Ambient particulate matter and in-hospital case fatality of acute myocardial infarction: A multi-province cross-sectional study in China

Xiaojun Lin; Miao Cai; Kun Tan; Echu Liu; Xiuli Wang; Chao Song; Jing Wei; Hualiang Lin; Jay Pan

doi:10.1016/j.ecoenv.2023.115731

Ambient particulate matter and in-hospital case fatality of acute myocardial infarction: A multi-province cross-sectional study in China

Ecotoxicol Environ Saf. 2023 Dec:268:115731. doi: 10.1016/j.ecoenv.2023.115731. Epub 2023 Nov 25.

Authors

Xiaojun Lin¹, Miao Cai², Kun Tan³, Echu Liu⁴, Xiuli Wang¹, Chao Song¹, Jing Wei⁵, Hualiang Lin⁶, Jay Pan⁷

Affiliations

¹ HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China.
² Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China.
³ Health Information Center of Sichuan Province, No. 39, Wangjiaguai Street, Chengdu, Sichuan 610041, China.
⁴ Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA.
⁵ Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA. Electronic address: weijing_rs@163.com.
⁶ Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd road, Yuexiu District, Guangzhou, Guangdong 510080, China. Electronic address: linhualiang@mail.sysu.edu.cn.
⁷ HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; China Center for South Asian Studies, Sichuan University, No.24 South Section I, Yihuan Road, Chengdu, Sichuan 610065, China. Electronic address: panjie.jay@scu.edu.cn.

PMID: 38007949
DOI: 10.1016/j.ecoenv.2023.115731

Abstract

The acute myocardial infarction (AMI) outcomes have been extensively linked with ambient particulate matter (PM). However, whether a smaller particle has greater impact and the consequent attributable burden associated with PM of different sizes remain unclear. We conducted a multi-province cross-sectional study among AMI patients using the inpatient discharge datasets from four Chinese provinces (Shanxi, Sichuan, Guangxi, and Guangdong) from 2014 to 2019. Ambient PM exposure for each patient was assessed using the ChinaHighAirPollutants dataset. We employed the mixed-effects logistic regression models to evaluate the association of PM of different sizes (PM₁, PM_2.5, PM₁₀) on in-hospital case fatality. The potential reducible fractions in in-hospital case fatality were estimated through counterfactual analyses. Of 177,749 participants, 125,501 (70.6 %) were male and the in-hospital case fatality rate was 4.9%. For short-term (7-day average) exposure, the odds ratios (ORs) for PM₁, PM_2.5, and PM₁₀ (per 10 µg/m³) were 1.052 (95 % confidence interval [CI], 1.032-1.071), 1.026 (95 % CI, 1.014-1.037), and 1.016 (95% CI, 1.008-1.024), respectively. The estimated ORs for long-term exposure (annual average) were 1.303 (95 % CI, 1.252-1.356) for PM₁, 1.209 (95 % CI, 1.178-1.241) for PM_2.5, 1.157 (95 % CI, 1.134-1.181) for PM₁₀. Short-term exposure to PM₁ showed the highest potential reducible fraction (8.5 %, 95 % CI, 5.0-11.7 %), followed by PM_2.5 and PM₁₀, while the greatest potential reducible fraction of long-term exposure was observed in PM₁₀ (30.9 %, 95 % CI, 27.2-34.4%), followed by PM_2.5 and PM₁. In summary, PM with smaller size had a more pronounced impact on in-hospital AMI case fatality, with PM₁ exhibiting greater effects than PM_2.5 and PM₁₀. Substantial health benefits for AMI patients could be achieved by mitigating ambient PM exposure.

Keywords: Acute myocardial infarction; Air pollution; Case fatality; China; Particulate matter.

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution*
China
Cross-Sectional Studies
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Female
Hospitals
Humans
Male
Particulate Matter / adverse effects
Particulate Matter / analysis

Substances

Particulate Matter
Air Pollutants