Long-Term Ambient Air Pollution Exposure and the Risk of Cardiovascular and Cerebrovascular Diseases in Rural Chinese Populations: 10-Year Follow-Up of a Multicenter Prospective Cohort Study

Dec 2, 2025JMIR public health and surveillance

Long-Term Air Pollution Exposure and Risk of Heart and Brain Blood Vessel Diseases in Rural China Over 10 Years

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Abstract

For every 1 μg/m3 increase in PM2.5, the risks of cardiovascular diseases increased by 5% to 10% across various conditions.

Long-term exposure to PM2.5 is associated with increased risks of cardiovascular diseases in rural Chinese populations.
The risk of ischemic stroke increased by 7%, coronary heart disease by 8%, acute coronary syndrome by 9%, and intracerebral hemorrhage by 10% for each 1 μg/m3 rise in PM2.5.
Participants in the high exposure group experienced significantly higher risks of CVD compared to those in the low exposure group.
Subgroup analysis showed that older individuals had a higher risk of CVD than those younger than 60 years, with a statistically significant interaction effect.

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BACKGROUND: Long-term follow-up studies investigating the relationship between ambient air pollution and cardiovascular and cerebrovascular diseases (CVD) in rural Chinese populations remain limited.

OBJECTIVE: This study aimed to investigate the impact of prolonged exposure to particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) on CVD in rural areas of China.

METHODS: On the basis of a multicenter population-based prospective study, adult rural residents (aged ≥15 y) from 3 study sites (ie, Xiangtan, Hunan Province; Longxi, Gansu Province; and Zhongmu, Henan Province) with different PM2.5 exposure levels were tracked for the incidence of CVD events between 2013 and 2023. The relationship was assessed by applying the Cox proportional hazards model and a trend test.

RESULTS: A total of 15,502 participants were included in the study. During the 10-year follow-up period, for every 1 μg/m3 increase in PM2.5, the risks of CVD, ischemic stroke, coronary heart disease, acute coronary syndrome, and intracerebral hemorrhage increased by 5% (hazard ratio [HR] 1.05, 95% CI 1.04-1.06), 7% (HR 1.07, 95% CI 1.06-1.08), 8% (HR 1.08, 95% CI 1.07-1.09), 9% (HR 1.09, 95% CI 1.06-1.11), and 10% (HR 1.10, 95% CI 1.07-1.14), respectively. Furthermore, the risk in the high exposure group (Q4) was found to be significantly higher than that in the low exposure group (Q1; P for trend <.001). The subgroup analysis indicated that the risk of CVD was higher among older people compared to individuals aged <60 years, and the interaction effect was statistically significant (interaction P value=.03).

CONCLUSIONS: Our results indicate that long-term exposure to PM2.5 significantly increases the risk of CVD in rural areas of China and shows regional differences. This finding may deepen our understanding of the potential public health risks associated with PM2.5 exposure and emphasize the crucial role of environmental governance in promoting public health outcomes.

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Long-Term Ambient Air Pollution Exposure and the Risk of Cardiovascular and Cerebrovascular Diseases in Rural Chinese Populations: 10-Year Follow-Up of a Multicenter Prospective Cohort Study

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