Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

Neil Wright; Katherine Newell; Ka Hung Chan; Simon Gilbert; Alex Hacker; Yan Lu; Yu Guo; Pei Pei; Canqing Yu; Jun Lv; Junshi Chen; Liming Li; Om Kurmi; Zhengming Chen; Kin Bong Hubert Lam; Christiana Kartsonaki

doi:10.1186/s12940-023-00978-9

Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

Neil Wright, Katherine Newell, Ka Hung Chan, Simon Gilbert, Alex Hacker, Yan Lu, Yu Guo, Pei Pei, Canqing Yu, Jun Lv, Junshi Chen, Liming Li, Om Kurmi, Zhengming Chen, Kin Bong Hubert Lam, Christiana Kartsonaki

Centre for Healthcare and Communities

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Abstract

Background: Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP. Methods: A prospective study included 50,407 participants aged 30–79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO ₂), sulphur dioxide (SO ₂), fine (PM _2.5), and inhalable (PM ₁₀) particulate matter, ozone (O ₃) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013–2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio–temporal modelling. Results: The study period of 2013–2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO ₂ and O ₃, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m ³ increase in SO ₂ was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m ³ increase in O ₃ was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia. Conclusions: Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease.

Original language	English
Article number	30
Journal	Environmental health : a global access science source
Volume	22
Issue number	1
Early online date	27 Mar 2023
DOIs	https://doi.org/10.1186/s12940-023-00978-9
Publication status	E-pub ahead of print - 27 Mar 2023

Bibliographical note

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Funder

Katherine Newell acknowledges the support from the Oxford-MRC Doctoral Training Partnership.

Funding Information:
The CKB baseline survey and the first re-survey were supported by the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up has been supported by Wellcome grants to Oxford University (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z) and grants from the National Natural Science Foundation of China (82192901, 82192904, 82192900, 91846303) and the National Key Research and Development Program of China (2016YFC0900500).

Funding Information:
UK Medical Research Council Global Challenges Research Fund (Foundation Award MR/P025080/1).

Funding Information:
The UK Medical Research Council (MC_UU_00017/1, MC_UU_12026/2, MC_U137686851), Cancer Research UK (C16077/A29186, C500/A16896) and the British Heart Foundation (CH/1996001/9454), provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project.

