Short-term exposure to ambient air pollutants increases the mortality risk of chronic kidney disease: a time-stratified case-crossover study in Zhejiang Province.
A significant association between short-term exposure to air pollutants and CKD mortality in the population of Zhejiang Province is revealed and a need for governmental authorities to enhance the monitoring and control of air pollution to mitigate the health burden on the elderly is suggested.
Abstract
Background
The association between air pollutants and mortality from chronic kidney disease (CKD) remains to be further investigated. This study aims to examine the impact of air pollutant exposure on CKD mortality in individuals.
Methods
This study utilized an individual-level, time-stratified case-crossover design to evaluate the association between short-term exposure to air pollutants (PM2.5, SO2, O3, and NO2) and mortality from CKD. The deceased population was identified from the mortality surveillance data of the Zhejiang Provincial Center for Disease Control and Prevention. For each decedent, we collected air pollutant concentrations on the day of death (case day) and on matched control days within the same month. This design inherently controls confounding factors such as age, place of residence, and seasonality.
Results
The study found that short-term exposure to all four air pollutants was associated with an increased risk of CKD mortality. The excess risk (ER) per interquartile range (IQR) increase in pollutant concentrations was evaluated across different lag periods. Using multi-day moving average lags (calculated as the mean exposure from the current day up to the specified preceding day), the most prominent ERs were observed for PM2.5 at lag02 (ER: 15.16%, 95% CI: 12.69-17.68), SO2 at lag03 (ER: 8.80%, 95% CI: 5.95-11.72), O3 at lag01 (ER: 5.67%, 95% CI: 2.07-9.39), and NO2 at lag03 (ER: 13.66%, 95% CI: 9.12-18.39). After adjusting for interactions with other pollutants, the associations for SO2 and PM2.5 remained significant. Additionally, the study found that this association was influenced by factors such as marriage, and season (cold vs. warm).
Conclusions
This study revealed a significant association between short-term exposure to air pollutants and CKD mortality in the population of Zhejiang Province. These findings provide novel evidence for understanding the impact of environmental factors on kidney disease and suggest a need for governmental authorities to enhance the monitoring and control of air pollution to mitigate the health burden on the elderly.
Stroke is a leading cause of death and disability worldwide. Exposure to ambient air pollutants and the risk of stroke have been reported in many studies, but the results vary greatly among different regions. This study aims to investigate the association between short-term exposure to air pollution and the admission of total stroke and its subtypes in the Luohu District, Shenzhen. A time-stratified case-crossover study was conducted among 21,973 newly diagnosed stroke cases in Luohu, Shenzhen from 2014 to 2022. Residential exposure to air pollution was assessed using validated grid datasets. A distributed lag model (DLM) and conditional logistic regression model were implemented to evaluate the relationship between ambient air pollution and the admission of stroke and its subtypes. We found that a 10 µg/m3 increase in exposure to NO2 and SO2 was positively associated with a 2.73% increase (95% confidence interval [CI]: 2.21%, 3.25%) and a 24.89% increase (20.87%, 29.06%) in the odds of total stroke admission, respectively. Statistical significance has also been found in subtypes. Stronger associations were observed in females (SO2), the elderly (NO2 and SO2), and the cold season (NO2 and SO2). Our findings indicate that exposure to NO2 and SO2 exacerbates the risk of stroke admission, especially in the elderly, females, and the cold season.
The substantial burden of cardiovascular disease (CVD) attributable to air pollution remains a critical public health challenge, yet its combined effect with cardiometabolic factors is not fully understood. This study leveraged data from the Global Burden of Disease Study (GBD) and the China High Air Pollutants (CHAP) database to evaluate the CVD burden attributable to air pollution, which was found to increase progressively with age. We conducted a cross-sectional analysis using baseline (2011) data from 7420 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS), and a prospective cohort analysis in 8792 participants followed through 2020. In the longitudinal analysis, long-term exposure to PM2.5 (HR = 1.09, 95% CI: 1.03–1.16) and PM10 (HR = 1.07, 95% CI: 1.04–1.10) was significantly associated with an elevated risk of incident CVD, whereas the association for NO2 was nominally significant (HR = 1.12, 95% CI: 1.00–1.24) and that for O3 was not statistically significant (HR = 1.08, 95% CI: 0.93–1.27). Furthermore, prolonged exposure to these pollutants was associated with a higher prevalence of hypertension, diabetes, dyslipidemia, and obesity, and with adverse levels of metabolic indicators, including the TyG, TyG-BMI, and TyG-WC indices. A random forest model showed modest discrimination for incident CVD (AUC = 0.656), identifying PM10 and PM2.5 as the most important predictors. In conclusion, long-term exposure to ambient air pollution, particularly particulate matter, is associated with an increased risk of CVD and cardiometabolic disorders in middle-aged and older Chinese adults.
