Each one-standard-deviation increase in PM₁₀ concentration is associated with a 16% higher odds of more advanced Cardio-Kidney-Metabolic syndrome.
Long-term exposure to air pollutants, including PM₁₀, SO₂, PM₂.₅, NO₂, and O₃, is linked to increased severity of .
The strongest association with CKM progression was observed for PM₁₀, with an odds ratio of 1.16 per 33.3 µg/m³ increase.
An overall mixture of pollutants is associated with an increased likelihood of CKM progression, with an odds ratio of 1.20 per quartile increase in the pollutant index.
Older adults (≥ 60 years) and residents of eastern China may be more susceptible to the adverse effects of air pollution on CKM syndrome.
Simplified
BACKGROUND: Cardio-Kidney-Metabolic (CKM) syndrome is a prevalent systemic disorder, but evidence linking it to air pollution is scarce. We investigated the association between long-term exposure to multiple air pollutants and severity in Chinese adults.
METHODS: In this cross-sectional study of 3,937 participants from the China Health and Retirement Longitudinal Study (CHARLS), we estimated long-term (2013-2015) residential exposures to PM₁, PM₂.₅, PM₁₀, NO₂, O₃, and SO₂. CKM syndrome was staged per American Heart Association criteria. We used ordered logistic, Weighted Quantile Sum (WQS), and restricted cubic spline regression to assess associations.
RESULTS: After full adjustment, each one-standard-deviation (SD) increase in pollutant concentration was significantly associated with higher odds of a more advanced CKM stage. The association was strongest for PM₁₀ (per 33.3 µg/m³ SD increase; OR = 1.16, 95% CI: 1.07-1.27), with significant positive associations also found for SO₂, PM₂.₅, NO₂, and O₃. The overall pollutant mixture was also positively associated with CKM progression (OR = 1.20, 95% CI: 1.02-1.41 per quartile increase in the WQS index). Older adults (≥ 60 years) and residents of eastern China were identified as particularly susceptible subgroups (P for interaction < 0.05).
CONCLUSION: Long-term exposure to ambient air pollutants, individually and as a mixture, is associated with advanced CKM syndrome in Chinese adults. Our findings identify air pollution as a critical modifiable factor and underscore the need for targeted public health interventions to mitigate the burden of this multisystem disease, especially for vulnerable populations.
Key numbers
1.16
Increase in Odds of Advanced CKM Stage (PM₁₀)
Per one-standard-deviation increase in PM₁₀ concentration.
1.20
Increase in Odds of Advanced CKM Stage (Pollutant Mixture)
Per quartile increase in the WQS index.
3,937
Study Population Size
Participants from the CHARLS study.
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Declarations. Ethics approval and consent to participate: The CHARLS study was approved by the Biomedical Ethics Committee of Peking University (approval number: IRB00001052-11015). All participants provided written informed consent before participating in the survey. Competing interests: The authors declare no competing interests.