Funding Information:
The chief acknowledgment is to the participants, the project staff, and the China National Centre for Disease Control and Prevention (CDC) and its regional offices for assisting with the fieldwork. We thank Judith Mackay in Hong Kong; Yu Wang, Gonghuan Yang, Zhengfu Qiang, Lin Feng, Maigeng Zhou, Wenhua Zhao, Yan Zhang and Zheng Bian in China CDC; Lingzhi Kong, Xiucheng Yu, and Kun Li in the Chinese Ministry of Health; and Garry Lancaster, Sarah Clark, Martin Radley, Mike Hill, Hongchao Pan, and Jill Boreham in the CTSU, Oxford, for assisting with the design, planning, organization, and conduct of the study. Professor Haidong Kan, School of Public Health Fudan University, Shanghai, for providing the fixed site monitoring data. Dr Steve Hung Lam Yim, Chinese University of Hong Kong, for providing all meteorological variables. Members of the China Kadoorie Biobank collaborative group: International Steering Committee: Junshi Chen, Zhengming Chen (PI), Robert Clarke, Rory Collins, Yu Guo, Liming Li (PI), Chen Wang, Jun Lv, Richard Peto, Robin Walters. International Co-ordinating Centre, Oxford: Daniel Avery, Maxim Barnard, Derrick Bennett, Ruth Boxall, Sushila Burgess, Ka Hung Chan, Yiping Chen, Zhengming Chen, Johnathan Clarke; Robert Clarke, Huaidong Du, Ahmed Edris Mohamed, Hannah Fry, Simon Gilbert, Pek Kei Im, Andri Iona, Maria Kakkoura, Christiana Kartsonaki, Hubert Lam, Kuang Lin, James Liu, Mohsen Mazidi, Iona Millwood, Sam Morris, Qunhua Nie, Alfred Pozarickij, Paul Ryder, Saredo Said, Dan Schmidt, Becky Stevens, Iain Turnbull, Robin Walters, Baihan Wang, Lin Wang, Neil Wright, Ling Yang, Xiaoming Yang, Pang Yao. National Co-ordinating Centre, Beijing: Xiao Han, Can Hou, Chun Li, Chao Liu, Jun Lv, Pei Pei, Dianjianyi Sun, Canqing Yu. 10 Regional Co-ordinating Centres: Guangxi Provincial CDC: Naying Chen, Duo Liu, Zhenzhu Tang. Liuzhou CDC: Ningyu Chen, Qilian Jiang, Jian Lan, Mingqiang Li, Yun Liu, Fanwen Meng, Jinhuai Meng, Rong Pan, Yulu Qin, Ping Wang, Sisi Wang, Liuping Wei, Liyuan Zhou. Gansu Provincial CDC: Caixia Dong, Pengfei Ge, Xiaolan Ren. Maiji CDC: Zhongxiao Li, Enke Mao, Tao Wang, Hui Zhang, Xi Zhang. Hainan Provincial CDC: Jinyan Chen, Ximin Hu, Xiaohuan Wang. Meilan CDC: Zhendong Guo, Huimei Li, Yilei Li, Min Weng, Shukuan Wu. Heilongjiang Provincial CDC: Shichun Yan, Mingyuan Zou, Xue Zhou. Nangang CDC: Ziyan Guo, Quan Kang, Yanjie Li, Bo Yu, Qinai Xu. Henan Provincial CDC: Liang Chang, Lei Fan, Shixian Feng, Ding Zhang, Gang Zhou. Huixian CDC: Yulian Gao, Tianyou He, Pan He, Chen Hu, Huarong Sun, Xukui Zhang. Hunan Provincial CDC: Biyun Chen, Zhongxi Fu, Yuelong Huang, Huilin Liu, Qiaohua Xu, Li Yin. Liuyang CDC: Huajun Long, Xin Xu, Hao Zhang, Libo Zhang. Jiangsu Provincial CDC: Jian Su, Ran Tao, Ming Wu, Jie Yang, Jinyi Zhou, Yonglin Zhou. Suzhou CDC: Yihe Hu, Yujie Hua, Jianrong Jin Fang Liu, Jingchao Liu, Yan Lu, Liangcai Ma, Aiyu Tang, Jun Zhang. Qingdao Qingdao CDC: Liang Cheng, Ranran Du, Ruqin Gao, Feifei Li, Shanpeng Li, Yongmei Liu, Feng Ning, Zengchang Pang, Xiaohui Sun, Xiaocao Tian, Shaojie Wang, Yaoming Zhai, Hua Zhang, Licang CDC: Wei Hou, Silu Lv, Junzheng Wang. Sichuan Provincial CDC: Xiaofang Chen, Xianping Wu, Ningmei Zhang, Weiwei Zhou. Pengzhou CDC: Xiaofang Chen, Jianguo Li, Jiaqiu Liu, Guojin Luo, Qiang Sun, Xunfu Zhong. Zhejiang Provincial CDC: Weiwei Gong, Ruying Hu, Hao Wang,Meng Wan, Min Yu. Tongxiang CDC: Lingli Chen, Qijun Gu, Dongxia Pan, Chunmei Wang, Kaixu Xie, Xiaoyi Zhang.

Funding Information:
This research was funded in whole, or in part, by the Wellcome Trust (212,946/Z/18/Z, 202,922/Z/16/Z, 104,085/Z/14/Z, 088,158/Z/09/Z). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Funding Information:
Ka Hung Chan acknowledges the support from the BHF Centre of Research Excellence, University of Oxford (RE/18/3/34214).

Publisher Copyright:
© 2023, The Author(s).

Keywords

Cardiovascular Diseases - chemically induced - epidemiology
China - epidemiology
Environmental Exposure - adverse effects - analysis
Pneumonia
Adult
Prospective Studies
Air pollution
Nitrogen Dioxide - analysis
Respiratory disease
Particulate Matter - adverse effects - analysis
Humans
Air Pollution - adverse effects - analysis
Cardiovascular disease
Bayes Theorem
Ozone - analysis
Air Pollutants - adverse effects - analysis
Respiration Disorders
Respiratory Tract Diseases - epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12940-023-00978-9

