We aimed to test a hypothesis that elevated ambient particulate matter (PM) 2.5 concentrations are significantly associated with risk of coronary heart disease (CHD), stroke, and diabetes mellitus (DM) in adults aged ...We aimed to test a hypothesis that elevated ambient particulate matter (PM) 2.5 concentrations are significantly associated with risk of coronary heart disease (CHD), stroke, and diabetes mellitus (DM) in adults aged 65 and older. We analyzed data (2010-2013) from U.S. 1118 counties to examine the association between PM2.5 concentrations and risk of prevalent CHD, stroke, and DM, and mortality from cardiovascular disease (CVD), CHD, stroke, and DM in adults aged ≥ 65. Multilevel regression analysis technique was applied to test these associations. The results show that the annual mean of PM2.5 concentration was 8.7 μg/m<sup>3</sup> in the total study sample. Significant differences in mean PM2.5 concentrations were observed across counties and states in the U.S. Multilevel regression analysis indicates that an average annual concentration of 1 μg/m<sup>3</sup> increase in PM2.5 concentration was significantly associated with an increased prevalence of CHD, stroke, and DM by 4.9‰ (95% CI: 3.1‰ - 6.7‰), 0.8‰ (0.5‰ - 1.1‰), and 3.3‰ (2.9‰ - 4.4‰), respectively. State-level correlation analyses indicate that increased PM2.5 concentrations were significantly associated with increased age-adjusted mortality from CVD (r = 0.76, p < 0.001), CHD (r = 0.0.40, p = 0.004), stroke (r = 0.60, p p = 0.02). In conclusion, Elevated PM2.5 concentrations were significantly associated with an increased risk of the prevalence and mortality from CVD, CHD, stroke, and DM. Continued effort to control ambient PM2.5 concentrations could play an important role in risk reduction of cardiovascular disease and diabetes in the elderly.展开更多
AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults...AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Fileson prescribed medicines for patients with DM were used to test the research questions. χ 2, Poisson and Cox’s regression models were applied in data analysis.RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD= 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI:1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM,respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations,specifically for metformin use, show a protective effect against all-cause and CVD mortalities.展开更多
Spatial epidemiology is the description and analysis of geographic patterns and variations in disease risk factors,morbidity and mortality with respect to their distributions associated with demographic,socioeconomic,...Spatial epidemiology is the description and analysis of geographic patterns and variations in disease risk factors,morbidity and mortality with respect to their distributions associated with demographic,socioeconomic,environmental,health behavior,and genetic risk factors,and time-varying changes.In the Letter to Editor,we had a brief description of the practice for the mortality and the spacetime patterns of John Snow's map of cholera epidemic in London,United Kingdom in 1854.This map is one of the earliest public heath practices of developing and applying spatial epidemiology.In the early history,spatial epidemiology was predominantly applied in infectious disease and risk factor studies.However,since the recent decades,noncommunicable diseases have become the leading cause of death in both developing and developed countries,spatial epidemiology has been used in the study of noncommunicable disease.In the Letter,we addressed two examples that applied spatial epidemiology to cluster and identify stroke belt and diabetes belt across the states and counties in the United States.Similar to any other epidemiological study design and analysis approaches,spatial epidemiology has its limitations.We should keep in mind when applying spatial epidemiology in research and in public health practice.展开更多
BACKGROUND A limited number of studies have been conducted to test the magnitudes of the association between apparent treatment resistant hypertension(aTRH)and risk of cardiovascular disease(CVD).AIM To investigate th...BACKGROUND A limited number of studies have been conducted to test the magnitudes of the association between apparent treatment resistant hypertension(aTRH)and risk of cardiovascular disease(CVD).AIM To investigate the association between aTRH and risk of CVD and examine whether sex and age modify this association.METHODS We applied an observational analysis study design using data from the United States Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial(ALLHAT).ALLHAT recruited participants(n=25516)from 625 primary care settings throughout the United States,Canada,Puerto Rico,and United States Virgin Islands,aged 55 and older with hypertension and at least one additional risk factor for heart disease.aTRH was assessed from the year 2 visit.CVD event was defined as one of the following from the year 2 follow-up visit:Fatal or non-fatal myocardial infarction,coronary revascularization,angina,stroke,heart failure,or peripheral artery disease.Cox proportional hazards regression was used to examine the effect of aTRH on CVD risk.Potential modifications of sex and age on this association were examined on the multiplicative scale by interaction term and additive scale by joint effects and relative excess risk for interaction.RESULTS Of the total study participants(n=25516),5030 experienced a CVD event during a mean of 4.7 years follow-up.aTRH was associated with a 30%increase in risk of CVD compared to non-aTRH[hazards ratio(HR)=1.3,95%CI:1.19-1.42].Sex and