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. 2024 Sep 11;22(1):370.
doi: 10.1186/s12916-024-03596-5.

Air pollution and risk of 32 health conditions: outcome-wide analyses in a population-based prospective cohort in Southwest China

Hanwen Zhou #  1 , Feng Hong #  2 , Lele Wang  1 , Xuewei Tang  1 , Bing Guo  1 , Yuying Luo  3 , Hui Yu  3 , Deqiang Mao  4 , Ting Liu  5 , Yuemei Feng  6 , Yangji Baima  7 , Juying Zhang  8 , Xing Zhao  9 ; China Multi-Ethnic Cohort (CMEC)
Affiliations

Air pollution and risk of 32 health conditions: outcome-wide analyses in a population-based prospective cohort in Southwest China

Hanwen Zhou et al. BMC Med. .

Abstract

Background: Uncertainty remains about the long-term effects of air pollutants (AP) on multiple diseases, especially subtypes of cardiovascular disease (CVD). We aimed to assess the individual and joint associations of fine particulate matter (PM2.5), along with its chemical components, nitrogen dioxide (NO2) and ozone (O3), with risks of 32 health conditions.

Methods: A total of 17,566 participants in Sichuan Province, China, were included in 2018 and followed until 2022, with an average follow-up period of 4.2 years. The concentrations of AP were measured using a machine-learning approach. The Cox proportional hazards model and quantile g-computation were applied to assess the associations between AP and CVD.

Results: Per interquartile range (IQR) increase in PM2.5 mass, NO2, O3, nitrate, ammonium, organic matter (OM), black carbon (BC), chloride, and sulfate were significantly associated with increased risks of various conditions, with hazard ratios (HRs) ranging from 1.06 to 2.48. Exposure to multiple air pollutants was associated with total cardiovascular disease (HR 1.75, 95% confidence intervals (CIs) 1.62-1.89), hypertensive diseases (1.49, 1.38-1.62), cardiac arrests (1.52, 1.30-1.77), arrhythmia (1.76, 1.44-2.15), cerebrovascular diseases (1.86, 1.65-2.10), stroke (1.77, 1.54-2.03), ischemic stroke (1.85, 1.61-2.12), atherosclerosis (1.77, 1.57-1.99), diseases of veins, lymphatic vessels, and lymph nodes (1.32, 1.15-1.51), pneumonia (1.37, 1.16-1.61), inflammatory bowel diseases (1.34, 1.16-1.55), liver diseases (1.59, 1.43-1.77), type 2 diabetes (1.48, 1.26-1.73), lipoprotein metabolism disorders (2.20, 1.96-2.47), purine metabolism disorders (1.61, 1.38-1.88), anemia (1.29, 1.15-1.45), sleep disorders (1.54, 1.33-1.78), renal failure (1.44, 1.21-1.72), kidney stone (1.27, 1.13-1.43), osteoarthritis (2.18, 2.00-2.39), osteoporosis (1.36, 1.14-1.61). OM had max weights for joint effects of AP on many conditions.

Conclusions: Long-term exposure to increased levels of multiple air pollutants was associated with risks of multiple health conditions. OM accounted for substantial weight for these increased risks, suggesting it may play an important role in these associations.

Keywords: Air pollution; Fine particulate matter components; Multiple exposure analysis; Outcome-wide analysis; Prospective cohort study.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Hazard ratios and corresponding 95% CI for associations between AP and 32 health conditions. Note: Units are per IQR increase in pollutants. An asterisk (*) indicates the P < 1.56 × 10−3. Models were adjusted for age, sex, education, annual household income, urbanicity, BMI, smoke, second-hand smoke, alcohol, indoor air pollution, physical activity, aMED index, hypertension, and diabetes. CVD, cardiovascular disease; HTN, hypertensive disease; IHD, ischemic heart disease; PHD, pulmonary heart disease; CAR, cardiac arrests; HF, heart failure; CER, cerebrovascular diseases; VL, diseases of veins, lymphatic vessels, and lymph nodes; COPD, chronic obstructive pulmonary disease; IBD, inflammatory bowel diseases; T2D, type 2 diabetes; GMD, glycoprotein metabolism disorders; LMD, lipoprotein metabolism disorders; PMD, purine metabolism disorders; CKD, chronic kidney disease; PM2.5, particulate matter with aerodynamic diameter ≤ 2.5 µm; NO2, nitrogen dioxide; O3, ozone; NO3−, nitrate; NH4+, ammonium; OM, organic matter; BC, black carbon; Cl−, chloride; SO42−, sulfate; HR, hazard ratio
Fig. 2
Fig. 2
Hazard ratios and corresponding 95% CI for associations between mixture pollutant and health conditions. Note: Units are per IQR increase in pollutants. Models were adjusted for age, sex, education, annual household income, urbanicity, BMI, smoke, second-hand smoke, alcohol, indoor air pollution, physical activity, aMED index, hypertension, and diabetes. CVD, cardiovascular disease; HTN, hypertensive disease; CAR, cardiac arrests; CER, cerebrovascular diseases; VL, diseases of veins, lymphatic vessels, and lymph nodes; IBD, inflammatory bowel diseases; T2D, type 2 diabetes; LMD, lipoprotein metabolism disorders; PMD, purine metabolism disorders
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