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

Abstract 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 (PM 2.5 ) 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 PM 2.5 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/m 3 increase in PM 2.5 , 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 PM 2.5 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 PM 2.5 exposure and emphasize the crucial role of environmental governance in promoting public health outcomes.