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Journal Article Epublish 25 citations

PubMed: 38383041 DOI: 10.1136/bmj-2023-076939

Exposure-response associations between chronic exposure to fine particulate matter and risks of hospital admission for major cardiovascular diseases: population based cohort study.

BMJ 384:e076939

Authors: Yaguang Wei, Yijing Feng, Mahdieh Danesh Yazdi, Kanhua Yin, Edgar Castro, Alexandra Shtein, Xinye Qiu, Adjani A Peralta, Brent A Coull, Francesca Dominici, Joel D Schwartz

Affiliations

  • Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
  • Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
  • Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
  • Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
  • Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Abstract

OBJECTIVE

To estimate exposure-response associations between chronic exposure to fine particulate matter (PM) and risks of the first hospital admission for major cardiovascular disease (CVD) subtypes.

DESIGN

Population based cohort study.

SETTING

Contiguous US.

PARTICIPANTS

59 761 494 Medicare fee-for-service beneficiaries aged ≥65 years during 2000-16. Calibrated PM predictions were linked to each participant's residential zip code as proxy exposure measurements.

MAIN OUTCOME MEASURES

Risk of the first hospital admission during follow-up for ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, valvular heart disease, thoracic and abdominal aortic aneurysms, or a composite of these CVD subtypes. A causal framework robust against confounding bias and bias arising from errors in exposure measurements was developed for exposure-response estimations.

RESULTS

Three year average PM exposure was associated with increased relative risks of first hospital admissions for ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, and thoracic and abdominal aortic aneurysms. For composite CVD, the exposure-response curve showed monotonically increased risk associated with PM: compared with exposures ≤5 µg/m (the World Health Organization air quality guideline), the relative risk at exposures between 9 and 10 µg/m, which encompassed the US national average of 9.7 µg/m during the study period, was 1.29 (95% confidence interval 1.28 to 1.30). On an absolute scale, the risk of hospital admission for composite CVD increased from 2.59% with exposures ≤5 µg/m to 3.35% at exposures between 9 and 10 µg/m. The effects persisted for at least three years after exposure to PM. Age, education, accessibility to healthcare, and neighborhood deprivation level appeared to modify susceptibility to PM.

CONCLUSIONS

The findings of this study suggest that no safe threshold exists for the chronic effect of PM on overall cardiovascular health. Substantial benefits could be attained through adherence to the WHO air quality guideline.

MeSH

Myocardial Ischemia, Research Design, Bias, Aortic Aneurysm, Heart Diseases, Air Pollution, Heart Failure, Heart, Arrhythmias, Cardiac, Cardiovascular Diseases, Aneurysm, Cohort Studies, Air, Cerebrovascular Disorders, Particulate Matter, Cardiomyopathies, Aortic Aneurysm, Abdominal

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