The effects of PM_2.5 components on the cardiovascular disease admissions in Shanghai City, China: a multi- region study

Background: The burden of cardiovascular disease (CVD) is severe worldwide. Although many studies have investigated the association of particulate pollution with CVD, the effect of finer particulate pollution components on CVD remains unclear. This study aimed to explore the effect of five PM_2.5 components ([Formula: see text], sulfate; [Formula: see text], nitrate; [Formula: see text], ammonium; OM, organic matter; BC, carbon black) on CVD admission in Shanghai City, identify the susceptible population, and provide clues for the prevention and control of particulate pollution.

Methods: Daily PM_2.5 components data during 2013-2019 in three districts of Shanghai were obtained from Tracking Air Pollution in China. We obtained CVD daily admissions data from relevant departments of Tongji Hospital, including basic information (sex, age, time of admissions, ICD code of root cause of admissions, etc.). First, generalized additive model (GAM) and distributed lag non-linear (DLNM) model were used to evaluate the individual effects of PM_2.5 components on CVD admission in three districts of Shanghai. Then, the three regions were pooled for analysis using either a random-effects model or a fixed-effects model.

Results: Overall, all five PM_2.5 components had significant effects on CVD admission risk. BC and OM were strongly associated with daily CVD admissions, with increasing interquartile range of the concentrations, the maximum values of cumulative RR (95% CI) were 1.318 (95%CI: 1.222-1.415) and 1.243 (95%CI: 1.164-1.322), respectively. The elderly (≥ 65 years old) was more sensitive to the four PM_2.5 components than the young population. [Formula: see text] and BC were strongest associated with CVD admissions in the elderly than in younger people, with increasing interquartile range of the concentrations, the maximum cumulative RR (95% CI) was 1.567 (95% CI: 1.116-2.019) and 1.534 (95% CI: 1.104-1.963), respectively.

Conclusions: This study found that five PM_2.5 components were significant risk factors for CVD admissions and specific CVD diseases in Shanghai City. The elderly were susceptible to [Formula: see text],[Formula: see text], OM, and BC.