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Hu J, Wang F, Shen H. The influence of PM 2.5 exposure duration and concentration on outpatient visits of urban hospital in a typical heavy industrial city. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:115098-115110. [PMID: 37880395 DOI: 10.1007/s11356-023-30544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
To explain the duration and dose effects of pollutant exposure on public health and provide scientific data for air pollution prevention and control and disease prevention by examining the influence of PM2.5 concentration and exposure duration on daily outpatient visits among patients with cardiovascular, cerebrovascular, and respiratory diseases in a typical heavy industrial city in China. Daily outpatient data on cardiovascular, cerebrovascular, and respiratory diseases and regional PM2.5 exposure duration and concentration were collected from a provincial hospital in Taiyuan, China, from 2016 to 2021. The correlations of numeric variables were analyzed using the Pearson correlation method. A generalized additive model (GAMs) was also established to investigate the effects of PM2.5 concentration and exposure duration on outpatient visits. Correlation analysis showed that the outpatient visits in Taiyuan was significantly correlated with the PM2.5 concentration and exposure duration. The longer the exposure time of PM2.5 pollution, the stronger the correlation of PM2.5 with outpatient visits showed. Cardiovascular outpatient visits were extremely significant related with medium to long-term exposure of PM2.5 (exposure with more than 30 days) (p < 0.001). In addition, outpatient visits of cerebrovascular and respiratory disease were extremely significant correlated with PM2.5 (exposures within 0-360 days) (p < 0.001). The results of GAMs showed the linear or the nonlinear relationships between outpatient visits and exposure of PM2.5. Among the linear relationships, when average concentration of PM2.5 (exposure within less than 15 days) increased by 1 mg/m3, the cardiovascular outpatient visits increased most dramatically (by about 440 people). For nonlinear relationships, when the average PM2.5 concentration (exposure with over 30 days or more) increased by 1 mg/m3, the most dramatic increase occurred in cardiovascular outpatient visits (with a maximum increase of 7000), followed by cerebrovascular outpatient visits (with a maximum increase of 1200), and respiratory outpatient visits (with a maximum increase of 250). The GAMs also revealed a dose effect in the relationship between outpatient visits and PM2.5 exposure. In moderately polluted air (based on air quality standards of China, GB3095-2012), when the average concentration of PM2.5 increased by 1 mg/m3, the cardiovascular outpatient visits increased the most (by 1200 people), followed by cerebrovascular outpatient visits (by 200 people) and respiratory outpatient visits (by 20 people). We concluded that outpatient visits in cardiovascular, cerebrovascular, and respiratory disease are closely correlated with the concentration and exposure duration of air pollution. There is a linear relationship between short-term air pollution exposure (exposure within less than 15 days) and outpatient visits. As PM2.5 concentration increases, cardiovascular outpatient visits increase gradually, with its growth trend exceeding that of cerebrovascular and respiratory disease. There is a nonlinear relationship between medium and long-term air pollution exposure (exposure with more than 30 days) and outpatient visits, with cardiovascular and cerebrovascular outpatient visits showed a nonlinear but overall upward trend when the atmosphere is moderately polluted.
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Affiliation(s)
- Jingran Hu
- School of Physical Education, Shanxi University, Taiyuan, 030006, Shanxi, China
- Shanxi Cardiovascular Hospital, No. 18 Yifen Road, Taiyuan, 030024, Shanxi, China
| | - Fei Wang
- School of Physical Education, Shanxi University, Taiyuan, 030006, Shanxi, China.
- Sports Science Institute, Shanxi University, Taiyuan, 030006, Shanxi, China.
