Ambient fine particulate matter and Life's essential 8 and mortality in adults in China: A Nationwide retrospective cohort study

Background

Enhanced cardiovascular health (CVH) is linked to reduced mortality risks, whereas long-term exposure to fine particulate matter (PM_2.5), elevates these risks. Whether long-term exposure to PM_2.5 counteracts the health benefits of high CVH is unknown. The study aims to evaluate whether the association of CVH assessed by Life's Essential 8 (LE8) with death was consistent between participants with different PM_2.5 exposures.

Methods

We included 134,727 participants in the field survey of China Chronic Disease and Risk Factor Surveillance which was conducted from August 2013 to June 2014. The deaths of participants were obtained by linking to the National Mortality Surveillance System (2013–2018). The environmental data is obtained by satellite inversion. The participants' CVH scores were calculated using the LE8 method. Hazard ratio (HR) and 95% confidence intervals (95%CI) for mortality were calculated using Cox regression models.

Results

A total of 2,936 all-cause deaths and 1,158 cardiovascular disease (CVD) deaths were recorded. Compared to those with low CVH, adults with high CVH demonstrated a reduced risk of all-cause mortality, irrespective of their PM_2.5 exposure levels (P < 0.05, all P for interaction >0.05). Furthermore, in comparison to those with low CVH and highest PM_2.5 exposure, adults with high CVH and lowest PM_2.5 exposure exhibited HR of 0.18 (95%CI, 0.12–0.25) for all-cause mortality and 0.13 (95%CI, 0.08–0.22) for CVD mortality.

Conclusions

High CVH is associated with reduced all-cause mortality risk, regardless of PM_2.5 exposure levels. For Chinese adults, sustaining high CVH is advisable, irrespective of their residential location.