Risk analysis of air pollutants and types of anemia: a UK Biobank prospective cohort study

Abstract

Background:Previous studies have suggested that exposure to air pollutants may be associated with speci c blood indicators or anemia in certain populations. However, there is insu cient epidemiological data and prospective evidence to evaluate the relationship between environmental air pollution and speci c types of anemia. Methods:We conducted a large-scale prospective cohort study based on the UK Biobank. Annual average concentrations of NO 2 , PM 2.5 , PM 2.5−10 , and PM 10 were obtained from the ESCAPE study using the Land Use Regression (LUR) model. The association between atmospheric pollutants and different types of anemia was investigated using the Cox proportional hazards model. Furthermore, restricted cubic splines were used to explore exposure-response relationships for positive associations, followed by strati cation and effect modi cation analyses by gender and age. Results:After adjusting for demographic characteristics, 3-4 of the four types of air pollution were signi cantly associated with an increased risk of iron de ciency, vitamin B12 de ciency and folate de ciency anemia, while there was no signi cant association with other de ned types of anemia. After full adjustment, we estimated that the hazard ratios (HRs) of iron de ciency anemia associated with each 10µg/m 3 increase in NO 2 , PM 2.5 , and PM 10 were 1.04 (95%CI: 1.02, 1.07), 2.00 (95%CI: 1.71, 2.33), and 1.10 (95%CI: 1.02, 1.20) respectively. The HRs of folate de ciency anemia with each 10µg/m 3 increase in NO 2 , PM 2.5 ,