| | - Hao Shen
- School of Physical Education, Shanxi University, Taiyuan, 030006, Shanxi, China
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Lv S, Shi Y, Xue Y, Hu Y, Hu M, Li S, Xie W, Li Y, Ouyang Y, Li Z, Liu M, Wei J, Guo X, Liu X. Long-term effects of particulate matter on incident cardiovascular diseases in middle-aged and elder adults: The CHARLS cohort study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115181. [PMID: 37393817 DOI: 10.1016/j.ecoenv.2023.115181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Although there is evidence of long-term effects of particulate matter (PM) on cardiovascular diseases (CVD), researches about long-term effects of PM1 on CVD are limited. We aimed to examine the long-term effects and magnitude of PM, especially PM1, on incident CVD in China. METHODS We included 6016 participants aged ≥ 45 years without CVD at baseline in 2011 from the China Health and Retirement Longitudinal Study. Personal PM (PM1, PM2.5, and PM10) concentrations were estimated using geocoded residential address. Generalized linear mixed models and SHapley Additive exPlanation were utilized to calculate the impacts and contributions of PM on CVD. Sensitivity analyses were used to check the robustness. RESULTS After a follow up of 4-year, 481 (7.99 %) participants developed CVD. Per 10 μg/m3 uptick in 1-year average concentrations of PM1, PM2.5 and PM10 was associated with a 1.20 [95 % confidence interval (CI): 1.05-1.37], 1.13 (95 % CI: 1.11-1.15), and 1.10 (95 % CI: 1.06-1.13) fold risk of incident CVD, respectively. The 2-year average concentrations of PM1, PM2.5 and PM10 were associated with incident CVD, corresponding to a 1.03 (95 % CI: 0.96-1.10), 1.11 (95 % CI: 1.02-1.21), and 1.09 (95 % CI: 1.03-1.15) fold risk, respectively. The SHapley Additive exPlanation values of PM1, PM2.5, and PM10 were 0.170, 0.153, and 0.053, respectively, corresponding to the first, second, and fifth among all air pollutants. Effects of PM1, PM2.5 and PM10 on CVD remained statistically significant in two-pollutant models. The elderly, males, smokers and alcohol drinkers tended to have slightly higher effects, while the differences were not statistically significant (all P-values > 0.05) between subgroups. CONCLUSION Long-term exposure to PM1, PM2.5, and PM10 was associated with an increased incidence of CVD. The smaller the particle size, the more important it was for incident CVD indicating that emphasis should be placed on small size of PM.
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Affiliation(s)
- Shiyun Lv
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yadi Shi
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yongxi Xue
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yaoyu Hu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Meiling Hu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Shuting Li
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Wenhan Xie
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yuan Li
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yixin Ouyang
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Zhiwei Li
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Mengmeng Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China; National Institute for Data Science in Health and Medicine, Capital Medical University, Beijing 100069, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, Maryland 20742, USA
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China; National Institute for Data Science in Health and Medicine, Capital Medical University, Beijing 100069, China.
| | - Xiangtong Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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Psistaki K, Achilleos S, Middleton N, Paschalidou AK. Exploring the impact of particulate matter on mortality in coastal Mediterranean environments. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 865:161147. [PMID: 36587685 DOI: 10.1016/j.scitotenv.2022.161147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Air pollution is one of the most important problems the world is facing nowadays, adversely affecting public health and causing millions of deaths every year. Particulate matter is a criteria pollutant that has been linked to increased morbidity, as well as all-cause and cause-specific mortality. However, this association remains under-investigated in smaller-size cities in the Eastern Mediterranean, which are also frequently affected by heat waves and dust storms. This study explores the impact of particulate matter with an aerodynamic diameter ≤ 10 μm (PM10) and ≤ 2.5 μm (PM2.5) on mortality (all-cause, cardiovascular, respiratory) in two coastal cities in the Eastern Mediterranean; Thessaloniki, Greece and Limassol, Cyprus. Generalized additive Poisson models were used to explore overall and gender-specific associations, controlling for long- and short-term patterns, day of week and the effect of weather variables. Moreover, the effect of different lags, season, co-pollutants and dust storms on primary associations was investigated. A 10 μg/m3 increase in PM2.5 resulted in 1.10 % (95 % CI: -0.13, 2.34) increase in cardiovascular mortality in Thessaloniki, and in 3.07 % (95 % CI: -0.90, 7.20) increase in all-cause mortality in Limassol on the same day. Additionally, significant positive associations were observed between PM2.5 as well as PM10 and mortality at different lags up to seven days. Interestingly, an association with dust storms was observed only in Thessaloniki, having a protective effect, while the gender-specific analysis revealed significant associations only for the males in both cities. The outcome of this study highlights the need of city- or county-specific public health interventions to address the impact of climate, population lifestyle behaviour and other socioeconomic factors that affect the exposure to air pollution and other synergistic effects that alter the effect of PM on population health.
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Affiliation(s)
- K Psistaki
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada 68200, Greece
| | - S Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - N Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - A K Paschalidou
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada 68200, Greece.
