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. 2025 Mar 5:13:1517507.
doi: 10.3389/fpubh.2025.1517507. eCollection 2025.

Time trends in coronary heart disease mortality attributed to outdoor PM2.5 in China: an age-period-cohort analysis using the Global Burden of Disease Study 2019

Yuan Ma  1   2 , Yuxiang Huang  1 , Li Li  1 , Li Yu  1 , Pei Xiao  3 , Qian Wang  4
Affiliations

Time trends in coronary heart disease mortality attributed to outdoor PM2.5 in China: an age-period-cohort analysis using the Global Burden of Disease Study 2019

Yuan Ma et al. Front Public Health. .

Abstract

Background: In China, coronary heart disease (CHD) is a significant public health issue affecting the population's health. Evidence suggests that outdoor PM2.5 is a crucial environmental risk factor for CHD mortality. This study aims to provide scientific evidence for the prevention and treatment of CHD by analyzing the trend of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.

Methods: Data were obtained from the Global Burden of Disease Study (GBD) 2019. CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019 was extracted from the GBD Data tool. We used an age-period-cohort (APC) model based on the intrinsic estimator (IE) algorithm to decompose the age, period, and cohort effects related to CHD mortality attributed to outdoor PM2.5.

Results: From 1994 to 2019, the crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs) of CHD attributed to outdoor PM2.5 in China showed an overall upward trend. The APC model analysis showed that the relative risk of CHD mortality attributed to outdoor PM2.5 increased exponentially with age, reaching 89.284 (95% CI: 48.669, 163.793) in the 90-95 age group. The period effect increased monotonically, with a relative risk of 3.699 (95% CI: 3.639, 3.760) in 2019. The cohort effect decreased monotonically, with the lowest relative risk of CHD mortality attributed to outdoor PM2.5 in residents born between 1990 and 1994, at 0.135 (95% CI: 0.031, 0.588).

Conclusion: The older adult, a high-risk population, should receive more attention. In the future, continuous efforts should be made to strengthen environmental air pollution control and implement targeted health interventions to reduce the impact of outdoor PM2.5 on CHD mortality.

Keywords: China; age-period-cohort model; coronary heart disease; mortality trends; outdoor PM2.5.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Trends in crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs) of CHD attributed to outdoor PM2.5 from 1994 to 2019.
Figure 2
Figure 2
Trends of age-specific CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.
Figure 3
Figure 3
Period-based variation of age-specific CHD mortality attributed to outdoor PM2.5 from 1994 to 2019. (A) 25–59 years; (B) 60–94 years.
Figure 4
Figure 4
Cohort-based variation of age-specific CHD mortality attributed to outdoor PM2.5 from 1994 to 2019. (C) 60–94 years; (D) 25–59 years.
Figure 5
Figure 5
Age effect and changes in the effect of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.
Figure 6
Figure 6
Period effect and changes in the effect of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.
Figure 7
Figure 7
Cohort effect and changes in the effect of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.
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