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Association between short-term exposure to fine particulate matter constituents and sudden cardiac death: A case-crossover study in Fujian Province, China.

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Title: Association between short-term exposure to fine particulate matter constituents and sudden cardiac death: A case-crossover study in Fujian Province, China.
Authors: Jin Z; Department of General Practice, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Yin Y; Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China., Li X; Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China., Chen T; Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China., Zhong W; Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China., Ni Y; Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Yang K; Department of Cardiovascular Medicine, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Fang N; Department of General Practice, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Du X; Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: duxihao@sjtu.edu.cn., Huang S; Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China. Electronic address: sf-huang@163.com.
Source: Ecotoxicology and environmental safety [Ecotoxicol Environ Saf] 2025 Oct 15; Vol. 305, pp. 119203. Date of Electronic Publication: 2025 Oct 13.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 7805381 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1090-2414 (Electronic) Linking ISSN: 01476513 NLM ISO Abbreviation: Ecotoxicol Environ Saf Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam, Netherlands : Elsevier
MeSH Terms: Particulate Matter*/adverse effects , Particulate Matter*/analysis , Death, Sudden, Cardiac*/epidemiology , Death, Sudden, Cardiac*/etiology , Air Pollutants*/analysis , Air Pollutants*/adverse effects , Environmental Exposure*/statistics & numerical data , Environmental Exposure*/adverse effects, China/epidemiology ; Humans ; Male ; Cross-Over Studies ; Female ; Middle Aged ; Aged ; Adult ; Young Adult
Abstract: Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Background: Fine particulate matter (PM 2.5 ) is a known trigger for acute cardiac events, but the specific constituents driving the risk for sudden cardiac death (SCD) remain unclear. This study aimed to identify these key constituents.
Methods: This time-stratified case-crossover study included 19,501 SCD cases in Fujian Province, China (2013-2023). Daily exposures to PM 2.5 and its major constituents were estimated using high-resolution satellite-derived data. A comprehensive strategy including two-pollutant, constituent-residual, and source apportionment models was employed to address multicollinearity among pollutants. Exposure-response and stratified analyses were also performed.
Results: Short-term exposure to PM 2.5 and its constituents was associated with an increased risk of SCD, especially for sulfate (SO 42- ) (odds ratio [OR] = 1.05, 95 % confidence interval [CI]: 1.03-1.08). Multicollinearity analyses showed that only the SO 42- association remained robust, statistically attenuating effects of other constituents and of total PM 2.5 mass. Source apportionment linked SCD risk primarily to the secondary inorganic aerosol source, for which SO 42- is a key marker. Exposure-response curves for inorganic ions were non-linear. While subgroup differences were not statistically significant, higher risks were observed for males, older adults, individuals with lower educational levels, and during cold months. Associations for most pollutants, particularly for SO 42- , appeared stronger in 2021-2023 despite declining average concentrations.
Conclusion: Short-term exposure to PM 2.5 constituents is a significant risk factor for SCD. SO 42- is proved to be a primary driver of this association. The findings indicate that the acute cardiac toxicity of PM 2.5 is determined more by its specific chemical composition than by total particle mass.
(Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)
Contributed Indexing: Keywords: Air pollution epidemiology; Case-crossover study; Fine particulate matter; Fine particulate matter constituents; Sudden cardiac death
Substance Nomenclature: 0 (Particulate Matter)
0 (Air Pollutants)
Entry Date(s): Date Created: 20251014 Date Completed: 20251104 Latest Revision: 20251108
Update Code: 20251108
DOI: 10.1016/j.ecoenv.2025.119203
PMID: 41086695
Database: MEDLINE
Description
Abstract:Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br />Background: Fine particulate matter (PM <subscript>2.5</subscript> ) is a known trigger for acute cardiac events, but the specific constituents driving the risk for sudden cardiac death (SCD) remain unclear. This study aimed to identify these key constituents.<br />Methods: This time-stratified case-crossover study included 19,501 SCD cases in Fujian Province, China (2013-2023). Daily exposures to PM <subscript>2.5</subscript> and its major constituents were estimated using high-resolution satellite-derived data. A comprehensive strategy including two-pollutant, constituent-residual, and source apportionment models was employed to address multicollinearity among pollutants. Exposure-response and stratified analyses were also performed.<br />Results: Short-term exposure to PM <subscript>2.5</subscript> and its constituents was associated with an increased risk of SCD, especially for sulfate (SO <subscript>4</subscript><sup>2-</sup> ) (odds ratio [OR] = 1.05, 95 % confidence interval [CI]: 1.03-1.08). Multicollinearity analyses showed that only the SO <subscript>4</subscript><sup>2-</sup> association remained robust, statistically attenuating effects of other constituents and of total PM <subscript>2.5</subscript> mass. Source apportionment linked SCD risk primarily to the secondary inorganic aerosol source, for which SO <subscript>4</subscript><sup>2-</sup> is a key marker. Exposure-response curves for inorganic ions were non-linear. While subgroup differences were not statistically significant, higher risks were observed for males, older adults, individuals with lower educational levels, and during cold months. Associations for most pollutants, particularly for SO <subscript>4</subscript><sup>2-</sup> , appeared stronger in 2021-2023 despite declining average concentrations.<br />Conclusion: Short-term exposure to PM <subscript>2.5</subscript> constituents is a significant risk factor for SCD. SO <subscript>4</subscript><sup>2-</sup> is proved to be a primary driver of this association. The findings indicate that the acute cardiac toxicity of PM <subscript>2.5</subscript> is determined more by its specific chemical composition than by total particle mass.<br /> (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)
ISSN:1090-2414
DOI:10.1016/j.ecoenv.2025.119203