Long-term exposure to air pollution and systemic inflammation are associated with increased prevalence of metabolic syndrome (MetS); however, their joint effects in Chinese middle-aged and older adults is unknown. In this cross-sectional study, 11,838 residents aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) Wave 3 in 2015 were included. MetS was diagnosed using the Joint Interim Societies' definition. C-Reactive Protein (CRP) was assessed to reflect systemic inflammation. Individual exposure to air pollutants (particulate matter with a diameter ≤2.5 μm (PM) or ≤ 10 μm (PM), sulfur dioxide (SO), nitrogen dioxide (NO), ozone (O), and carbon monoxide (CO)) was evaluated using satellite-based spatiotemporal models according to participant residence at county-level. Generalized linear models (GLMs) were applied to examine the association between air pollution and MetS, and the modification effects of CRP between air pollution and MetS were estimated using interaction terms of CRP and air pollutants in the GLM models. The prevalence of MetS was 32.37%. The adjusted odd ratio (OR) of MetS was 1.192 (95% confidence interval (CI): 1.116, 1.272), 1.177 (95% CI: 1.103, 1.255), 1.158 (95% CI: 1.072, 1.252), 1.303 (95% CI: 1.211,1.403), 1.107 (95% CI: 1.046, 1.171) and 1.156 (95% CI:1.083, 1.234), per inter-quartile range increase in PM(24.04 μg/m), PM(39.00 μg/m), SO(19.05 μg/m), NO(11.28 μg/m), O(9.51 μg/m) and CO (0.46 mg/m), respectively. CRP was also associated with increased prevalence of MetS (OR = 1.049, 95% CI: 1.035, 1.064; per 1.90 mg/L increase in CRP). Interaction analysis suggested that high CRP levels enhanced the association between air pollution exposure and MetS. Long-term exposure to air pollution is associated with increased prevalence of MetS, which might be enhanced by systemic inflammation. Given the rapidly aging society and heavy burden of MetS, measures should be taken to improve air quality and reduce systemic inflammation. 2.5 10 2 2 3 2.5 10 2 2 3 3 3 3 3 3 3
