Time Trends in Ischemic Heart Disease Mortality Attributable to PM2.5 Exposure in Southeastern China from 1990 to 2019: An Age-Period-Cohort Analysis

Abstract

PM2.5 exposure is a major environmental risk factor for the mortality of ischemic heart disease (IHD). This study aimed to analyze trends in IHD mortality attributable to PM2.5 exposure in Jiangsu Province, China, from 1990 to 2019, and their correlation with age, period, and birth cohort. Methods: Data were extracted from the Global Burden of Disease study 2019 (GBD2019). The magnitude and direction of the trends in IHD mortality attributable to PM2.5 exposure were analyzed by Joinpoint regression. The age-period-cohort (APC) model was used to evaluate the cohort and period effect. Results: Age-standardized mortality rate (ASMR) of IHD attributable to PM2.5 exposure decreased from 1990 to 2019, with an average annual percentage change (AAPC) of −1.71% (95%CI: −2.02~−1.40), which, due to ambient PM2.5 (APM) exposure and household PM2.5 (HPM) exposure increased with AAPCs of 1.45% (95%CI: 1.18~1.72) and −8.27% (95%CI: −8.84~−7.69), respectively. APC analysis revealed an exponential distribution in age effects on IHD mortality attributable to APM exposure, which rapidly increased in the elderly. The risk for IHD mortality due to HPM exposure showed a decline in the period and cohort effects, which, due to APM, increased in the period and cohort effects. However, favorable period effects were found in the recent decade. The overall net drift values for APM were above zero, and were below zero for HPM. The values for local drift with age both for APM and HPM exposures were initially reduced and then enhanced. Conclusion: The main environmental risk factor for IHD mortality changed from HPM to APM exposure in Jiangsu Province, China. Corresponding health strategies and prevention management should be adopted to reduce ambient air pollution and decrease the effects of APM exposure on IHD mortality.

Trends in breast cancer mortality attributable to metabolic risks in Chinese women from 1990 to 2019: an age-period-cohort analysis

“…The period effects were any outcomes linked with living during a particular period in all age groups, including control and prevention strategies, policies, and regulations. The cohort effects were any changes in outcomes between groups with the same birth years, presumably arising from differences in lifestyle and exposure degrees to risk factors ( 26 ). The general logarithmic linear form ( 27 , 28 ) of the APC model is…”

“…The longitudinal age curve was plotted to calculate the fitted age-specific rates adjusted for period deviations in a reference cohort, thus reflecting age effects. The period (or cohort) rate ratio (RR) was the ratio of age-specific rates value in each period (or cohort) relative to the reference period (or cohort), thus reflecting period (or cohort) effects ( 26 , 29 ). This study used the APC model analysis tool developed by the Biostatistics Branch of the National Institutes of Health.…”