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You X, Cao X, Guo Y, Wang D, Qiu W, Zhou C, Zhou M, Chen W, Zhang X. Associations between short-term PM2.5 exposure and daily hospital admissions for circulatory system diseases in Ganzhou, China: A time series study. Front Public Health 2023; 11:1134516. [PMID: 36969639 PMCID: PMC10034184 DOI: 10.3389/fpubh.2023.1134516] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivePrevious epidemiological studies have shown that both long-term and short-term exposure to fine particulate matters (PM2.5) were associated with the morbidity and mortality of circulatory system diseases (CSD). However, the impact of PM2.5 on CSD remains inconclusive. This study aimed to investigate the associations between PM2.5 and circulatory system diseases in Ganzhou.MethodsWe conducted this time series study to explore the association between ambient PM2.5 exposure and daily hospital admissions for CSD from 2016 to 2020 in Ganzhou by using generalized additive models (GAMs). Stratified analyses were also performed by gender, age, and season.ResultsBased on 201,799 hospitalized cases, significant and positive associations were found between short-term PM2.5 exposure and hospital admissions for CSD, including total CSD, hypertension, coronary heart disease (CHD), cerebrovascular disease (CEVD), heart failure (HF), and arrhythmia. Each 10 μg/m3 increase in PM2.5 concentrations was associated with a 2.588% (95% confidence interval [CI], 1.161%–4.035%), 2.773% (95% CI, 1.246%–4.324%), 2.865% (95% CI, 0.786%–4.893%), 1.691% (95% CI, 0.239%–3.165%), 4.173% (95% CI, 1.988%–6.404%) and 1.496% (95% CI, 0.030%–2.983%) increment in hospitalizations for total CSD, hypertension, CHD, CEVD, HF, and arrhythmia, respectively. As PM2.5 concentrations rise, the hospitalizations for arrhythmia showed a slow upward trend, while other CSD increased sharply at high PM2.5 levels. In subgroup analyses, the impacts of PM2.5 on hospitalizations for CSD were not materially changed, although the females had higher risks of hypertension, HF, and arrhythmia. The relationships between PM2.5 exposure and hospitalizations for CSD were more significant among individuals aged ≤65 years, except for arrhythmia. PM2.5 had stronger effects on total CSD, hypertension, CEVD, HF, and arrhythmia during cold seasons.ConclusionPM2.5 exposure was positively associated with daily hospital admissions for CSD, which might provide informative insight on adverse effects of PM2.5.
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Affiliation(s)
- Xiaojie You
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiuyu Cao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - You Guo
- First Affiliated Hospital, Gannan Medical University, Ganzhou, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weihong Qiu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuanfei Zhou
- First Affiliated Hospital, Gannan Medical University, Ganzhou, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Min Zhou
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Weihong Chen
| | - Xiaokang Zhang
- First Affiliated Hospital, Gannan Medical University, Ganzhou, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
- Xiaokang Zhang
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Hu M, Wei J, Hu Y, Guo X, Li Z, Liu Y, Li S, Xue Y, Li Y, Liu M, Wang L, Liu X. Long-term effect of submicronic particulate matter (PM 1) and intermodal particulate matter (PM 1-2.5) on incident dyslipidemia in China: A nationwide 5-year cohort study. ENVIRONMENTAL RESEARCH 2023; 217:114860. [PMID: 36423667 DOI: 10.1016/j.envres.2022.114860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is insufficient evidence of associations between incident dyslipidemia with PM1 (submicronic particulate matter) and PM1-2.5 (intermodal particulate matter) in the middle-aged and elderly. We aimed to determine the long-term effects of PM1 and PM1-2.5 on incident dyslipidemia respectively. METHODS We studied 6976 individuals aged ≥45 from the China Health and Retirement Longitudinal Study from 2013 to 2018. The concentrations of particular matter (PM) for every individual's address were evaluated using a satellite-based spatiotemporal model. Dyslipidemia was evaluated by self-reported. The generalized linear mixed model was applied to quantify the correlations between PM and incident dyslipidemia. RESULTS After a 5-year follow-up, 333 (4.77%) participants developed dyslipidemia. Per 10 μg/m³ uptick in four-year average concentrations of PMs (PM1 and PM1-2.5) corresponded to 1.11 [95% confidence interval (CI): 1.01-1.23)] and 1.23 (95% CI: 1.06-1.43) fold risks of incident dyslipidemia. Nonlinear exposure-response curves were observed between PM and incident dyslipidemia. The effect size of PM1 on incident dyslipidemia was slightly higher in males [1.14 (95% CI: 0.98-1.32) vs. 1.04 (95% CI: 0.89-1.21)], the elderly [1.23 (95% CI: 1.04-1.45) vs. 1.03 (95% CI: 0.91-1.17)], people with less than primary school education [1.12 (95% CI: 0.94-1.33) vs. 1.08 (95% CI: 0.94-1.23)], and solid cooking fuel users [1.17 (95% CI: 1.00-1.36) vs. 1.06 (95% CI: 0.93-1.21)], however, the difference was not statistically significant (Z = -0.82, P = 0.413; Z = -1.66, P = 0.097; Z = 0.32, P = 0.752; Z = -0.89, P = 0.372). CONCLUSIONS Long-term exposure to PM1 and PM1-2.5 were linked with an increased morbidity of dyslipidemia in the middle-aged and elderly population. Males, the elderly, and solid cooking fuel users had higher risk. Further studies would be warranted to establish an accurate reference value of PM to mitigate growing dyslipidemia.
