| Objective:China is one of the few countries with highest particulate matter levels in the world. However, only limited epidemiological studies on the health effect of particulate matter have been performed in China. In order to collect important scientific evidence for further modification of the public health policies, evaluate the health risk of air pollution and further to investigate the mechanisms of coronary heart disease (CHD), it is important to understand the contributions of specific components of ambient particulate pollutants to cardiopulmonary mortality and other health effects. The objectives of the present study were to explore the effects of short-term exposure to air pollutants on cardiopulmonary mortality, incidence of cardiac arrest and also to investigate the association of urinary metal levels and mean platelet volume (MPV) with the risk of coronary heart disease (CHD).Methods:Daily average concentrations of PM10, PM2.5, SO2, NO2, CO and O3were obtained from Environmental Monitoring Centers in Wuhan and Shenzhen city while daily concentrations of each channel black carbon, heavy metals, and size-fractionated particle number concentrations were collected from Hubei Air Pollution Monitoring Stations Automatically (Supersites). Data on daily total non-accidental, cardiovascular and respiratory mortality from the local Center for Disease Control and Emergency Medical Service in two cities were also collected. The association between air pollutants and mortality was analyzed by time-series analysis with the generalized additive model (GAM) linked quasi-Poisson regression. In addition, we separately performed two independent CHD case-control studies in Wuhan (209pairs) and Shenzhen (139pairs) to examine the associations of urinary metal levels and MPV with the risk of CHD, using multivariate logistic regression models, in which23urinary metals were used as internal exposure biomarkers of air pollution.Results:High concentrations of PM10, SO2and NO2were significantly associated with high risks of none-accident mortality, cardiovascular mortality and respiratory mortality in both cities, In Wuhan, an inter-quartile range (IQR) increase of PM10, SO2and NO2concentrations, on Lag2days (Lag2) none-accident mortality was associated with the increase of1.63%,2.79%and3.90%, respectively (all P<0.05); on day LagO-1respiratory mortality was associated with the increase of5.47%,5.64%and6.74%(all P<0.05), respectively; on day Lag1-2, cardiovascular mortality was associated with the increase of3.73%,3.60%and6.30%, respectively (all P<0.05). An IQR increase of SO2concentration, on day Lag6none-accident mortality was associated with the increase of3.17%. An IQR increase of NO2concentration, on day Lag6none-accident mortality was associated with the increase of4.37%, on day Lag2-3cardiovascular mortality was associated with the increase of5.83%(P<0.05).In single-pollutant model, none of Lags of PM10, CO and O3was significantly associated with cardiac arrest events. SO2was significantly associated with cardiac arrest events on day Lag2. An IQR increase in concentration of SO2was associated with7.25%increase of the risk of cardiac arrest events. NO2was statistically significant associated with cardiac arrest events in LagO and Lagl. The effect estimates were7.44%and8.01%, respectively, In double-pollutant model, only the effect of NO2was statistically significant after adjusting for PM10or SO2. When further adjustment for CO or O3, the corresponding effects estimated of NO2were increased significantly to8.60%and8.11%, respectively.The daily concentration of each black carbon channel was positively correlated with the concentration of SO2, NO2or CO. The daily concentration of each channel black carbon was statistically significant associated with daily respiratory mortality. An IQR increase of red, infrared1, and infrared2of black carbon channel concentrations, on day Lag2-3cardiovascular mortality was associated with the increase of14.40%,14.44%and13.94%, respectively (all P<0.05).The concentrations of metals in air were also significantly associated with health effects. An IQR increase of copper concentration was associated with the increase of8.53%(P<0.05) of cardiovascular mortality on day Lag2, An IQR increase of iron and titanium concentrations were associated with the none-accident mortality, cardiovascular mortality and respiratory mortality with the increase of5.24%,4.34%,17.23%and5.14%,5.42%,14.24%(P<0.05).In case-control study, urinary metals concentrations were associated with an increased risk of CHD. We found that urinary vanadium, chromium, zinc, barium and tungsten were associated with an increased CHD risk in Shenzhen (all FDR-adjusted P<0.05), and all urinary metals except for manganese and iron were associated with an increased CHD risk in Wuhan (all FDR-adjusted P<0.05). Based on the pooled analysis, we observed positive associations of urinary aluminum, titanium, vanadium, chromium, cobalt, nickel, copper, zinc, selenium, cadmium, tin, antimony, barium, tungsten and uranium with CHD risk (all FDR-adjusted P<0.05). We also found that urinary iron, arsenic and uranium were positively associated with MPV among the control group based on the multiple pollutants models of (all P<0.05). In addition, we also observed significant associations of cobalt and cadmium with increased MPV among the case group through the multiple pollutant models (both P<0.05) and MPV were associated with an increased CHD risk.Conclusion:Our study suggested that air pollutants and their constituents were associated with increased risks of none-accident mortality, cardiovascular mortality and respiratory mortality, and the associations were in manners of dose-response. The present study suggested the short-term elevations of SO2and NO2in air pollution might be associated with the high risk of cardiac arrest events. Meanwhile, several metal ions including copper, iron and titanium were associated with none-accident mortality, cardiovascular mortality and respiratory mortality. Combining with the environmental monitoring data and biological monitoring data, high urinary metals were associated with high MPV levels and played a crucial role in the risk of coronary heart disease. |
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