Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China

Chen Huang; Andrew E Moran; Pamela G Coxson; Xueli Yang; Fangchao Liu; Jie Cao; Kai Chen; Miao Wang; Jiang He; Lee Goldman; Dong Zhao; Patrick L Kinney; Dongfeng Gu

doi:10.1161/CIRCULATIONAHA.116.026487

Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China

Circulation. 2017 Oct 24;136(17):1575-1584. doi: 10.1161/CIRCULATIONAHA.116.026487. Epub 2017 Sep 7.

Authors

Affiliations

¹ From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.).
² From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.). gudongfeng@vip.sina.com.

Abstract

Background: Outdoor air pollution ranks fourth among preventable causes of China's burden of disease. We hypothesized that the magnitude of health gains from air quality improvement in urban China could compare with achieving recommended blood pressure or smoking control goals.

Methods: The Cardiovascular Disease Policy Model-China projected coronary heart disease, stroke, and all-cause deaths in urban Chinese adults 35 to 84 years of age from 2017 to 2030 if recent air quality (particulate matter with aerodynamic diameter ≤2.5 µm, PM_2.5) and traditional cardiovascular risk factor trends continue. We projected life-years gained if urban China were to reach 1 of 3 air quality goals: Beijing Olympic Games level (mean PM_2.5, 55 μg/m³), China Class II standard (35 μg/m³), or World Health Organization standard (10 μg/m³). We compared projected air pollution reduction control benefits with potential benefits of reaching World Health Organization hypertension and tobacco control goals.

Results: Mean PM_2.5 reduction to Beijing Olympic levels by 2030 would gain ≈241,000 (95% uncertainty interval, 189 000-293 000) life-years annually. Achieving either the China Class II or World Health Organization PM_2.5 standard would yield greater health benefits (992 000 [95% uncertainty interval, 790 000-1 180 000] or 1 827 000 [95% uncertainty interval, 1 481 00-2 129 000] annual life-years gained, respectively) than World Health Organization-recommended goals of 25% improvement in systolic hypertension control and 30% reduction in smoking combined (928 000 [95% uncertainty interval, 830 000-1 033 000] life-years).

Conclusions: Air quality improvement in different scenarios could lead to graded health benefits ranging from 241 000 life-years gained to much greater benefits equal to or greater than the combined benefits of 25% improvement in systolic hypertension control and 30% smoking reduction.

Keywords: China; air pollution; cardiovascular diseases; computer modeling; health benefits.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Air Pollution / adverse effects*
China / epidemiology
Coronary Disease / mortality*
Female
Humans
Hypertension / mortality*
Male
Middle Aged
Models, Biological*
Smoking / mortality*
Urban Population*

Grants and funding

K08 HL089675/HL/NHLBI NIH HHS/United States