Benefits of active commuting on cardiovascular health modified by ambient fine particulate matter in China: A prospective cohort study

• Type of Material: Article
• Authors: Yuan Lin, Chinese Academy of Medical Sciences and Peking Union Medical College; Xueli Yang, Tianjin Medical University; Fengchao Liang, Southern University of Science & Technology; Keyong Huang, Chinese Academy of Medical Sciences and Peking Union Medical College; Fangchao Liu, Chinese Academy of Medical Sciences and Peking Union Medical College; Jianxin Li, Chinese Academy of Medical Sciences and Peking Union Medical College; Xiao Qingyang, Tsinghua University; Jichun Chen, Chinese Academy of Medical Sciences and Peking Union Medical College; Xiaoqing Liu, Guangdong Provincial People’s Hospital and Cardiovascular Institute; Jie Cao, Chinese Academy of Medical Sciences and Peking Union Medical College; Shufeng Chen, Chinese Academy of Medical Sciences and Peking Union Medical College; Chong Shen, Nanjing Medical University; Ling Yu, Fujian Provincial Hospital; Fanghong Lu, Shandong Academy of Medical Sciences; Xianping Wu, Sichuan Center for Disease Control and Prevention, Chengdu; Liancheng Zhao, Chinese Academy of Medical Sciences and Peking Union Medical College; Xihui Wu, Chinese Academy of Medical Sciences and Peking Union Medical College; Ying Li, Chinese Academy of Medical Sciences and Peking Union Medical College; Dongsheng Hu, Zhengzhou University; Jianfeng Huang, Chinese Academy of Medical Sciences and Peking Union Medical College; Xianfeng Lu, Chinese Academy of Medical Sciences and Peking Union Medical College; Yang Liu, Emory University; Dongfeng Gu, Chinese Academy of Medical Sciences and Peking Union Medical College
• Language: English
• Date: 2021-08-27
• Publisher: ACADEMIC PRESS INC ELSEVIER SCIENCE
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 The Authors. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ecoenv.2021.112641
• Title of Journal or Parent Work: ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY
• Volume: 224
• Start Page: 112641
• End Page: 112641
• Grant/Funding Information: This study was funded by the National Key Research and Development Program of China (2017YFC0211703, 2016YFC0206503, 2018YFE0115300, and 2018YFC1311703), the National Natural Science Foundation of China (91643208 and 91843302), the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2017-I2M-1-004 and 2019-I2M-2-003), and the China Medical Board (15–220). The work of Y. Liu was supported by the MAIA science team at the JPL, California Institute of Technology (Subcontract #1588347), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Award #1R01ES032140). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: LONG-TERM EXPOSURE; Environmental Sciences; Fine particulate matter; Cardiovascular disease; Cohort study; Toxicology; Air pollution; Life Sciences & Biomedicine; TIME PHYSICAL-ACTIVITY; HEART-DISEASE; EXERCISE; AIR-POLLUTION; Environmental Sciences & Ecology; MORTALITY; Science & Technology; Active commuting; LEISURE-TIME; WALKING; RESIDENTS; HYPERTENSION

Abstract

Background: Active commuting as a contributor to daily physical activity is beneficial for cardiovascular health, but leads to more chances of exposure to ambient air pollution. This study aimed to investigate associations between active commuting to work with cardiovascular disease (CVD), mortality and life expectancy among general Chinese adults, and to further evaluate the modification effect of fine particulate matter (PM2.5) exposure on these associations. Methods: We included 76,176 Chinese adults without CVD from three large cohorts of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project. Information about commuting mode and physical activity were collected by unified questionnaire. Satellite-based PM2.5 concentrations at 1-km spatial resolution was used for estimating PM2.5 exposure of participants. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence, mortality and all-cause mortality were estimated using Cox proportional hazards regression models. Multiplicative interaction term of commuting mode and PM2.5 level was tested to investigate potential effect modification. Results: During 448,499 person-years of follow-up, 2230 CVD events and 2777 all-cause deaths were recorded. Compared with the non-active commuters, the multivariable-adjusted HRs (95% CIs) of CVD incidence and all-cause mortality were 0.95(0.85–1.05) and 0.79(0.72–0.87) for walking commuters, respectively. Corresponding HRs (95% CIs) for cycling commuters were 0.71(0.62–0.82) and 0.67(0.59–0.76). Active commuters over 45 years old were estimated to have more CVD-free years and life expectancy than non-active commuters under lower PM2.5 concentration. However, these beneficial effects of active commuting were alleviated or counteracted by long-term exposure to high PM2.5 concentration. Significant multiplicative interaction of commuting mode and PM2.5 level was showed in all-cause mortality, with the lowest risk observed in cycling participants exposed to lower level of PM2.5. Conclusions: Active commuting was associated with lower risk of CVD, all-cause mortality, and longer life expectancy among Chinese adults under ambient settings with lower PM2.5 level. It will be valuable to encourage active commuting among adults and develop stringent strategies on ambient PM2.5 pollution control for prevention of CVD and prolongation of life expectancy.