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

Abstract

ObjectiveTo estimate exposure-response associations between chronic exposure to fine particulate matter (PM2.5) and risks of the first hospital admission for major cardiovascular disease (CVD) subtypes.DesignPopulation based cohort study.SettingContiguous US.Participants59 761 494 Medicare fee-for-service beneficiaries aged ≥65 years during 2000-16. Calibrated PM2.5predictions were linked to each participant’s residential zip code as proxy exposure measurements.Main outcome measuresRisk 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.ResultsThree year average PM2.5exposure 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 PM2.5: compared with exposures ≤5 µg/m3(the World Health Organization air quality guideline), the relative risk at exposures between 9 and 10 µg/m3, which encompassed the US national average of 9.7 µg/m3during 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/m3to 3.35% at exposures between 9 and 10 µg/m3. The effects persisted for at least three years after exposure to PM2.5. Age, education, accessibility to healthcare, and neighborhood deprivation level appeared to modify susceptibility to PM2.5.ConclusionsThe findings of this study suggest that no safe threshold exists for the chronic effect of PM2.5on overall cardiovascular health. Substantial benefits could be attained through adherence to the WHO air quality guideline.

The updated WHO air quality guidelines are a big step forward but not a complete solution

“…Our research, recently published in The BMJ (doi:10.1136/bmj-2023-076939),4 focusing on the effects of chronic exposure to PM 2.5 on risk of hospital admission for seven major cardiovascular diseases among people aged 65 years or over in the US, shows the benefits to health of meeting air quality guidelines. The annual PM 2.5 level in the US averaged 9.7 µg/m 3 during the study period.…”