Background The existing literature on the associations between short-term exposure to PM2.5 and O3 and acute cardiovascular events (ACE) has yielded inconclusive findings, and little is known about the potential interactions of PM2.5 and O3. This study aims to analyze the impacts of PM2.5 and O3 on ACE onset and their potential interactions. Methods A time-stratified case-crossover study was implemented to examine 424,069 cases of ACE in Jining City, China, between 2015 and 2023. This study used each case as its own control. PM2.5 and O3 concentrations were allocated to each case and control day based on the home address of each individual. Quantitative effects of short-term exposure to PM2.5 and O3 on the onset of ACE and its subtypes, including acute myocardial infarction (AMI), stroke, and sudden cardiac death (SCD), were assessed using conditional logistic regression models. Subgroup analyses were performed to investigate the effect modification by gender, age, and season. Stratified analyses by co-pollutant exposures and synergy index (SI) were applied to test the interaction of PM2.5 and O3. Results Exposure to PM2.5 and O3 was associated with an increased risk of ACE onset, particularly on the day of onset and the day before. Specifically, for each interquartile range (IQR) increase of 45.10 µg/m³in PM2.5 at lag0-1 and 72.70 µg/m³in O3 at lag0-1, the ORs were 1.023 (95% CI: 1.018–1.029) and 1.032 (95% CI: 1.020–1.044) for ACE. Similar results were observed for AMI and stroke, but not for SCD. PM2.5 had more pronounced detrimental effects on older adults (age ≥ 65), males, and during cold seasons, while O3 had more pronounced detrimental effects on older adults (age ≥ 65) and during warm seasons, with no significant gender difference for O3. No significant interaction between PM2.5 and O3 on ACE onset was found (SI [95% CI]: 1.50 [0.36–6.29]), though PM2.5 or O3 had more pronounced detrimental effects at lower concentrations of the other pollutants. Conclusions PM2.5 and O3 are risk factors for ACE onset, particularly on the day of onset and the day before. Moreover, we found no significant interaction of PM2.5 and O3 on ACE onset. Reducing PM2.5 and O3 concentrations and avoiding exposure to high levels of these pollutants in the early phase may mitigate ACE onset. Targeted policies aimed at reducing PM2.5 and O3 pollution should be developed to mitigate their adverse health effects among high-risk populations, including older adults and males.

Ambient PM_2.5 and O₃ and their combined effects on the onset of acute cardiovascular events: a time-stratified case-crossover study in Jining, China (2015–2023)

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2025年12月5日

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Si-Hao Song,
Michael Tong,
Mei Wang,
Shu-Fen Li,
Chuan-Long Cheng,
Rui Xi,
Qi Gao,
Rui Li,
Yu-Min Liang,
Xiu-Jun Li

摘要

Background

The existing literature on the associations between short-term exposure to PM_2.5 and O₃ and acute cardiovascular events (ACE) has yielded inconclusive findings, and little is known about the potential interactions of PM_2.5 and O₃. This study aims to analyze the impacts of PM_2.5 and O₃ on ACE onset and their potential interactions.

Methods

A time-stratified case-crossover study was implemented to examine 424,069 cases of ACE in Jining City, China, between 2015 and 2023. This study used each case as its own control. PM_2.5 and O₃ concentrations were allocated to each case and control day based on the home address of each individual. Quantitative effects of short-term exposure to PM_2.5 and O₃ on the onset of ACE and its subtypes, including acute myocardial infarction (AMI), stroke, and sudden cardiac death (SCD), were assessed using conditional logistic regression models. Subgroup analyses were performed to investigate the effect modification by gender, age, and season. Stratified analyses by co-pollutant exposures and synergy index (SI) were applied to test the interaction of PM_2.5 and O₃.

Results

Exposure to PM_2.5 and O₃ was associated with an increased risk of ACE onset, particularly on the day of onset and the day before. Specifically, for each interquartile range (IQR) increase of 45.10 µg/m³in PM_2.5 at lag0-1 and 72.70 µg/m³in O₃ at lag0-1, the ORs were 1.023 (95% CI: 1.018–1.029) and 1.032 (95% CI: 1.020–1.044) for ACE. Similar results were observed for AMI and stroke, but not for SCD. PM_2.5 had more pronounced detrimental effects on older adults (age ≥ 65), males, and during cold seasons, while O₃ had more pronounced detrimental effects on older adults (age ≥ 65) and during warm seasons, with no significant gender difference for O₃. No significant interaction between PM_2.5 and O₃ on ACE onset was found (SI [95% CI]: 1.50 [0.36–6.29]), though PM_2.5 or O₃ had more pronounced detrimental effects at lower concentrations of the other pollutants.

Conclusions

PM_2.5 and O₃ are risk factors for ACE onset, particularly on the day of onset and the day before. Moreover, we found no significant interaction of PM_2.5 and O₃ on ACE onset. Reducing PM_2.5 and O₃ concentrations and avoiding exposure to high levels of these pollutants in the early phase may mitigate ACE onset. Targeted policies aimed at reducing PM_2.5 and O₃ pollution should be developed to mitigate their adverse health effects among high-risk populations, including older adults and males.

Ambient PM2.5 and O3 and their combined effects on the onset of acute cardiovascular events: a time-stratified case-crossover study in Jining, China (2015–2023)

摘要

Ambient PM_2.5 and O₃ and their combined effects on the onset of acute cardiovascular events: a time-stratified case-crossover study in Jining, China (2015–2023)