Long-term influence of air pollutants on morbidity and all-cause mortality of cardiometabolic multi-morbidity: A cohort analysis of the UK Biobank participants

Zhou Jiang; Shuo Zhang; Keying Chen; Yuxuan Wu; Ping Zeng; Ting Wang

doi:10.1016/j.envres.2023.116873

Long-term influence of air pollutants on morbidity and all-cause mortality of cardiometabolic multi-morbidity: A cohort analysis of the UK Biobank participants

Environ Res. 2023 Nov 15;237(Pt 1):116873. doi: 10.1016/j.envres.2023.116873. Epub 2023 Aug 10.

Authors

Zhou Jiang¹, Shuo Zhang¹, Keying Chen¹, Yuxuan Wu¹, Ping Zeng², Ting Wang³

Affiliations

¹ Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
² Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China; Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China; Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China; Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China; Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China. Electronic address: zpstat@xzhmu.edu.cn.
³ Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China. Electronic address: wangtgw@163.com.

PMID: 37573024
DOI: 10.1016/j.envres.2023.116873

Abstract

Background: The effects of air pollutants on cardiometabolic diseases (CMDs) have been widely explored, whereas their influences on cardiometabolic multi-morbidity (CMM) were not clear.

Methods: We employed the UK Biobank cohort (N = 317,160) to study the association between six air pollutants (PM_2.5, PM₁₀, PM_2.5-10, PM_2.5abs, NO₂, and NO_x) and four CMDs including type II diabetes (T2D), coronary artery disease (CAD), stroke and hypertension. CMM was defined as occurrence of two or more of the four diseases. Multi-state Cox models were performed to estimate hazard ratio (HR) and its 95% confidence interval (95%CI).

Results: During a median follow-up of 12.8 years, 52,211 participants developed only one CMD, 15,446 further developed CMM, and 16,861 ultimately died. It was demonstrated that per interquartile range increase (IQR) increases in PM_2.5, PM₁₀, PM_2.5-10, PM_2.5abs, NO₂, and NO_x would increase 12% (9%-15%), 4% (1%-7%), 3% (1%-6%), 7% (4%-10%), 11% (8%-15%) and 10% (7%-13%) higher risk of developing one CMD from health baseline; 7% (2%-12%), 8% (3%-13%), 6% (2%-11%), 10% (5%-15%), 13% (7%-18%) and 10% (5%-15%) greater risk of occurring CMM from one CMD baseline; and 11% (-2%∼26%), 22% (7%-38%), 17% (3%-32%), 31% (16%-49%), 33% (17%-51%) and 32% (17%-50%) larger risk of causing death from CMM baseline, respectively.

Conclusions: We revealed that people living in areas with high air pollution suffered from higher hazard of CMD, CMM and all-cause mortality; our findings implied keeping clean air was an effective approach to prevent or mitigate initiation, progression, and death from healthy to CMDs and from CMDs to CMM.

Keywords: Air pollution; All-cause mortality; Cardiometabolic disease; Cardiometabolic multimorbidity; Long-term influence; UK biobank.