TY - JOUR
T1 - Individual and joint associations of long-term exposure to air pollutants and cardiopulmonary mortality
T2 - a 22-year cohort study in Northern China
AU - Huang, Wenzhong
AU - Zhou, Yang
AU - Chen, Xi
AU - Zeng, Xiaowen
AU - Knibbs, Luke D.
AU - Zhang, Yunting
AU - Jalaludin, Bin
AU - Dharmage, Shyamali C.
AU - Morawska, Lidia
AU - Guo, Yuming
AU - Yang, Xueli
AU - Zhang, Liwen
AU - Shan, Anqi
AU - Chen, Jie
AU - Wang, Tong
AU - Heinrich, Joachim
AU - Gao, Meng
AU - Lin, Lizi
AU - Xiao, Xiang
AU - Zhou, Peien
AU - Yu, Yunjiang
AU - Tang, Naijun
AU - Dong, Guanghui
N1 - Funding Information:
This work was supported by the Guangxi Key Research and Development Plan ( GUIKEAB18050024 ), National Key Research and Development Program of China ( 2018YFC1004300 , 2018YFC1004301 , 2018YFE0106900 ), the China Scholarship Council ( 202006380055 ), the National Natural Science Foundation of China ( M-0420 , 82103823 , 81872582 ), and Natural Science Foundation of Guangdong Province ( 2021B1515020015 , 2021A1515011754 , 2020A1515011131 , 2018B030312005 , 2017A090905042 ).
Funding: National Key Research and Development Program of China, the China Scholarship Council, the National Natural Science Foundation of China, Natural Science Foundation of Guangdong Province.
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/7
Y1 - 2023/7
N2 - Background: Evidence on the associations between long-term exposure to multiple air pollutants and cardiopulmonary mortality is limited, especially for developing regions with higher pollutant levels. We aimed to characterise the individual and joint (multi-pollutant) associations of long-term exposure to air pollutants with cardiopulmonary mortality, and to identify air pollutant that primarily contributes to the mortality risk. Methods: We followed 37,442 participants with a mean age of 43.5 years in four cities in northern China (Tianjin, Shenyang, Taiyuan, and Rizhao) from January 1998 to December 2019. Annual particulate matter (PM) with diameters ≤2.5 μm (PM2.5), ≤10 μm (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were estimated using daily average values from satellite-derived machine learning models and monitoring stations. Time-varying Cox proportional hazards model was used to evaluate the individual association between air pollutants and mortality from non-accidental causes, cardiovascular diseases (CVDs), non-malignant respiratory diseases (RDs) and lung cancer, accounting for demographic and socioeconomic factors. Effect modifications by age, sex, income and education level were also examined. Quantile-based g-Computation integrated with time-to-event data was additionally applied to evaluate the co-effects and the relative weight of contributions for air pollutants. Findings: During 785,807 person-years of follow-up, 5812 (15.5%) died from non-accidental causes, among which 2932 (7.8%) were from all CVDs, 479 (1.3%) from non-malignant RDs, and 552 (1.4%) from lung cancer. Long-term exposure to PM10 (mean [baseline]: 136.5 μg/m3), PM2.5 (mean [baseline]: 70.2 μg/m3), SO2 (mean [baseline]: 113.0 μg/m3) and NO2 (mean [baseline]: 39.2 μg/m3) were adversely and consistently associated with all mortality outcomes. A 10 μg/m3 increase in PM2.5 was associated with higher mortality from non-accidental causes (hazard ratio 1.20; 95% confidence interval 1.17–1.23), CVDs (1.23; 1.19–1.28), non-malignant RDs (1.37; 1.25–1.49) and lung cancer (1.14; 1.05–1.23). A monotonically increasing curve with linear or supra-linear shape with no evidence of a threshold was observed for the exposure-response relationship of mortality with individual or joint exposure to air pollutants. PM2.5 consistently contributed most to the elevated mortality risks related to air pollutant mixture, followed by SO2 or PM10. Interpretation: There was a strong and positive association of long-term individual and joint exposure to PM10, PM2.5, SO2, and NO2 with mortalities from non-accidental causes, CVDs, non-malignant RDs and lung cancer in high-exposure settings, with PM2.5 potentially being the main contributor. The shapes of associations were consistent with a linear or supra-linear exposure-response relationship, with no lower threshold observed within the range of concentrations in this study.
AB - Background: Evidence on the associations between long-term exposure to multiple air pollutants and cardiopulmonary mortality is limited, especially for developing regions with higher pollutant levels. We aimed to characterise the individual and joint (multi-pollutant) associations of long-term exposure to air pollutants with cardiopulmonary mortality, and to identify air pollutant that primarily contributes to the mortality risk. Methods: We followed 37,442 participants with a mean age of 43.5 years in four cities in northern China (Tianjin, Shenyang, Taiyuan, and Rizhao) from January 1998 to December 2019. Annual particulate matter (PM) with diameters ≤2.5 μm (PM2.5), ≤10 μm (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were estimated using daily average values from satellite-derived machine learning models and monitoring stations. Time-varying Cox proportional hazards model was used to evaluate the individual association between air pollutants and mortality from non-accidental causes, cardiovascular diseases (CVDs), non-malignant respiratory diseases (RDs) and lung cancer, accounting for demographic and socioeconomic factors. Effect modifications by age, sex, income and education level were also examined. Quantile-based g-Computation integrated with time-to-event data was additionally applied to evaluate the co-effects and the relative weight of contributions for air pollutants. Findings: During 785,807 person-years of follow-up, 5812 (15.5%) died from non-accidental causes, among which 2932 (7.8%) were from all CVDs, 479 (1.3%) from non-malignant RDs, and 552 (1.4%) from lung cancer. Long-term exposure to PM10 (mean [baseline]: 136.5 μg/m3), PM2.5 (mean [baseline]: 70.2 μg/m3), SO2 (mean [baseline]: 113.0 μg/m3) and NO2 (mean [baseline]: 39.2 μg/m3) were adversely and consistently associated with all mortality outcomes. A 10 μg/m3 increase in PM2.5 was associated with higher mortality from non-accidental causes (hazard ratio 1.20; 95% confidence interval 1.17–1.23), CVDs (1.23; 1.19–1.28), non-malignant RDs (1.37; 1.25–1.49) and lung cancer (1.14; 1.05–1.23). A monotonically increasing curve with linear or supra-linear shape with no evidence of a threshold was observed for the exposure-response relationship of mortality with individual or joint exposure to air pollutants. PM2.5 consistently contributed most to the elevated mortality risks related to air pollutant mixture, followed by SO2 or PM10. Interpretation: There was a strong and positive association of long-term individual and joint exposure to PM10, PM2.5, SO2, and NO2 with mortalities from non-accidental causes, CVDs, non-malignant RDs and lung cancer in high-exposure settings, with PM2.5 potentially being the main contributor. The shapes of associations were consistent with a linear or supra-linear exposure-response relationship, with no lower threshold observed within the range of concentrations in this study.
KW - Air pollution
KW - Mortality
KW - Cohort study
KW - Cardiorespiratory disease
KW - Lung cancer
KW - Joint association
UR - http://www.scopus.com/inward/record.url?scp=85157999992&partnerID=8YFLogxK
U2 - 10.1016/j.lanwpc.2023.100776
DO - 10.1016/j.lanwpc.2023.100776
M3 - Journal article
C2 - 37547049
AN - SCOPUS:85157999992
SN - 2666-6065
VL - 36
JO - The Lancet Regional Health - Western Pacific
JF - The Lancet Regional Health - Western Pacific
M1 - 100776
ER -
