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The Association Between Long-Term Exposure to Particulate Matter and Incidence of Hypertension Among Chinese Elderly: A Retrospective Cohort Study.

ABSTRACT: Background and Objectives: Studies that investigate the links between particulate matter ≤2. 5 μm (PM_2.5) and hypertension among the elderly population, especially those including aged over 80 years, are limited. Therefore, we aimed to examine the association between PM_2.5 exposure and the risk of hypertension incidence among Chinese elderly. Methods: This prospective cohort study used 2008, 2011, 2014, and 2018 wave data from a public database, the Chinese Longitudinal Healthy Longevity Survey, a national survey investigating the health of those aged over 65 years in China. We enrolled cohort participants who were free of hypertension at baseline (2008) from 706 counties (districts) and followed up in the 2011, 2014, and 2018 survey waves. The annual PM_2.5 concentration of 706 counties (districts) units was derived from the Atmospheric Composition Analysis Group database as the exposure variable, and exposure to PM_2.5 was defined as 1-year average of PM_2.5 concentration before hypertension event occurrence or last interview (only for censoring). A Cox proportional hazards model with penalized spline was used to examine the non-linear association between PM_2.5 concentration and hypertension risk. A random-effects Cox proportional hazards model was built to explore the relationship between each 1 μg/m³, 10 μg/m³ and quartile increment in PM_2.5 concentration and hypertension incidence after adjusting for confounding variables. The modification effects of the different characteristics of the respondents were also explored. Results: A total of 7,432 participants aged 65-116 years were enrolled at baseline. The median of PM_2.5 exposure concentration of all the participants was 52.7 (inter-quartile range, IQR = 29.1) μg/m³. Overall, the non-linear association between PM_2.5 and hypertension incidence risk indicated that there was no safe threshold for PM_2.5 exposure. The higher PM_2.5 exposure, the greater risk for hypertension incidence. Each 1 μg/m³ [adjusted hazard ratio (AHR): 1.01; 95% CI: 1.01-1.02] and 10 μg/m³ (AHR: 1.12; 95% CI: 1.09-1.16) increments in PM_2.5, were associated with the incidence of hypertension after adjusting for potential confounding variables. Compared to first quartile (Q1) exposure, the adjusted HRs of hypertension incidence for the Q2, Q3 and Q4 exposure of PM_2.5 were 1.31 (95% CI: 1.13-1.51), 1.35 (95% CI: 1.15-1.60), and 1.83 (95% CI: 1.53-2.17), respectively. The effects appear to be stronger among those without a pension, living in a rural setting, and located in central/western regions. Conclusion: We found no safe threshold for PM_2.5 exposure related to hypertension risk, and more rigorous approaches for PM_2.5 control were needed. The elderly without a pension, living in rural and setting in the central/western regions may be more vulnerable to the effects of PM_2.5 exposure.

SUBMITTER: Wensu Z

PROVIDER: S-EPMC8788195 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Long-term exposure to particulate matter (PM) air pollution may increase blood pressure and the risk of hypertension. However, epidemiological evidence is scarce and inconsistent. OBJECTIVES:We investigated the associations between long-term exposure to PM with an aerodynamic diameter <2.5?m (PM2.5), blood pressure, and incident hypertension in a large Taiwanese cohort. METHODS:We studied 361,560 adults ?18y old from a large cohort who participated in a standard medical examination program during 2001 to 2014. Among this group, 125,913 nonhypertensive participants were followed up. A satellite-based spatiotemporal model was used to estimate the 2-y average PM2.5 concentrations at each participant's address. Multivariable linear regression was used in the cross-sectional data analysis with the 361,560 participants to investigate the associations between PM2.5 and systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), and Cox proportional hazard regression was used in the cohort data analysis with the 125,913 participants to investigate the associations between PM2.5 and incident hypertension. RESULTS:Each 10-?g/m3 increment in the 2-y average PM2.5 concentration was associated with increases of 0.45?mmHg [95% confidence interval (CI): 0.40, 0.50], 0.07?mmHg (95% CI: 0.04, 0.11), and 0.38?mmHg (95% CI: 0.33, 0.42) in SBP, DBP, and PP, respectively, after adjusting for a wide range of covariates and possible confounders. Each 10-?g/m3 increment in the 2-y average PM2.5 concentration was associated with an increase of 3% in the risk of developing hypertension [hazard?ratio=1.03 (95% CI: 1.01, 1.05)]. Stratified and sensitivity analyses yielded similar results. CONCLUSIONS:Long-term exposure to PM2.5 air pollution is associated with higher blood pressure and an increased risk of hypertension. These findings reinforce the importance of air pollution mitigation strategies to reduce the risk of cardiovascular disease. https://doi.org/10.1289/EHP2466.

Project description:Studies have suggested associations between elevated blood pressure and short-term air pollution exposures, but the evidence is mixed regarding long-term exposures on incidence of hypertension.We examined the association of hypertension incidence with long-term residential exposures to ambient particulate matter (PM) and residential distance to roadway.We estimated 24-month and cumulative average exposures to PM10, PM2.5, and PM2.5-10 and residential distance to road for women participating in the prospective nationwide Nurses' Health Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for incident hypertension from 1988 to 2008 using Cox proportional hazards models adjusted for potential confounders. We considered effect modification by age, diet, diabetes, obesity, region, and latitude.Among 74,880 participants, 36,812 incident cases of hypertension were observed during 960,041 person-years. In multivariable models, 10-?g/m3 increases in 24-month average PM10, PM2.5, and PM2.5-10 were associated with small increases in the incidence of hypertension (HR: 1.02, 95% CI: 1.00, 1.04; HR: 1.04, 95% CI: 1.00, 1.07; and HR: 1.03, 95% CI: 1.00, 1.07, respectively). Associations were stronger among women < 65 years of age (HR: 1.04, 95% CI: 1.01, 1.06; HR: 1.07, 95% CI: 1.02, 1.12; and HR: 1.05, 95% CI: 1.01, 1.09, respectively) and the obese (HR: 1.07, 95% CI: 1.04, 1.12; HR: 1.15, 95% CI: 1.07, 1.23; and HR: 1.13, 95% CI: 1.07, 1.19, respectively), with p-values for interaction < 0.05 for all models except age and PM2.5-10. There was no association with roadway proximity.Long-term exposure to particulate matter was associated with small increases in risk of incident hypertension, particularly among younger women and the obese.Zhang Z, Laden F, Forman JP, Hart JE. 2016. Long-term exposure to particulate matter and self-reported hypertension: a prospective analysis in the Nurses' Health Study. Environ Health Perspect 124:1414-1420;?http://dx.doi.org/10.1289/EHP163.

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The Association Between Long-Term Exposure to Particulate Matter and Incidence of Hypertension Among Chinese Elderly: A Retrospective Cohort Study.

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