.31 (1.21, 1.41), 1.28 (1.20, 1.37) and 1.24 (1.17, 1.32), respectively.

Conclusion: The results of our study indicate that exposure to various ambient air pollutants might play key but differential roles in both the incidence and mortality of PH.

Keywords: Ambient air pollution; Dynamic association; Multistate analysis; Pulmonary hypertension.