age modified this relationship on both multiplicative and additive scales independently.Stratified by sex,aTRH was associated with a 64%increase in risk of CVD(HR=1.64,95%CI:1.43–1.88)in women,and a 13%increase in risk of CVD(HR=1.13,95%CI:1.01–1.27)in men.Stratified by age,aTRH had a stronger impact on the risk of CVD in participants aged<65(HR=1.53,95%CI:1.32–1.77)than it did in those aged≥65(HR=1.18,95%CI:1.05–1.32).Significant two-way interactions of sex and aTRH,and age and aTRH on risk of CVD were observed(P<0.05).The observed joint effect of aTRH and ages≥65 years(HR=1.85,95%CI:1.22–2.48)in males was less than what was expected for both additive and multiplicative models(HR=4.10,95%CI:3.63–4.57 and 4.88,95%CI:3.66–6.31),although three-way interaction of sex,age,and aTRH on the risk of CVD and coronary heart disease did not reach a statistical significance(P>0.05).CONCLUSION aTRH was significantly associated with an increased risk of CVD and this association was modified by both sex and age.Further studies are warranted to test these mechanisms.展开更多
BACKGROUND In spite of an increase in the incidence and prevalence of diabetes mellitus(DM)and Alzheimer’s disease(AD)in the aging population worldwide,limited attention has been paid to their potential association.A...BACKGROUND In spite of an increase in the incidence and prevalence of diabetes mellitus(DM)and Alzheimer’s disease(AD)in the aging population worldwide,limited attention has been paid to their potential association.AIM To investigate the association of DM and cardiometabolic syndrome(CMS,a precursor to DM)with risk of incident AD among postmenopausal women.METHODS Postmenopausal women aged 50-79(n=63117)who participated in the U.S.Women’s Health Initiative Observational Study(WHIOS),recruited in 1993-1998,without baseline AD and followed up through March 1,2019,were analyzed.AD was classified by participant-reported history of doctor-diagnosis of incident AD in the WHIOS.DM was defined by participant-report or treated because of diabetes or serum glucose concentrations≥126 mg/dL.CMS was defined as having≥3 of five CMS components:large waist circumference,high blood pressure,elevated triglycerides,elevated glucose,and low high-density lipoprotein cholesterol.The associations of DM and CMS with AD were analyzed using Cox’s proportional hazards regression analysis.RESULTS During a median follow-up of 20 years(range:3.36 to 23.36 years),of 63117 participants,8340 developed incident AD.Women with DM had significantly higher incidence of AD[8.5,95%confidence interval(CI):8.0-9.0 per 1000 personyears(PY)]than those without DM(7.1,95%CI:6.9-7.2 per 1000 PY).Multivariate Cox’s regression analysis indicated that women with DM or CMS had a significantly higher risk of AD than those without DM or CMS.The corresponding hazard ratios[HR(95%CI)]were 1.22(1.13-1.31,P<0.001)in subjects with DM,and 1.18(1.09-1.27,P<0.001)in subjects with CMS.The HRs diminished with age and became non-significant in the oldest age group.CONCLUSION During a median follow-up of 20 years,DM and CMS were significantly associated with the risk of AD among postmenopausal women.More specifically,women aged 50-69 with DM or CMS vs those without these conditions had significantly higher relative risks of AD than the relative risks of AD in those aged 70-79 with DM or CMS vs those without DM or CMS.展开更多
BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hyd...BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.展开更多
Air pollution has posed a serious public health issue in China. In the study, we aimed to examine the burden of air pollution and its association with climate factors and total mortality. City-level daily air quality ...Air pollution has posed a serious public health issue in China. In the study, we aimed to examine the burden of air pollution and its association with climate factors and total mortality. City-level daily air quality index (AQI) data in 161 cities of China in 2014, and meteorological factors, socioeconomic status and total morality were obtained from China environmental, meteor-ology and healthcare agencies. Linear regression, spatial autocorrelation analysis and panel fixed models were applied in data analysis. Among 161 cities, monthly average AQI was significantly different by seasons and regions. The highest average AQI was in winter, and the lowest in summer. A significant clustering distribution of AQI by cities was observed, with the highest AQI in north China (22 cities, mean = 117.36). Among the 161 cities, 5 cities (3%) had AQI > 150 (e.g., moderate polluted reference value), and 50 cities (31.1%) had AQI between 100 and 150 (slightly polluted value). Daily heat index, precipitation and sunshine hours were negatively and significantly, but air pressure was positively correlated with AQI. Cities with higher AQI concentrations had higher total mortality than those with lower AQI. This AQI-mortality association remained significant after adjustment for socioeconomic status. In conclusion, the study highlights the burden and seasonal, regional and areas variations in air pollution across the nation. Air pollution is estimated to account for more than 4% of the urban health inequality in total mortality in China.展开更多
