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Cardiac risk factors and prevention
Original research
Associations between air pollution and the risk of first admission and multiple readmissions for cardiovascular diseases
  1. Shiyu Zhang1,
  2. Lan Chen1,
  3. Zhengmin (Min) Qian2,
  4. Dan Li1,
  5. Miao Cai1,
  6. Chongjian Wang3,
  7. Zilong Zhang1,
  8. Michael G. Vaughn4,
  9. Amy E. Keith2,
  10. Haitao Li5,
  11. Hualiang Lin1
  1. 1Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
  2. 2Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, Saint Louis, Missouri, USA
  3. 3Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
  4. 4School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
  5. 5Department of Social Medicine and Health Service Management, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
  1. Correspondence to Hualiang Lin, Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China; linhualiang{at}mail.sysu.edu.cn

Abstract

Objectives We aimed to investigate the associations between air pollutants and the risk of admission and multiple readmission events for cardiovascular disease (CVD).

Methods A total of 285 009 participants free of CVD at baseline from the UK Biobank were included in this analysis. Four major cardiovascular admission events were identified during the follow-up: chronic ischaemic heart disease (CIHD), cerebrovascular disease, atrial fibrillation and heart failure. We used Prentice, Williams and Peterson-Total Time model to examine the association between ambient air pollution and first admission, as well as multiple readmissions for these CVDs.

Results During a median follow-up of 12 years, 17 176 (6.03%) participants were hospitalised with CVDs, and 6203 (36.11%) patients with CVD had subsequent readmission events for CVDs. We observed significant associations between air pollution and both first admission and readmission for CVDs, with generally stronger associations on readmission for cardiovascular events. For example, the adjusted HRs for the first admission and subsequent readmission for cerebrovascular disease were 1.130 (95% CI 1.070 to 1.194) and 1.270 (95% CI 1.137 to 1.418) for each IQR increase of particulate matter with a diameter ≤2.5 µm. The corresponding HRs for CIHD were 1.060 (95% CI 1.008 to 1.114) and 1.120 (95% CI 1.070 to 1.171). Sex stratified analyses showed that the associations were generally more pronounced among females than males.

Conclusion This study provides evidence that ambient air pollutants might play an important role in both first admission and readmission for cardiovascular events. In addition, patients with pre-existing CVDs may be more vulnerable to air pollution compared with healthy population.

  • epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. This research was conducted using the UK Biobank resource under access application 69550. UK Biobank will make the data available to all bona fide researchers for all types of health-related research that is in the public interest, without preferential or exclusive access for any persons. All researchers will be subject to the same application process and approval criteria as specified by UK Biobank. For more details on the access procedure, see the UK Biobank website: http://www.ukbiobank.ac.uk/register-apply.

http://dx.doi.org/10.1136/heartjnl-2023-322682

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This research was conducted using the UK Biobank resource under access application 69550. UK Biobank will make the data available to all bona fide researchers for all types of health-related research that is in the public interest, without preferential or exclusive access for any persons. All researchers will be subject to the same application process and approval criteria as specified by UK Biobank. For more details on the access procedure, see the UK Biobank website: http://www.ukbiobank.ac.uk/register-apply.

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    Footnotes

    • Contributors SZ and HLin conceptualised the idea and design the statistical analysis plan. MC advised on statistical analysis and performed the analysis. SZ, LC, ZMQ and HLin drafted the manuscript. DL, CW and ZZ contributed to the discussion. MV, AK and HLi revised the manuscript. HLin is the guarantor of the work. All authors critically reviewed and edited the manuscript.

    • Funding Guangdong Basic and Applied Basic Research Foundation (grant number: 2022A1515110995).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.