Abstract
BackgroundTo investigate the effects of short-term exposure to sulfur dioxide (SO2) and carbon monoxide (CO) in the central and southern China areas on ischemic heart disease (IHD) and non-accidental deaths.MethodWe investigated the associations between short-term exposure to SO2 and CO in a city in south-central China and IHD and non-accidental death using a time-series design and generalized additive models with up to a 5-day lag adjusting for day of the week, temperature, air pressure, wind speed, and relative humidity. The relative risks of IHD and non-accidental death per 10-unit increase in SO2 and CO were derived from zero to five days in single-pollutant models.ResultsBetween 2016 and 2018, a total of 10,507 IHD and 44,070 non-accidental deaths were identified. The largest significant relative risk for IHD death was lag 02 for both SO2 (1.080; 95% confidence interval: 1.075–1.084) and CO (5.297; 95% confidence interval: 5.177–5.418) in single-pollutants models. A significant association was shown at all lag multiple-day moving averages. Two-pollutant models identified an association between SO2 and mortality when adjusting for CO. In stratified analyses, SO2 exhibited a stronger association with death during the cold season, while CO exhibited a stronger association with mortality from IHD during the warm season. The risk of death was more robust in the elderly for both pollutants, but was greater in men for CO and in women for SO2.ConclusionsOverall, we found an association between short-term exposure to low-level SO2 and CO and the risk of IHD and non-accidental death.
Highlights
Estimated years of life lost from ischemic heart disease (IHD) increased by 20.9% (19.0–22.9) between 1990 and 2007, and by a further 17.3% (15.4–19.0) between 2007 and 2017 [1]
Two-pollutant models identified an association between sulfur dioxide (SO2) and mortality when adjusting for carbon monoxide (CO)
SO2 exhibited a stronger association with death during the cold season, while CO exhibited a stronger association with mortality from IHD during the warm season
Summary
Estimated years of life lost from ischemic heart disease (IHD) increased by 20.9% (19.0–22.9) between 1990 and 2007, and by a further 17.3% (15.4–19.0) between 2007 and 2017 [1]. Sulfur dioxide (SO2) and carbon monoxide (CO) have both been associated with a higher risk of heart failure and death [9,10,11]. China is the leading SO2 emitter in the world, with the average for annual-mean SO2 levels in 338 Chinese cites reported as 3–87 μg/m3 in 2015 [17], well beyond the ranges in developed countries [18]. With the efforts made by the Chinese government in recent years to improve the ecological environment, SO2 pollution has been largely mitigated and the average annual-mean SO2 levels in 338 Chinese cites reported as 13 and 11 μg/m3 in 2018 and 2019, respectively [19]. To investigate the effects of short-term exposure to sulfur dioxide (SO2) and carbon monoxide (CO) in the central and southern China areas on ischemic heart disease (IHD) and nonaccidental deaths
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