| Objective:1. We aimed to build a cohort to examine the effects of higher concentrations of particulate air pollution on cardiopulmonary mortality, and made evidence for mechanism by which long-term exposure to air pollution may increase the risk of cardiovascular mortality from epidemiology.2. We aimed to assess to the cardiovascular effects of long-term exposure to higher concentrations of air pollutants and to identify the susceptible population among Chinese.3. According to the results of PM source apportionment, the greatest impact to cardiovascular disease of source should be identify.4. When the air pollution reach to the national standard, the health benefits from cardiovascular disease obtained will computed.5. Make the foundation of air pollution effects of dose-response relationship and provide a scientific basis for making air quality standards.Methods:1. A retrospective cohort, containing39,054subjects from four cities in northern China, was followed for mortality of all cause and specific cardiovascular diseases from1998to2009. Information on concentrations of pollutants were collected from the local Environmental Monitoring Centers. The estimated exposure for the study participants was the mean concentration of pollutants over their surviving years during the cohort period.2. Relative risk values were obtained using Cox proportional hazards regression models after adjusting for potential confounding factors.3. Heterogeneity in subgroup effects by air pollutants were tested using stratified Cox proportional hazards regression models.4. According to the methods of health impact assessment from WHO, the health benefits from cardiovascular disease computed.Results:1. For each10μg/m3increase in PMio, the relative risk ratios (RRs) of all cause mortality, cardiovascular disease mortality, ischemic heart disease mortality, cardiac arrhythmia/heart failure/cardiac arrest, and cerebrovascular disease mortality were1.24(95%CI:1.22-1.27),1.23(95%CI,1.19-1.26),1.37(95%CI,1.28-1.47),1.11(95%CI:1.05-1.17) and1.23(95%CI:1.17-1.28), respectively. 2. For each10μg/m3increase in SO2, the relative risk ratios (RRs) of all cause mortality, cardiovascular disease mortality, ischemic heart disease mortality, cardiac arrhythmia/heart failure/cardiac arrest, and cerebrovascular disease mortality were1.05(95%CI:1.03-1.07),1.06(95%CI:1.03-1.09),1.03(95%CI:0.97-1.08),1.00(95%CI:0.95-1.06)and1.08(95%CI:1.04-1.12), respectively.3. For each10μg/m3increase in NO2, the relative risk ratios (RRs) of all cause mortality, cardiovascular disease mortality, ischemic heart disease mortality, cardiac arrhythmia/heart failure/cardiac arrest, and cerebrovascular disease mortality were0.94(95%CI:0.90-0.97),0.97(95%CI:0.93-1.03),1.13(95%CI:1.02-1.25),0.97(95%CI:0.87-1.09)and0.93(95%CI:0.86-1.01), respectively.4. Several variables such as gender, age, smoking status, exercise, BMI, personal income, education and diet habits were significantly association with cardiovascular disease mortality. The effects were more evident in male than in female, and with the increase in one age, the risk will increase in10%cardiovascular disease. Exercise and fruit and vegetable consumpation were protective factors, and smoking, meat consumpation and high BMI were risk factors. But the personal income and education were much complicated with cardiovascular disease.5. Results from stratified analyses suggest that the effects of PM10on cardiovascular mortality were more pronounced in younger people (<60), males, smokers and people with a higher socioeconomic status; the effects of SO2on cardiovascular mortality were more pronounced in males, people with a higher personal income and with exposure work.6. The order of PM source RRs with cardiovascular disease was:vehicle exhaust> building cement dust> other source> coal dust> soil wind dust. The greatest impact to cardiovascular disease of source was vehicle exhaust.7. According to air quality standard, when the concentration of PM10in Tianjin decrease to national standard (70μg/m3), the concentration will reduce4μg/m3every year, and the mortality of cardiovascular disease will decrease30%(95%CI:26%-33%); in Shenyang, the concentration will reduce10ug/m3every year, and the mortality of cardiovascular disease will decrease60%(95%CI:54%-65%); and in Taiyuan, the concentration will reduce5μg/m3every year, and the mortality of cardiovascular disease will decrease36%(95%CI:32%-40%).Conclusions:1. Long-term exposure to high concentrations of PM10and SO2increase mortality from cardiovascular disease, especially from ischemic heart disease and this association seemed to be modified by other factors. This may be fill blank of the effects of long term exposure to high concentration of pollutants lead to chronic diseases.2. Our study concluded that the dose-response relationship may not be linear, and there may be an increased tendency at the high concentration point.3. The greatest impact to cardiovascular disease of source was vehicle exhaust. Measurements should be taken to manage the verticles, and when the air pollution reach to the national standard, the health benefits from cardiovascular disease will be obtain significantly. |
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