TY - JOUR
T1 - Long-term exposure to outdoor and household air pollution and blood pressure in the Prospective Urban and Rural Epidemiological (PURE) study
AU - Arku, Raphael E.
AU - Brauer, Michael
AU - Ahmed, Suad H.
AU - AlHabib, Khalid F.
AU - Avezum, Álvaro
AU - Bo, Jian
AU - Choudhury, Tarzia
AU - Dans, Antonio ML
AU - Gupta, Rajeev
AU - Iqbal, Romaina
AU - Ismail, Noorhassim
AU - Kelishadi, Roya
AU - Khatib, Rasha
AU - Koon, Teo
AU - Kumar, Rajesh
AU - Lanas, Fernando
AU - Lear, Scott A.
AU - Wei, Li
AU - Lopez-Jaramillo, Patricio
AU - Mohan, Viswanathan
AU - Poirier, Paul
AU - Puoane, Thandi
AU - Rangarajan, Sumathy
AU - Rosengren, Annika
AU - Soman, Biju
AU - Caklili, Ozge Telci
AU - Yang, Shunyun
AU - Yeates, Karen
AU - Yin, Lu
AU - Yusoff, Khalid
AU - Zatoński, Tomasz
AU - Yusuf, Salim
AU - Hystad, Perry
N1 - Funding Information:
This work was supported by the Canadian Institutes of Health Research [grant # 136893 ]; by the Office of The Director, National Institutes of Health of the National Institutes of Health [Award Number DP5OD019850 ]; and by the Michael Smith Foundation for Health Research Trainee Award [Award Number 28160 ]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Canadian Institutes of Health Research. Dr S Yusuf is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. Additional funding supports are found in the Appendix.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/7
Y1 - 2020/7
N2 - Exposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking with solid fuels with BP and hypertension in the Prospective Urban and Rural Epidemiology (PURE) study. Outdoor PM2.5 exposures were estimated at year of enrollment for 137,809 adults aged 35–70 years from 640 urban and rural communities in 21 countries using satellite and ground-based methods. Primary use of solid fuel for cooking was used as an indicator of HAP exposure, with analyses restricted to rural participants (n = 43,313) in 27 study centers in 10 countries. BP was measured following a standardized procedure and associations with air pollution examined with mixed-effect regression models, after adjustment for a comprehensive set of potential confounding factors. Baseline outdoor PM2.5 exposure ranged from 3 to 97 μg/m3 across study communities and was associated with an increased odds ratio (OR) of 1.04 (95% CI: 1.01, 1.07) for hypertension, per 10 μg/m3 increase in concentration. This association demonstrated non-linearity and was strongest for the fourth (PM2.5 > 62 μg/m3) compared to the first (PM2.5 < 14 μg/m3) quartiles (OR = 1.36, 95% CI: 1.10, 1.69). Similar non-linear patterns were observed for systolic BP (β = 2.15 mmHg, 95% CI: −0.59, 4.89) and diastolic BP (β = 1.35, 95% CI: −0.20, 2.89), while there was no overall increase in ORs across the full exposure distribution. Individuals who used solid fuels for cooking had lower BP measures compared to clean fuel users (e.g. 34% of solid fuels users compared to 42% of clean fuel users had hypertension), and even in fully adjusted models had slightly decreased odds of hypertension (OR = 0.93; 95% CI: 0.88, 0.99) and reductions in systolic (−0.51 mmHg; 95% CI: −0.99, −0.03) and diastolic (−0.46 mmHg; 95% CI: −0.75, −0.18) BP. In this large international multi-center study, chronic exposures to outdoor PM2.5 was associated with increased BP and hypertension while there were small inverse associations with HAP.
AB - Exposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking with solid fuels with BP and hypertension in the Prospective Urban and Rural Epidemiology (PURE) study. Outdoor PM2.5 exposures were estimated at year of enrollment for 137,809 adults aged 35–70 years from 640 urban and rural communities in 21 countries using satellite and ground-based methods. Primary use of solid fuel for cooking was used as an indicator of HAP exposure, with analyses restricted to rural participants (n = 43,313) in 27 study centers in 10 countries. BP was measured following a standardized procedure and associations with air pollution examined with mixed-effect regression models, after adjustment for a comprehensive set of potential confounding factors. Baseline outdoor PM2.5 exposure ranged from 3 to 97 μg/m3 across study communities and was associated with an increased odds ratio (OR) of 1.04 (95% CI: 1.01, 1.07) for hypertension, per 10 μg/m3 increase in concentration. This association demonstrated non-linearity and was strongest for the fourth (PM2.5 > 62 μg/m3) compared to the first (PM2.5 < 14 μg/m3) quartiles (OR = 1.36, 95% CI: 1.10, 1.69). Similar non-linear patterns were observed for systolic BP (β = 2.15 mmHg, 95% CI: −0.59, 4.89) and diastolic BP (β = 1.35, 95% CI: −0.20, 2.89), while there was no overall increase in ORs across the full exposure distribution. Individuals who used solid fuels for cooking had lower BP measures compared to clean fuel users (e.g. 34% of solid fuels users compared to 42% of clean fuel users had hypertension), and even in fully adjusted models had slightly decreased odds of hypertension (OR = 0.93; 95% CI: 0.88, 0.99) and reductions in systolic (−0.51 mmHg; 95% CI: −0.99, −0.03) and diastolic (−0.46 mmHg; 95% CI: −0.75, −0.18) BP. In this large international multi-center study, chronic exposures to outdoor PM2.5 was associated with increased BP and hypertension while there were small inverse associations with HAP.
KW - Air pollution
KW - Blood pressure
KW - Cardiovascular
KW - Global health
KW - Household
KW - Hypertension
UR - http://www.scopus.com/inward/record.url?scp=85081014514&partnerID=8YFLogxK
U2 - 10.1016/j.envpol.2020.114197
DO - 10.1016/j.envpol.2020.114197
M3 - Article
C2 - 32146361
AN - SCOPUS:85081014514
SN - 0269-7491
VL - 262
JO - Environmental Pollution
JF - Environmental Pollution
M1 - 114197
ER -