Long-term exposure to air pollution is a significant public health concern, yet its association with chronic pain remains underexplored, particularly regarding the combined effects of multiple pollutants. This retrospective cohort study investigated the link between long-term exposure to five air pollutants (PM₂.₅, PM₁₀, NO₂, SO₂, CO) and the incidence of chronic pain among middle-aged and older adults in China. Utilizing data from the China Health and Retirement Longitudinal Study from 2011 to 2020, this study included 10,378 participants free of chronic pain at baseline. Individual pollutant exposures were assessed and analyzed via time-dependent Cox and accelerated failure time models, integrated with Weighted Quantile Sum regression to evaluate mixture effects. During a mean follow-up of 7.39 years, 8,047 new-onset chronic pain cases were identified. Elevated concentrations of PM₂.₅, PM₁₀, SO₂, and CO were individually associated with increased chronic pain risk and shortened time to pain onset, with SO₂ showing the strongest effect. The combined exposure to all five pollutants was significantly associated with a higher risk and earlier onset of chronic pain, with SO₂ being the predominant contributor. This study reveals that long-term exposure to multiple air pollutants, especially SO₂, is significantly associated with an increased risk of chronic pain in middle-aged and older adults, underscoring the need for targeted air quality interventions to mitigate this health burden. PERSPECTIVE: This study identifies SO2 and CO as the principal driver within air pollutant co-exposure to increase chronic pain risk by mixture analysis. It provides direct evidence for revising air quality standards to target specific pollutants and mitigate the pain burden in aging populations.
Yu-Hang Yang, Nai-Jin Zhang, Jia-Ming Chen et al.· Journal of Pain· 0 citations
Cardiometabolic multimorbidity (CMM) is increasingly common and carries substantial clinical and public-health burden. The cholesterol-high-density lipoprotein-glucose (CHG) index has been linked to adverse cardiometabolic outcomes, but prospective evidence comparing baseline and cumulative exposure and testing external reproducibility under design-appropriate survey methods remains limited.
We analyzed a baseline CHG cohort (
n
= 7,077) and a cumulative-CHG subcohort (
n
= 4,881) from the China Health and Retirement Longitudinal Study (CHARLS), and conducted a supportive external replication analysis in the National Health and Nutrition Examination Survey (NHANES; 1999–2018;
n
= 23,797). Cox models were used in CHARLS and fasting-subsample survey-weighted logistic models in NHANES. CHG and cumulative CHG were modeled per 1-standard deviation (SD) increment and by tertiles. Restricted cubic spline and threshold analyses characterized dose–response patterns. Sensitivity analyses included a stricter disease-free cumulative CHARLS cohort and additional hypertension adjustment in NHANES.
Higher baseline CHG in CHARLS was associated with greater incident CMM risk (adjusted hazard ratio [HR] per 1-SD increase, 1.55; 95% CI, 1.39–1.73); participants in the highest tertile had higher risk than those in the lowest tertile (adjusted HR, 2.93; 95% CI, 2.15–4.00). Associations were stronger for cumulative CHG (adjusted HR per 1-SD increase, 1.75; 95% CI, 1.61–1.89; adjusted HR for T3 vs. T1, 5.46; 95% CI, 3.91–7.63). In weighted NHANES analyses, CHG remained positively associated with prevalent CMM (adjusted odds ratio per 1-SD increase, 1.91; 95% CI, 1.75–2.08; adjusted OR for T3 vs. T1, 3.58; 95% CI, 2.73–4.69). Baseline CHG in CHARLS showed a significant overall association without clear nonlinearity, whereas cumulative CHG in CHARLS and CHG in NHANES showed significant nonlinear patterns. Sensitivity analyses were directionally consistent with the main findings.
Higher baseline and cumulative CHG were associated with greater incident CMM risk in the longitudinal CHARLS analyses, with larger effect estimates observed for cumulative CHG. A positive association was also observed between CHG and prevalent CMM in the cross-sectional NHANES analysis. These findings suggest that CHG, particularly its cumulative exposure, may serve as a potential marker of CMM risk and burden. However, further prospective validation is needed before CHG can be used for clinical risk prediction or to define decision thresholds.
Huilin Li, Yuxin Zhang, Fuxin Zha et al.· Lipids in Health and Disease· 0 citations
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