Ambient carbon monoxide and cause-specific years of life lost: a nationwide time-series analysis in China

Abstract

Background: Ambient carbon monoxide (CO) has been evaluated the effect on public health, mainly linked with mortality and morbidity. Little evidence is available regarding the relation between CO and years of life lost (YLL). Methods: Using data from 49 major cities in China from 2013 to 2017, we applied generalized additive models and random effects meta-analyses to explore the effects of CO on YLL from various diseases. In addition, stratified analyses were performed to estimate the effect modification of demographic factors. Results: A 1-mg/m³ increase of CO concentrations (lagged over 0–3 d), was associated with 24.1 (95% confidence interval [CI], 14.7, 33.5), 11.5 (6.4, 16.6), 0.9 (-0.5, 2.2), 3.4 (1.3, 5.5), 5.3 (2.5, 8.1), 0.8 (0.0, 1.6) increments in daily YLL from non-accidental causes, cardiovascular diseases, respiratory diseases, coronary heart disease, stroke and chronic obstructive pulmonary disease, respectively. These associations were robust to the adjustment of co-pollutants and varied substantially by geography and demographic characteristics. Associations were stronger in the elder people (≥75 years), males and those with low education attainment, than younger people, females and high educated populations. Conclusions: This nationwide analysis showed significant and positive associations between short-term ambient CO exposure and cause-specific YLL, and modified by geography and demographic characteristics. These findings may have significant public health implications for the reduction of CO-attributed disease burden in China.