PublishedFinal published version, 1.98 MBLicence: CC BY

Cite this

Wright, N., Newell, K., Chan, K. H., Gilbert, S., Hacker, A., Lu, Y., Guo, Y., Pei, P., Yu, C., Lv, J., Chen, J., Li, L., Kurmi, O., Chen, Z., Lam, K. B. H., & Kartsonaki, C. (2023). Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study. Environmental health : a global access science source, 22(1), Article 30. Advance online publication. https://doi.org/10.1186/s12940-023-00978-9

Wright, N, Newell, K, Chan, KH, Gilbert, S, Hacker, A, Lu, Y, Guo, Y, Pei, P, Yu, C, Lv, J, Chen, J, Li, L, Kurmi, O, Chen, Z, Lam, KBH & Kartsonaki, C 2023, 'Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study', Environmental health : a global access science source, vol. 22, no. 1, 30. https://doi.org/10.1186/s12940-023-00978-9

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abstract = "Background: Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP. Methods: A prospective study included 50,407 participants aged 30–79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO 2), sulphur dioxide (SO 2), fine (PM 2.5), and inhalable (PM 10) particulate matter, ozone (O 3) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013–2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio–temporal modelling. Results: The study period of 2013–2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO 2 and O 3, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m 3 increase in SO 2 was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m 3 increase in O 3 was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia. Conclusions: Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease. ",

keywords = "Cardiovascular Diseases - chemically induced - epidemiology, China - epidemiology, Environmental Exposure - adverse effects - analysis, Pneumonia, Adult, Prospective Studies, Air pollution, Nitrogen Dioxide - analysis, Respiratory disease, Particulate Matter - adverse effects - analysis, Humans, Air Pollution - adverse effects - analysis, Cardiovascular disease, Bayes Theorem, Ozone - analysis, Air Pollutants - adverse effects - analysis, Respiration Disorders, Respiratory Tract Diseases - epidemiology",

author = "Neil Wright and Katherine Newell and Chan, {Ka Hung} and Simon Gilbert and Alex Hacker and Yan Lu and Yu Guo and Pei Pei and Canqing Yu and Jun Lv and Junshi Chen and Liming Li and Om Kurmi and Zhengming Chen and Lam, {Kin Bong Hubert} and Christiana Kartsonaki",

note = "This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. ",

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doi = "10.1186/s12940-023-00978-9",

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T1 - Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

AU - Wright, Neil

AU - Newell, Katherine

AU - Chan, Ka Hung

AU - Gilbert, Simon

AU - Hacker, Alex

AU - Lu, Yan

AU - Guo, Yu

AU - Pei, Pei

AU - Yu, Canqing

AU - Lv, Jun

AU - Chen, Junshi

AU - Li, Liming

AU - Kurmi, Om

AU - Chen, Zhengming

AU - Lam, Kin Bong Hubert

AU - Kartsonaki, Christiana

N1 - This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

PY - 2023/3/27

Y1 - 2023/3/27

N2 - Background: Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP. Methods: A prospective study included 50,407 participants aged 30–79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO 2), sulphur dioxide (SO 2), fine (PM 2.5), and inhalable (PM 10) particulate matter, ozone (O 3) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013–2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio–temporal modelling. Results: The study period of 2013–2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO 2 and O 3, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m 3 increase in SO 2 was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m 3 increase in O 3 was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia. Conclusions: Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease.

AB - Background: Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP. Methods: A prospective study included 50,407 participants aged 30–79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO 2), sulphur dioxide (SO 2), fine (PM 2.5), and inhalable (PM 10) particulate matter, ozone (O 3) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013–2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio–temporal modelling. Results: The study period of 2013–2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO 2 and O 3, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m 3 increase in SO 2 was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m 3 increase in O 3 was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia. Conclusions: Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease.

KW - Cardiovascular Diseases - chemically induced - epidemiology

KW - China - epidemiology

KW - Environmental Exposure - adverse effects - analysis

KW - Pneumonia

KW - Adult

KW - Prospective Studies

KW - Air pollution

KW - Nitrogen Dioxide - analysis

KW - Respiratory disease

KW - Particulate Matter - adverse effects - analysis

KW - Humans

KW - Air Pollution - adverse effects - analysis

KW - Cardiovascular disease

KW - Bayes Theorem

KW - Ozone - analysis

KW - Air Pollutants - adverse effects - analysis

KW - Respiration Disorders

KW - Respiratory Tract Diseases - epidemiology

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JO - Environmental health : a global access science source

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Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

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