Reductions in acute myocardial infarction burden linked to short-term PM2.5 exposure: Evidence from the Chinese CCA Registry
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PUBLIC SUMMARY
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Concentrations of fine particulate matter (PM2.5) and its constituents pronouncedly declined during 2017-2020.
The burden of acute myocardial infarction (AMI) by PM2.5 mass and its constituents substantially declined.
The declines of AMI morbidity burden were greater for organic matter and sulfate than other constituents.
The AMI morbidity burden by PM2.5 declined more in females, people aged ≥65 years, and in Southern China.
Our study could assist in establishing targeted policies and driving actions in prevention strategies for AMI.
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ABSTRACT
BackgroundPM2.5 (fine particulate matter with aerodynamic diameter ≤ 2.5μm) concentrations have substantially declined in the past decade across China, but temporal changes of morbidity burden of acute myocardial infarction (AMI) attributable to short-term exposures to PM2.5 and its various chemical constituents, including black carbon (BC), organic matter (OM), ammonium ($ {\mathrm{NH}}_{\mathrm{4}}^{\mathrm{+}} $), nitrate ($ {\mathrm{NO}}_{\mathrm{3}}^{\mathrm{-}} $) and sulfate ($ {\mathrm{SO}}_{\mathrm{4}}^{\mathrm{2}\mathrm{-}} $) in China remain unknown.MethodsA time-stratified case-crossover design was applied in 785,052 AMI cases across China during 2017-2020. We utilized conditional logistic regression models to estimate the excess risks (ERs) and attributable fractions (AFs) from AMI onset attributable to short-term exposures (lag01 day) to PM2.5 and constituents, and used linear regression models to estimate temporal changes of AFs of AMI morbidity.ResultsThe annual average reductions in concentrations of PM2.5 mass, BC, OM, $ {\mathrm{NH}}_{\mathrm{4}}^{\mathrm{+}} $, $ {\mathrm{NO}}_{\mathrm{3}}^{\mathrm{-}} $ and $ {\mathrm{SO}}_{\mathrm{4}}^{\mathrm{2}\mathrm{-}} $ during 2017-2020 were respectively 3.05μg/m3/year, 0.15μg/m3/year, 0.70μg/m3/year, 0.31μg/m3/year, 0.44μg/m3/year, and 0.51μg/m3/year. Correspondingly, the annual average reductions in AFs were recorded as -0.53% (95%CI: -0.92%, -0.15%), -0.29% (95%CI: -0.43%, -0.15%), -0.45% (95%CI: -0.78%, -0.12%), -0.33% (95%CI: -0.51%, -0.16%), -0.36% (95%CI: -0.59%, -0.13%), and -0.48% (95%CI: -0.86%, -0.10%), respectively. The temporal reduction of PM2.5-attributed and chemical constituents-attributed AFs were greater in females, people aged ≥65 years, non-ST-segment-elevation myocardial infarction (NSTEMI) cases, and people resided in Southern China.ConclusionsAs the concentration of PM2.5 mass and chemical constituents decreased over the years, the decline was observed in the morbidity burden of AMI attributable to PM2.5 and its constituents across China from 2017 to 2020. -
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Li Y., He G., Zhu Q., et al. (2025). Reductions in acute myocardial infarction burden linked to short-term PM2.5 exposure: Evidence from the Chinese CCA Registry. The Innovation Medicine 3:100148. https://doi.org/10.59717/j.xinn-med.2025.100148
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Li Y., He G., Zhu Q., et al. (2025). Reductions in acute myocardial infarction burden linked to short-term PM2.5 exposure: Evidence from the Chinese CCA Registry. The Innovation Medicine 3:100148. https://doi.org/10.59717/j.xinn-med.2025.100148
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Figure 1.
Geographic distribution of chest pain centers across China from 2017 to 2020.
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Figure 2.
Spatial distribution of PM2.5 concentrations
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Figure 3.
Nonlinear exposure-response associations of short-term exposure to ambient PM2.5 and its chemical constituents with overall AMI onset from 2017 to 2020.
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Figure 4.
The attributable fraction (AF, %) of AMI onset attributable to short-term exposure to PM2.5 and its chemical constituents during 2017 to 2020.
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Figure 5.
The average change of attributable fraction (AF, %) of AMI onset caused by PM2.5 with its chemical constituents’ exposure during 2017 to 2020 in different subgroups.