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Affiliation(s)
- Meiling Hu
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA.
| | - Yaoyu Hu
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China; National Institute for Data Science in Health and Medicine, Capital Medical University, China; Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Australia.
| | - Zhiwei Li
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Yuhong Liu
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Shuting Li
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Yongxi Xue
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Yuan Li
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Mengmeng Liu
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Lei Wang
- Department of Food and Nutritional Hygiene, School of Public Health, Capital Medical University, China.
| | - Xiangtong Liu
- School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
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Heo S, Son JY, Lim CC, Fong KC, Choi HM, Hernandez-Ramirez RU, Nyhan K, Dhillon PK, Kapoor S, Prabhakaran D, Spiegelman D, Bell ML. Effect modification by sex for associations of fine particulate matter (PM 2.5) with cardiovascular mortality, hospitalization, and emergency room visits: systematic review and meta-analysis. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2022; 17:053006. [PMID: 35662857 PMCID: PMC9162078 DOI: 10.1088/1748-9326/ac6cfb] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Particulate matter with aerodynamic diameter no larger than 2.5 μm (PM2.5) has been linked to cardiovascular diseases (CVDs) but evidence for vulnerability by sex remains unclear. We performed systematic review and meta-analysis to synthesize the state of scientific evidence on whether cardiovascular risks from PM2.5 differ for men compared to women. The databases Pubmed, Scopus, Embase, and GreenFILE were searched for studies published Jan. 1995 to Feb. 2020. Observational studies conducting subgroup analysis by sex for impacts of short-term or long-term exposure to PM2.5 on target CVDs were included. Data were independently extracted in duplicate and pooled with random-effects meta-regression. Risk ratios (RRs) for long-term exposure and percent changes in outcomes for short-term exposure were calculated per 10 μg/m3 PM2.5 increase. Quality of evidence of risk differences by sex was rated following Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 12,502 articles were screened, with 61 meeting inclusion criteria. An additional 32 studies were added from citation chaining. RRs of all CVD mortality for long-term PM2.5 for men and women were the same (1.14; 95% CI: 1.09, 1.22) indicating no statistically different risks. Men and women did not have statistically different risks of daily CVD mortality, hospitalizations from all CVD, ischemic heart disease, cardiac arrest, acute myocardial infarction, and heart failure from short-term PM2.5 exposure (difference in % change in risk per 10 μg/m3 PM2.5: 0.04 (95% CI, -0.42 to 0.51); -0.05 (-0.47 to 0.38); 0.17 (-0.90, 1.24); 1.42 (-1.06, 3.97); 1.33 (-0.05, 2.73); and -0.48 (-1.94, 1.01), respectively). Analysis using GRADE found low or very low quality of evidence for sex differences for PM2.5-CVD risks. In conclusion, this meta-analysis and quality of evidence assessment of current observational studies found very limited evidence of the effect modification by sex for effects of PM2.5 on CVD outcomes in adults, which can inform clinical approaches and policies.
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Affiliation(s)
- Seulkee Heo
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Ji-Young Son
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Chris C Lim
- School of the Environment, Yale University, New Haven, CT, United States of America
- Community, Environment & Policy Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Kelvin C Fong
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Hayon Michelle Choi
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Raul U Hernandez-Ramirez
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Kate Nyhan
- Harvey Cushing / John Hay Whitney Medical Library, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | | | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, United States of America
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