Association of School Residential PM 2.5 with Childhood High Blood Pressure: Results from an Observational Study in 6 Cities in China

Int J Environ Res Public Health. 2019 Jul 14;16(14):2515. doi: 10.3390/ijerph16142515.


Objective: To investigate the association of long-term PM2.5 exposure with blood pressure (BP) outcomes in children aged 6-18 years, and to examine the population attributable risk (PAR) of PM2.5 exposure.

Methods: A total of 53,289 participants aged 6-18 years with full record of age, sex, BP, height, and local PM2.5 exposure from a cross-sectional survey conducted in 6 cities of China in 2013 were involved in the present study. PM2.5 data from 18 January 2013 to 31 December 2013 were obtained from the nearest environmental monitoring station for each selected school. Two-level linear and logistic regression models were used to evaluate the influence of PM2.5 on children's BP, and PAR was calculated in each sex and age group.

Results: Participants had a mean age of 10.8 (standard deviation: 3.4) years at enrollment, 51.7% of them were boys. U-shaped trends along with increased PM2.5 concentration were found for both systolic blood pressure (SBP) and diastolic blood pressure (DBP), with the thresholds of 57.8 and 65.0 μg/m3, respectively. Both increased annual mean of PM2.5 concentration and ratio of polluted days were associated with increased BP levels and high blood pressure (HBP), with effect estimates for BP ranging from 2.80 (95% CI: -0.51, 6.11) mmHg to 5.78 (95% CI: 2.32, 9.25) mmHg for SBP and from 0.77 (95% CI: -1.98, 3.52) mmHg to 2.66 (-0.35, 5.66) mmHg for DBP, and the odds ratios for HBP from 1.21 (0.43, 3.38) to 1.92 (0.65, 5.67) in the highest vs. the lowest quartiles. Overall, 1.16% of HBP in our participants could be attributed to increased annual mean of PM2.5 concentration, while 2.82% could be attributed to increased ratio of polluted days. These proportions increased with age.

Conclusions: The association between long-term PM2.5 exposure and BP values appeared to be U-shaped in Chinese children aged 6-18 years, and increased PM2.5 exposure was associated with higher risk of HBP.

Keywords: air pollution; children; high blood pressure; particulate matter.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Pressure
  • Child
  • Child, Preschool
  • China / epidemiology
  • Cities
  • Cross-Sectional Studies
  • Environmental Exposure*
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Male
  • Odds Ratio
  • Particulate Matter / analysis*
  • Schools*


  • Particulate Matter