Xue-Hua Wang, Zhaohui Wang, Yan Wang· Bioengineering· 0 citations
PM2.5, PM10, NO2, and CO exposures were associated with COPD hospitalization in Kashi, precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for COPD associated with air pollutants.
Li Li, Ayiguli Alimu, Jing-Ran Xu et al.· International Journal of COP...· 0 citations
Novel evidence is provided that short-term absolute increases in air pollution levels are associated with elevated risks of depression, which is worth consideration in future disease prevention practices.
Yating Ma, Chen-Lu Yang, Lijun Bai et al.· Ecotoxicology and Environmen...· 0 citations
Although long-term exposure to ambient fine particulate matter (PM
2.5
) is an established risk factor for stroke, evidence on the detrimental effects of its specific constituents remains limited. This study aimed to investigate the associations between long-term exposure to PM
2.5
constituents and incident stroke, and to identify the key contributor.
We conducted a nationwide prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2013 and 2018. Incident stroke cases were identified from CHARLS self-reported physician diagnoses during follow-up interviews. PM
2.5
constituent concentration data were derived from the Tracking Air Pollution in China (TAP) dataset, while temperature and relative humidity data were obtained from the European Center for Medium-Range Weather Forecasts Reanalysis v5 (ERA5). Individual records were matched with environmental exposure data to quantify the associations between specific PM
2.5
constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) and the incident stroke. Multivariate Cox models and quantile-based g-computation were applied to assess the associations of PM
2.5
constituents with incident stroke and to identify the key contributor.
Over a median follow-up of 5.0 years, 610 incident stroke cases occurred among 8,724 participants. All five constituents were significantly associated with stroke onset, the adjusted hazard ratios (95% confidence interval [CI]) for each interquartile range increase were 1.55 (95% CI: 1.35–1.79) for PM
2.5
, 1.55 (95% CI: 1.34–1.79) for sulfate, 1.37 (95% CI: 1.18–1.59) for nitrate, 1.42 (95% CI: 1.24–1.63) for ammonium, 1.59 (95% CI: 1.40–1.80) for organic matter, and 1.77 (95% CI: 1.54–2.03) for black carbon, respectively. In the joint effect analysis, black carbon (28.6%) exhibited the largest weight within the mixture. Stratified analyses revealed that individuals aged over 65 years and residents of southern China were more susceptible.
Long-term exposure to PM
2.5
constituents is associated with an elevated risk of incident stroke, with black carbon showing the strongest association among the five constituents. Older adults and residents of southern China were found to exhibit heightened susceptibility. These findings highlight the importance of mitigating the growing stroke burden through tailored clinical approaches and targeted regulation of carbonaceous emissions, accounting for demographic and regional vulnerabilities.
Hao Wang, Miao-Miao Wei, Tai-Kun Lu et al.· Frontiers in Public Health· 0 citations
BACKGROUND
Sudden unexpected death in infancy (SUDI) remains poorly understood, and the potential contribution of air pollution exposure is largely unexplored. Given its known impact on infant health, air pollution may influence the risk of SUDI, particularly through short-term effects.
OBJECTIVES
We aimed to evaluate the short-term effect of exposure to ambient air pollutants on SUDI in France.
METHODS
Using data from the French national SUDI registry (2015-2022) and modelled air pollution data, we assigned daily concentrations of particulate matter (PM10 and PM2.5, μg/m3), nitrogen dioxide (NO2, μg/m3) and ozone (O3, μg/m3) at each infant's residence. We conducted a time-stratified case-crossover analysis comparing single- and multi-pollutant exposure on the day of death with matched control days, considering lagged effects up to 6 days. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression, adjusted for public holiday, influenza-like syndrome and daily mean temperature. We assessed the potential effect of several effect modifiers, such as biological sex, age at death, season, urban or rural residence, social deprivation and sleeping position at discovery.
RESULTS
A total of 1078 SUDI cases were included. Exposure to PM was consistently associated with higher odds of SUDI, with a lag effect of 3 to 5 days before death and during the last week of life. NO2 exposure presented a trend of association. Higher effects were observed for PM and NO2 with cumulative exposure, especially for PM and consistent with the multi-pollutant model. We observed seasonal heterogeneity, with higher ORs in the spring for PM and O3.
CONCLUSIONS
Our findings support a plausible short-term trigger effect of air pollution on SUDI. These results highlight the need to integrate environmental determinants, particularly for NO2 and PM, into SUDI prevention strategies.
Emmanuel Bourdet, N. Letellier, T. Benmarhnia et al.· Paediatric and Perinatal Epi...· 0 citations
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