文摘We aimed to test a hypothesis that elevated ambient particulate matter (PM) 2.5 concentrations are significantly associated with risk of coronary heart disease (CHD), stroke, and diabetes mellitus (DM) in adults aged 65 and older. We analyzed data (2010-2013) from U.S. 1118 counties to examine the association between PM2.5 concentrations and risk of prevalent CHD, stroke, and DM, and mortality from cardiovascular disease (CVD), CHD, stroke, and DM in adults aged ≥ 65. Multilevel regression analysis technique was applied to test these associations. The results show that the annual mean of PM2.5 concentration was 8.7 μg/m<sup>3</sup> in the total study sample. Significant differences in mean PM2.5 concentrations were observed across counties and states in the U.S. Multilevel regression analysis indicates that an average annual concentration of 1 μg/m<sup>3</sup> increase in PM2.5 concentration was significantly associated with an increased prevalence of CHD, stroke, and DM by 4.9‰ (95% CI: 3.1‰ - 6.7‰), 0.8‰ (0.5‰ - 1.1‰), and 3.3‰ (2.9‰ - 4.4‰), respectively. State-level correlation analyses indicate that increased PM2.5 concentrations were significantly associated with increased age-adjusted mortality from CVD (r = 0.76, p < 0.001), CHD (r = 0.0.40, p = 0.004), stroke (r = 0.60, p p = 0.02). In conclusion, Elevated PM2.5 concentrations were significantly associated with an increased risk of the prevalence and mortality from CVD, CHD, stroke, and DM. Continued effort to control ambient PM2.5 concentrations could play an important role in risk reduction of cardiovascular disease and diabetes in the elderly.
基金Supported by A grant from the Drexel-Ameri Health Faculty Initiatives,No.282573
文摘AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Fileson prescribed medicines for patients with DM were used to test the research questions. χ 2, Poisson and Cox’s regression models were applied in data analysis.RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD= 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI:1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM,respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations,specifically for metformin use, show a protective effect against all-cause and CVD mortalities.
文摘Spatial epidemiology is the description and analysis of geographic patterns and variations in disease risk factors,morbidity and mortality with respect to their distributions associated with demographic,socioeconomic,environmental,health behavior,and genetic risk factors,and time-varying changes.In the Letter to Editor,we had a brief description of the practice for the mortality and the spacetime patterns of John Snow's map of cholera epidemic in London,United Kingdom in 1854.This map is one of the earliest public heath practices of developing and applying spatial epidemiology.In the early history,spatial epidemiology was predominantly applied in infectious disease and risk factor studies.However,since the recent decades,noncommunicable diseases have become the leading cause of death in both developing and developed countries,spatial epidemiology has been used in the study of noncommunicable disease.In the Letter,we addressed two examples that applied spatial epidemiology to cluster and identify stroke belt and diabetes belt across the states and counties in the United States.Similar to any other epidemiological study design and analysis approaches,spatial epidemiology has its limitations.We should keep in mind when applying spatial epidemiology in research and in public health practice.
文摘BACKGROUND A limited number of studies have been conducted to test the magnitudes of the association between apparent treatment resistant hypertension(aTRH)and risk of cardiovascular disease(CVD).AIM To investigate the association between aTRH and risk of CVD and examine whether sex and age modify this association.METHODS We applied an observational analysis study design using data from the United States Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial(ALLHAT).ALLHAT recruited participants(n=25516)from 625 primary care settings throughout the United States,Canada,Puerto Rico,and United States Virgin Islands,aged 55 and older with hypertension and at least one additional risk factor for heart disease.aTRH was assessed from the year 2 visit.CVD event was defined as one of the following from the year 2 follow-up visit:Fatal or non-fatal myocardial infarction,coronary revascularization,angina,stroke,heart failure,or peripheral artery disease.Cox proportional hazards regression was used to examine the effect of aTRH on CVD risk.Potential modifications of sex and age on this association were examined on the multiplicative scale by interaction term and additive scale by joint effects and relative excess risk for interaction.RESULTS Of the total study participants(n=25516),5030 experienced a CVD event during a mean of 4.7 years follow-up.aTRH was associated with a 30%increase in risk of CVD compared to non-aTRH[hazards ratio(HR)=1.3,95%CI:1.19-1.42].Sex and age modified this relationship on both multiplicative and additive scales independently.Stratified by sex,aTRH was associated with a 64%increase in risk of CVD(HR=1.64,95%CI:1.43–1.88)in women,and a 13%increase in risk of CVD(HR=1.13,95%CI:1.01–1.27)in men.Stratified by age,aTRH had a stronger impact on the risk of CVD in participants aged<65(HR=1.53,95%CI:1.32–1.77)than it did in those aged≥65(HR=1.18,95%CI:1.05–1.32).Significant two-way interactions of sex and aTRH,and age and aTRH on risk of CVD were observed(P<0.05).The observed joint effect of aTRH and ages≥65 years(HR=1.85,95%CI:1.22–2.48)in males was less than what was expected for both additive and multiplicative models(HR=4.10,95%CI:3.63–4.57 and 4.88,95%CI:3.66–6.31),although three-way interaction of sex,age,and aTRH on the risk of CVD and coronary heart disease did not reach a statistical significance(P>0.05).CONCLUSION aTRH was significantly associated with an increased risk of CVD and this association was modified by both sex and age.Further studies are warranted to test these mechanisms.
