Time-weighted average of fine particulate matter exposure and cause-specific mortality in China: a nationwide analysis

摘要

BackgroundMost previous assessments of the hazardous effects attributable to fine particulate matter (PM2·5) exposure have used ambient PM2·5as an exposure metric, resulting in substantial bias in effect estimates. We did a study to examine the association between cause-specific mortality and the time-weighted average of PM2·5exposure after accounting for indoor exposure in 267 cities in China.MethodsWe did a nationwide study, using Laser Egg air quality monitors in 36 cities to obtain data for indoor PM2·5concentrations from 18?484 anonymised households between Nov 1, 2015 and July 2, 2018. We developed and validated a nationwide indoor PM2·5prediction model for a further 302 cities by retrieving raw records of hourly concentrations from residents' air sensors; the model was used to predict indoor PM2·5during 2013 to 2018. Daily ambient PM2·5concentration data were estimated by averaging hourly ambient PM2·5concentrations obtained from China's National Urban Air Quality Real-time Publishing Platform. Daily numbers of deaths from all non-accidental causes were obtained from 324 cities from the Disease Surveillance Point System of China between Jan 1, 2013, to Dec 31, 2017, and calculated for 267 cities that had an average daily mortality above three, and data for PM2·5concentrations and meteorological information for at least 1 year between 2013 and 2017. We used distributed lag non-linear models to estimate city-specific associations between cause-specific mortality and reconstructed PM2·5exposure by considering indoor PM2·5exposure. We combined the city-specific effect estimates at the national level using a random effects meta-analysis.Findings13?972 records of daily indoor PM2·5concentrations for 36 cities, extracted from 47?459?183 raw records from the sensors were included for modelling indoor PM2·5levels. The nationwide indoor PM2·5concentration was 40 μg/m3(SD 21) between 2013 and 2017, which was approximately 20% lower than the ambient PM2·5concentration of 50 μg/m3(42). An increase of 10 μg/m3in time-averaged PM2·5exposure concentrations was associated with increased daily mortality estimates of 0·44% (95% CI 0·33–0·54) for total non-accidental causes, 0·50% (0·37–0·63) for cardiovascular diseases, 0·46% (0·28–0·63) for coronary heart disease, 0·49% (0·32–0·66) for stroke, 0·59% (0·39–0·79) for respiratory diseases, and 0·69% (0·45–0·92) for chronic obstructive pulmonary disease, respectively. Compared with previous estimations based on ambient PM2·5, our estimates approximately doubled the size of the effects related to PM2·5.InterpretationThis nationwide study revealed a higher mortality risk attributed to time-averaged indoor and ambient PM2·5exposure compared with the risk associated with ambient PM2·5exposure alone, which indicates that caution should be exercised when using ambient PM2·5as a surrogate for PM2·5exposure.FundingNational Natural Science Foundation of China (Youth Program) and the Fundamental Research Project of Beihang University.