Benefits of active commuting on cardiovascular health modified by ambient fine particulate matter in China: A prospective cohort study

Yuan Lin; Xueli Yang; Fengchao Liang; Keyong Huang; Fangchao Liu; Jianxin Li; Qingyang Xiao; Jichun Chen; Xiaoqing Liu; Jie Cao; Shufeng Chen; Chong Shen; Ling Yu; Fanghong Lu; Xianping Wu; Liancheng Zhao; Xigui Wu; Ying Li; Dongsheng Hu; Jianfeng Huang; Xiangfeng Lu; Yang Liu; Dongfeng Gu

doi:10.1016/j.ecoenv.2021.112641

Benefits of active commuting on cardiovascular health modified by ambient fine particulate matter in China: A prospective cohort study

Ecotoxicol Environ Saf. 2021 Aug 27:224:112641. doi: 10.1016/j.ecoenv.2021.112641. Online ahead of print.

Authors

Yuan Lin¹, Xueli Yang², Fengchao Liang³, Keyong Huang⁴, Fangchao Liu⁴, Jianxin Li⁴, Qingyang Xiao⁵, Jichun Chen⁴, Xiaoqing Liu⁶, Jie Cao⁴, Shufeng Chen⁴, Chong Shen⁷, Ling Yu⁸, Fanghong Lu⁹, Xianping Wu¹⁰, Liancheng Zhao⁴, Xigui Wu⁴, Ying Li⁴, Dongsheng Hu¹¹, Jianfeng Huang⁴, Xiangfeng Lu⁴, Yang Liu¹², Dongfeng Gu¹³

Affiliations

¹ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China.
² Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China.
³ School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China.
⁴ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
⁵ School of Environment, Tsinghua University, Beijing 100084, China.
⁶ Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou 510080, China.
⁷ Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
⁸ Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350014, China.
⁹ Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China.
¹⁰ Center for Chronic and Noncommunicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu 610041, China.
¹¹ Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen 518071, China.
¹² Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
¹³ Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; School of Medicine, Southern University of Science and Technology, Shenzhen 518055, China. Electronic address: gudongfeng@cashq.ac.cn.

Abstract

Background: Active commuting as a contributor to daily physical activity is beneficial for cardiovascular health, but leads to more chances of exposure to ambient air pollution. This study aimed to investigate associations between active commuting to work with cardiovascular disease (CVD), mortality and life expectancy among general Chinese adults, and to further evaluate the modification effect of fine particulate matter (PM_2.5) exposure on these associations.

Methods: We included 76,176 Chinese adults without CVD from three large cohorts of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project. Information about commuting mode and physical activity were collected by unified questionnaire. Satellite-based PM_2.5 concentrations at 1-km spatial resolution was used for estimating PM_2.5 exposure of participants. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence, mortality and all-cause mortality were estimated using Cox proportional hazards regression models. Multiplicative interaction term of commuting mode and PM_2.5 level was tested to investigate potential effect modification.

Results: During 448,499 person-years of follow-up, 2230 CVD events and 2777 all-cause deaths were recorded. Compared with the non-active commuters, the multivariable-adjusted HRs (95% CIs) of CVD incidence and all-cause mortality were 0.95(0.85-1.05) and 0.79(0.72-0.87) for walking commuters, respectively. Corresponding HRs (95% CIs) for cycling commuters were 0.71(0.62-0.82) and 0.67(0.59-0.76). Active commuters over 45 years old were estimated to have more CVD-free years and life expectancy than non-active commuters under lower PM_2.5 concentration. However, these beneficial effects of active commuting were alleviated or counteracted by long-term exposure to high PM_2.5 concentration. Significant multiplicative interaction of commuting mode and PM_2.5 level was showed in all-cause mortality, with the lowest risk observed in cycling participants exposed to lower level of PM_2.5.

Conclusions: Active commuting was associated with lower risk of CVD, all-cause mortality, and longer life expectancy among Chinese adults under ambient settings with lower PM_2.5 level. It will be valuable to encourage active commuting among adults and develop stringent strategies on ambient PM_2.5 pollution control for prevention of CVD and prolongation of life expectancy.

Keywords: Active commuting; Air pollution; Cardiovascular disease; Cohort study; Fine particulate matter.

Grants and funding

R01 ES032140/ES/NIEHS NIH HHS/United States