基金The study was reviewed and approved by Drexel University Institutional Review Board(Approval No.1910007425).
文摘BACKGROUND In spite of an increase in the incidence and prevalence of diabetes mellitus(DM)and Alzheimer’s disease(AD)in the aging population worldwide,limited attention has been paid to their potential association.AIM To investigate the association of DM and cardiometabolic syndrome(CMS,a precursor to DM)with risk of incident AD among postmenopausal women.METHODS Postmenopausal women aged 50-79(n=63117)who participated in the U.S.Women’s Health Initiative Observational Study(WHIOS),recruited in 1993-1998,without baseline AD and followed up through March 1,2019,were analyzed.AD was classified by participant-reported history of doctor-diagnosis of incident AD in the WHIOS.DM was defined by participant-report or treated because of diabetes or serum glucose concentrations≥126 mg/dL.CMS was defined as having≥3 of five CMS components:large waist circumference,high blood pressure,elevated triglycerides,elevated glucose,and low high-density lipoprotein cholesterol.The associations of DM and CMS with AD were analyzed using Cox’s proportional hazards regression analysis.RESULTS During a median follow-up of 20 years(range:3.36 to 23.36 years),of 63117 participants,8340 developed incident AD.Women with DM had significantly higher incidence of AD[8.5,95%confidence interval(CI):8.0-9.0 per 1000 personyears(PY)]than those without DM(7.1,95%CI:6.9-7.2 per 1000 PY).Multivariate Cox’s regression analysis indicated that women with DM or CMS had a significantly higher risk of AD than those without DM or CMS.The corresponding hazard ratios[HR(95%CI)]were 1.22(1.13-1.31,P<0.001)in subjects with DM,and 1.18(1.09-1.27,P<0.001)in subjects with CMS.The HRs diminished with age and became non-significant in the oldest age group.CONCLUSION During a median follow-up of 20 years,DM and CMS were significantly associated with the risk of AD among postmenopausal women.More specifically,women aged 50-69 with DM or CMS vs those without these conditions had significantly higher relative risks of AD than the relative risks of AD in those aged 70-79 with DM or CMS vs those without DM or CMS.
文摘BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.
文摘Air pollution has posed a serious public health issue in China. In the study, we aimed to examine the burden of air pollution and its association with climate factors and total mortality. City-level daily air quality index (AQI) data in 161 cities of China in 2014, and meteorological factors, socioeconomic status and total morality were obtained from China environmental, meteor-ology and healthcare agencies. Linear regression, spatial autocorrelation analysis and panel fixed models were applied in data analysis. Among 161 cities, monthly average AQI was significantly different by seasons and regions. The highest average AQI was in winter, and the lowest in summer. A significant clustering distribution of AQI by cities was observed, with the highest AQI in north China (22 cities, mean = 117.36). Among the 161 cities, 5 cities (3%) had AQI > 150 (e.g., moderate polluted reference value), and 50 cities (31.1%) had AQI between 100 and 150 (slightly polluted value). Daily heat index, precipitation and sunshine hours were negatively and significantly, but air pressure was positively correlated with AQI. Cities with higher AQI concentrations had higher total mortality than those with lower AQI. This AQI-mortality association remained significant after adjustment for socioeconomic status. In conclusion, the study highlights the burden and seasonal, regional and areas variations in air pollution across the nation. Air pollution is estimated to account for more than 4% of the urban health inequality in total mortality in China.
