title: Association between long-term exposure to outdoor air pollution and mortality in China: a cohort study.
abstract: No prior cohort studies exist in China examining the association of outdoor air pollution with mortality. We studied 70,947 middle-aged men and women in the China National Hypertension Survey and its follow-up study. Baseline data were obtained in 1991 using a standard protocol. The follow-up evaluation was conducted in 1999 and 2000. Annual average air pollution exposure between 1991 and 2000, including total suspended particle (TSP), sulfur dioxide (SO(2)) and nitrogen oxides (NO(x)), were estimated by linking fixed-site monitoring data with resident zip code. We examined the association of air pollution with mortality using proportional hazards regression model. We found significant associations between air pollution levels and mortality from cardiopulmonary diseases and from lung cancer. Each 10 μg/m(3) elevation of TSP, SO(2) and NO(x) was associated with a 0.9% (95%CI: 0.3%, 1.5%), 3.2% (95%CI: 2.3%, 4.0%), and 2.3% (95%CI: 0.6%, 4.1%) increased risk of cardiovascular mortality, respectively. We found significant effects of SO(2) on mortality after adjustment for TSP. Conclusively, ambient air pollution was associated with increased cardiopulmonary and lung cancer mortality in China. These data contribute to the scientific literature on long-term effects of air pollution for high exposure settings typical in developing countries.
authors.affiliation: Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, and Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Cao
authors.forename: Chunxue
authors.initials: C
authors.lastname: Yang
authors.forename: Jianxin
authors.initials: J
authors.lastname: Li
authors.forename: Renjie
authors.initials: R
authors.lastname: Chen
authors.forename: Bingheng
authors.initials: B
authors.lastname: Chen
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Gu
authors.forename: Haidong
authors.initials: H
authors.lastname: Kan
mesh_terms: D000368:Aged; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D000428:Alcohol Drinking / Q000401:mortality; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D015331:Cohort Studies; D003625:Data Collection; D004522:Educational Status; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000401:mortality; D008171:Lung Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009043:Motor Activity; D016016:Proportional Hazards Models; D012737:Sex Factors; D012907:Smoking / Q000401:mortality; D014505:Urban Population