Introduction Evidence linking long-term air pollution exposure to new-onset pain in Chinese middle-aged and older adults remains scarce. This cohort study aimed to clarify the association between major air pollutants and new-onset pain risk in this population, providing epidemiological evidence for targeted prevention. Methods We collected data from China Health and Retirement Longitudinal Study (CHARLS) and China High Air Pollution (CHAP) for the period August 2015 and August 2020 for cross-sectional and longitudinal analyses. A total of 12,062 participants aged 45 and above were ultimately included in the study, with 8583 of them being followed up until 2020. We calculated the annual average concentrations of PM2.5, PM10, and SO2 by region, and pain was assessed by self-reported questionnaires. We further investigated the joint effects of multiple air pollutants by applying weighted quantile sum (WQS) regression hybrid analysis techniques. The longitudinal relationship between air pollution and pain was analyzed with the use of binary logistic regression and Cox risk regression models. Results After 5-year of follow-up, 3956 (46.1%) were categorized as pain patients. In cross-sectional analyses, we found a significant positive correlation between air pollution and the prevalence of pain reports (OR = 1.53 [1.32–1.77] for PM2.5; OR = 1.72 [1.47–2.02] for PM10; OR = 1.40 [1.17–1.67] for SO2). In longitudinal analyses, the risk ratios for new-onset pain were related to an increased interquartile range (IQR) for PM2.5 (HR = 1.12 [1.07–1.17]), PM10 (HR = 1.17 [1.12–1.23]), and SO2 (HR = 1.09 [1.05–1.13]). The gWQS regression analysis showed a remarkable correlation between air pollution compounds and the incidence of prevalence pain (OR = 1.52 [1.39–1.65]). Moreover, older females, rural residents, and individuals with lower levels of education were more affected. Conclusion Middle-aged and elderly people who are chronically exposed to PM2.5, PM10, and SO2 were associated with an enhanced risk of reporting new-onset pain.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> Key Points • Elevated annual mean concentrations of PM2.5, PM10, and SO₂ were significantly positively associated with the incidence of pain among older adults over age 45. The combined effects of multiple pollutants contributed to an elevated incidence of pain were confirmed through WQS regression. • The adverse effects of air pollution on pain were more pronounced in women, rural residents, and individuals with lower educational attainment, untangling the interactions between sociodemographic factors and environmental exposures. • By integrating WQS regression with longitudinal risk models, this study quantified the cumulative effects of multipollutant co-exposure, providing a novel analytical framework for pain epidemiology research. • This study may promote mechanistic studies on the association between air pollution and pain, while providing data support for formulating air pollution protection guidelines targeting middle-aged and elderly populations (particularly high-risk subgroups). </entry> </row> </tbody> </tgroup> </Table>

Association of long-term exposure to air pollution with the risk of new-onset pain among middle-aged and older people: a cohort study in China

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发表日期：

2026年1月13日

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Yang Cheng,
Wenwen Sheng,
Zhenzhe Yu,
Shujun Xia,
Mengyao Liu,
Weijie Wang

摘要

Introduction

Evidence linking long-term air pollution exposure to new-onset pain in Chinese middle-aged and older adults remains scarce. This cohort study aimed to clarify the association between major air pollutants and new-onset pain risk in this population, providing epidemiological evidence for targeted prevention.

Methods

We collected data from China Health and Retirement Longitudinal Study (CHARLS) and China High Air Pollution (CHAP) for the period August 2015 and August 2020 for cross-sectional and longitudinal analyses. A total of 12,062 participants aged 45 and above were ultimately included in the study, with 8583 of them being followed up until 2020. We calculated the annual average concentrations of PM_2.5, PM₁₀, and SO₂ by region, and pain was assessed by self-reported questionnaires. We further investigated the joint effects of multiple air pollutants by applying weighted quantile sum (WQS) regression hybrid analysis techniques. The longitudinal relationship between air pollution and pain was analyzed with the use of binary logistic regression and Cox risk regression models.

Results

After 5-year of follow-up, 3956 (46.1%) were categorized as pain patients. In cross-sectional analyses, we found a significant positive correlation between air pollution and the prevalence of pain reports (OR = 1.53 [1.32–1.77] for PM_2.5; OR = 1.72 [1.47–2.02] for PM₁₀; OR = 1.40 [1.17–1.67] for SO₂). In longitudinal analyses, the risk ratios for new-onset pain were related to an increased interquartile range (IQR) for PM_2.5 (HR = 1.12 [1.07–1.17]), PM₁₀ (HR = 1.17 [1.12–1.23]), and SO₂ (HR = 1.09 [1.05–1.13]). The gWQS regression analysis showed a remarkable correlation between air pollution compounds and the incidence of prevalence pain (OR = 1.52 [1.39–1.65]). Moreover, older females, rural residents, and individuals with lower levels of education were more affected.

Conclusion

Middle-aged and elderly people who are chronically exposed to PM_2.5, PM₁₀, and SO₂ were associated with an enhanced risk of reporting new-onset pain.

Key Points

• Elevated annual mean concentrations of PM2.5, PM10, and SO₂ were significantly positively associated with the incidence of pain among older adults over age 45. The combined effects of multiple pollutants contributed to an elevated incidence of pain were confirmed through WQS regression.

• The adverse effects of air pollution on pain were more pronounced in women, rural residents, and individuals with lower educational attainment, untangling the interactions between sociodemographic factors and environmental exposures.

• By integrating WQS regression with longitudinal risk models, this study quantified the cumulative effects of multipollutant co-exposure, providing a novel analytical framework for pain epidemiology research.

• This study may promote mechanistic studies on the association between air pollution and pain, while providing data support for formulating air pollution protection guidelines targeting middle-aged and elderly populations (particularly high-risk subgroups).