. 2023 Mar 27;22(1):30.

doi: 10.1186/s12940-023-00978-9.

Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

Neil Wright^#¹, Katherine Newell^#¹, Ka Hung Chan^{1

2}, Simon Gilbert¹, Alex Hacker¹, Yan Lu³, Yu Guo⁴, Pei Pei⁵, Canqing Yu^{5

6}, Jun Lv^{5

6}, Junshi Chen⁷, Liming Li^{5

6}, Om Kurmi⁸, Zhengming Chen^{1

9}, Kin Bong Hubert Lam¹⁰, Christiana Kartsonaki^{11

12}

Affiliations

¹ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, OX3 7LF, Oxford, UK.
² Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK.
³ NCDs Prevention and Control Department, Suzhou CDC, Jiangsu, China.
⁴ Chinese Academy of Medical Sciences, Beijing, China.
⁵ Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China.
⁶ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁷ National Center for Food Safety Risk Assessment, Beijing, China.
⁸ Research Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
⁹ MRC Population Health Research Unit, University of Oxford, Oxford, UK.
¹⁰ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, OX3 7LF, Oxford, UK. hubert.lam@ndph.ox.ac.uk.
¹¹ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, OX3 7LF, Oxford, UK. christiana.kartsonaki@ndph.ox.ac.uk.
¹² MRC Population Health Research Unit, University of Oxford, Oxford, UK. christiana.kartsonaki@ndph.ox.ac.uk.

^# Contributed equally.

PMID: 36973808
PMCID: PMC10041804
DOI: 10.1186/s12940-023-00978-9

Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

Neil Wright et al. Environ Health. 2023.

. 2023 Mar 27;22(1):30.

doi: 10.1186/s12940-023-00978-9.

Authors

Affiliations

¹ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, OX3 7LF, Oxford, UK.
² Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK.
³ NCDs Prevention and Control Department, Suzhou CDC, Jiangsu, China.
⁴ Chinese Academy of Medical Sciences, Beijing, China.
⁵ Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China.
⁶ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁷ National Center for Food Safety Risk Assessment, Beijing, China.
⁸ Research Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
⁹ MRC Population Health Research Unit, University of Oxford, Oxford, UK.
¹⁰ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, OX3 7LF, Oxford, UK. hubert.lam@ndph.ox.ac.uk.
¹¹ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, OX3 7LF, Oxford, UK. christiana.kartsonaki@ndph.ox.ac.uk.
¹² MRC Population Health Research Unit, University of Oxford, Oxford, UK. christiana.kartsonaki@ndph.ox.ac.uk.

^# Contributed equally.

PMID: 36973808
PMCID: PMC10041804
DOI: 10.1186/s12940-023-00978-9

Abstract

Background: Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP.

Methods: A prospective study included 50,407 participants aged 30-79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO₂), sulphur dioxide (SO₂), fine (PM_2.5), and inhalable (PM₁₀) particulate matter, ozone (O₃) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013-2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio-temporal modelling.

Results: The study period of 2013-2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO₂ and O₃, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m³ increase in SO₂ was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m³ increase in O₃ was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia.

Conclusions: Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease.

Keywords: Air pollution; Cardiovascular disease; Respiratory disease.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Annual pollutant concentrations by assessment centre location and pollutant, Suzhou (2013–2015)

**Fig. 2**
Associations between cardiovascular diseases and long-term pollutant exposures

**Fig. 3**
Associations between respiratory diseases and long-term pollutant exposures

See this image and copyright information in PMC

References

1. Health Effect Institute, State of global air 2020, in Special report. Boston: Health Effects Institute; 2020. ISSN 2578-6873.
1. Chan KH, Newell K, Lam KBH. Environmental Pollutant Exposures and Public Health. Royal Soc Chem; 2021. The Effects of Air Pollution upon Public Health; pp. 115–150.
1. Organisation WH, Air quality guidelines. Global update 2005. Particulate matter, ozone, nitrogen dioxide and sulfur dioxide 2006, Editor.
1. China, M.o.E.a.E.f.t.P.s.R.o., Ambient air quality standard (GB 3095–2012). 2012.
1. Wong CM, et al. Public Health and Air Pollution in Asia (PAPA): a multicity study of short-term effects of air pollution on mortality. Environ Health Perspect. 2008;116(9):1195–1202. doi: 10.1289/ehp.11257. - DOI - PMC - PubMed

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Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

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Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

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