Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study

Environmental Health

Mojgan Karbakhsh¹  Mehdi Momeni²  Saeid Amini³  Marjan Mansourian⁴  Nizal Sarrafzadegan⁵  Marzieh Taheri⁶  Soheila Jalali⁷ 

[1] Department of Community and Preventive Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran;Department of Surveying Engineering, University of Isfahan, Isfahan, Iran;Department of Surveying and Geomatics Engineering, University of Isfahan, Isfahan, Iran;Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;Department of Automatic Control, Biomedical Engineering Research Center, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Building H, Floor 4, Av. Diagonal 647, 08028, Barcelona, Spain;Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;School of Population & Public Health, University of British Columbia, Vancouver, Canada;Pediatric Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;Student Research Committee, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran;

关键词: PM;    Outdoor air pollution;    Mortality;    Cardiovascular diseases;    AMI;    Stroke;    Survival models;    Cox proportional hazards frailty models;   

DOI  :  10.1186/s12940-021-00797-w

来源: Springer

【 摘 要 】

BackgroundEvidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 μm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM2.5 exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran.MethodsThe cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM2.5 exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM2.5 and the follow-up data of each residential area were combined.ResultsMean three-year PM2·5 exposure for the cohort was measured at 45.28 μg/m3, ranging from 20.01 to 69.80 μg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 μg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 μg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality.ConclusionsResults from analyses suggest that the effect of PM2.5 on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM2.5 with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries.

【 授权许可】

CC BY