Associations of long-term exposure to ambient PM2.5 with mortality in Chinese adults: A pooled analysis of cohorts in the China-PAR project

• Authors: Xueli Yang, Chinese Academy of Medical Sciences; Fengchao Liang, Chinese Academy of Medical Sciences; Jianxin Li, Chinese Academy of Medical Sciences; Jichun Chen, Chinese Academy of Medical Sciences; Keyong Huang, Chinese Academy of Medical Sciences; Jie Cao, Chinese Academy of Medical Sciences; Shufeng Chen, Chinese Academy of Medical Sciences; Qingyang Xiao, Tsinghua University; Xiaoqing Liu, Guangdong Provincial People’s Hospital and Cardiovascular Institute; 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; Xigui Wu, Chinese Academy of Medical Sciences; Ying Li, Chinese Academy of Medical Sciences; Liancheng Zhao, Chinese Academy of Medical Sciences; Dongsheng Hu, Shenzhen University; Jianfeng Huang, Chinese Academy of Medical Sciences; Xiangfeng Lu, Chinese Academy of Medical Sciences; Yang Liu, Emory University; Dongfeng Gu, Chinese Academy of Medical Sciences
• Journal Title: ENVIRONMENT INTERNATIONAL
• Volume: Volume 138
• Publisher: PERGAMON-ELSEVIER SCIENCE LTD | 2020-05-01, Pages 105589-105589
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.envint.2020.105589
• Subjects: Health Sciences, Epidemiology; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Environmental Sciences; Environmental Sciences & Ecology; Satellite-based PM2.5; Long-term exposure; Cohort study; Mortality; Concentration-response relationship; FINE PARTICULATE MATTER; CANADIAN CENSUS HEALTH; ALL-CAUSE MORTALITY; AIR-POLLUTION; CARDIOVASCULAR-DISEASE; GLOBAL BURDEN; FUEL USE; RISK

Abstract

Background: The concentration-response relationship between mortality and long-term exposure to fine particulate matter (PM2.5) has not been fully elucidated, especially at high levels of PM2.5 concentrations. Objective: We aimed to evaluate chronic effects of ambient PM2.5 exposure on deaths among Chinese adults in high-exposure settings. Methods: Participants of the Prediction for Atherosclerotic cardiovascular disease Risk in China (China-PAR) project were included from four prospective cohorts among Chinese adults aged ≥18 years old. The overall follow-up rate of the four cohorts was 93.4% until the recent follow-up survey that ended in 2015. The average of satellite-based PM2.5 concentrations during 2000–2015 at 1-km spatial resolution was assigned to each participant according to individual residence addresses. Based on the pooled analysis of individual data from the four cohorts, a Cox proportional hazards model was used to estimate the hazard ratio (HR) and corresponding 95% confidence intervals (95% CIs) for the association of PM2.5 exposure with mortality after multivariate adjustment. Results: A total of 116,821 participants were eligible in the final analysis. During a mean of 7.7 years of follow-up, 6,395 non-accidental deaths and 2,507 cardio-metabolic deaths occurred. The mean of PM2.5 concentration was 64.9 μg/m3 ranging from 31.2 μg/m3 to 97.0 μg/m3. For each 10 μg/m3 increment in PM2.5, the HR was 1.11 (95% CI: 1.08–1.14) for non-accidental mortality and 1.22 (95% CI: 1.16–1.27) for cardio-metabolic mortality. In addition, a weak exponential curve for the concentration-response association between mortality and PM2.5 was observed among Chinese adults. Conclusions: Our study provided important evidence of the long-term effects of PM2.5 exposure on deaths among Chinese adults. The findings expand our knowledge on concentration-response relationship in high-exposure environments, which is essential to address the urgent challenge of reducing the disease burden attributable to PM2.5 exposure in rapidly industrializing countries such as China.