Jul 2026· Journal of Exposure Science and Environmental Epidemiology· 0 citations· 20 references
Medicine
TL;DR
Positive associations between long-term exposure to NO2 and CKD incidence were greater in never smokers than in ever-smokers, and stronger associations among never-smokers suggest that environmental exposures may independently influence kidney health.
Abstract
Background
Air pollution is an established risk factor for cardiovascular and metabolic diseases, but evidence on chronic kidney diseases (CKD) remains limited.
Objective
We aim to examine the association between long-term exposure to air pollutants and CKD incidence.
Methods
We followed 24,581 female nurses from the Danish Nurse Cohort, recruited in 1993 or 1999, for their first-ever hospital contact with a primary or secondary CKD diagnosis until 2018. We estimated annual mean levels of particulate matter with a diameter < 2.5 µm (PM2.5) and 10 µm (PM10), nitrogen dioxide (NO2), and black carbon (BC) at nurses' residential addresses using the DEHM/UBM/AirGIS modeling system. We used Cox regression models to examine the association of 14-year running means of air pollutants with CKD incidence and to explore the effect modification of this association by lifestyles.
Results
Over 521,211 person-years of follow-up, 429 nurses developed CKD. We found positive associations of modest magnitude between long-term exposure to air pollutants and CKD, with hazard ratios (95% confidence intervals) per interquartile range: 1.18 (0.93-1.50) per 2.86 µg/m3 for PM2.5, 1.14 (0.93-1.40) per 3.33 µg/m3 for PM10, 1.13 (0.99-1.28) per 8.09 µg/m3 for NO2, and 1.09 (1.00-1.20) per 0.34 µg/m3 for BC. The associations between long-term exposure to NO2 and CKD incidence were greater in never smokers than in ever-smokers. Associations with NO2 and BC remained unchanged in two-pollutant models, whereas those with PM10 and PM2.5 attenuated.
Significance
Our study adds important new findings to the growing evidence suggesting that air pollution may be associated with CKD incidence.
IMPACT STATEMENT
This study provides longitudinal evidence that long-term exposure to ambient air pollution contributes to chronic kidney disease (CKD) incidence, even in a relatively healthy occupational cohort and at comparatively low pollution levels. Although effect sizes were modest, consistent positive associations, particularly for NO2 and black carbon, highlight traffic-related pollution as a potential renal risk factor. Stronger associations among never-smokers suggest that environmental exposures may independently influence kidney health. These findings reinforce the need to integrate air pollution into CKD risk assessment and prevention strategies. Strengthening air quality policies and reducing long-term residential exposure could help lower CKD burden and protect kidney health at the population level.
BACKGROUND
The association between air pollutants and mortality from chronic kidney disease (CKD) remains to be further investigated. This study aims to examine the impact of air pollutant exposure on CKD mortality in individuals.
METHODS
This study utilized an individual-level, time-stratified case-crossover design to evaluate the association between short-term exposure to air pollutants (PM2.5, SO2, O3, and NO2) and mortality from CKD. The deceased population was identified from the mortality surveillance data of the Zhejiang Provincial Center for Disease Control and Prevention. For each decedent, we collected air pollutant concentrations on the day of death (case day) and on matched control days within the same month. This design inherently controls confounding factors such as age, place of residence, and seasonality.
RESULTS
The study found that short-term exposure to all four air pollutants was associated with an increased risk of CKD mortality. The excess risk (ER) per interquartile range (IQR) increase in pollutant concentrations was evaluated across different lag periods. Using multi-day moving average lags (calculated as the mean exposure from the current day up to the specified preceding day), the most prominent ERs were observed for PM2.5 at lag02 (ER: 15.16%, 95% CI: 12.69-17.68), SO2 at lag03 (ER: 8.80%, 95% CI: 5.95-11.72), O3 at lag01 (ER: 5.67%, 95% CI: 2.07-9.39), and NO2 at lag03 (ER: 13.66%, 95% CI: 9.12-18.39). After adjusting for interactions with other pollutants, the associations for SO2 and PM2.5 remained significant. Additionally, the study found that this association was influenced by factors such as marriage, and season (cold vs. warm).
CONCLUSIONS
This study revealed a significant association between short-term exposure to air pollutants and CKD mortality in the population of Zhejiang Province. These findings provide novel evidence for understanding the impact of environmental factors on kidney disease and suggest a need for governmental authorities to enhance the monitoring and control of air pollution to mitigate the health burden on the elderly.
P. Dai, Xiaoyan Zhou, Weiwei Gong et al.· BMC Nephrology· 0 citations
The substantial burden of cardiovascular disease (CVD) attributable to air pollution remains a critical public health challenge, yet its combined effect with cardiometabolic factors is not fully understood. This study leveraged data from the Global Burden of Disease Study (GBD) and the China High Air Pollutants (CHAP) database to evaluate the CVD burden attributable to air pollution, which was found to increase progressively with age. We conducted a cross-sectional analysis using baseline (2011) data from 7420 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS), and a prospective cohort analysis in 8792 participants followed through 2020. In the longitudinal analysis, long-term exposure to PM2.5 (HR = 1.09, 95% CI: 1.03–1.16) and PM10 (HR = 1.07, 95% CI: 1.04–1.10) was significantly associated with an elevated risk of incident CVD, whereas the association for NO2 was nominally significant (HR = 1.12, 95% CI: 1.00–1.24) and that for O3 was not statistically significant (HR = 1.08, 95% CI: 0.93–1.27). Furthermore, prolonged exposure to these pollutants was associated with a higher prevalence of hypertension, diabetes, dyslipidemia, and obesity, and with adverse levels of metabolic indicators, including the TyG, TyG-BMI, and TyG-WC indices. A random forest model showed modest discrimination for incident CVD (AUC = 0.656), identifying PM10 and PM2.5 as the most important predictors. In conclusion, long-term exposure to ambient air pollution, particularly particulate matter, is associated with an increased risk of CVD and cardiometabolic disorders in middle-aged and older Chinese adults.
Xuehua Wang, Zhaohui Wang, Yan Wang· Bioengineering· 0 citations
Air pollution at least 4 years before hospitalization may increase the odds of hospitalization with Parkinson’s Disease, and reducing air pollution exposure may have long-term effects on PD prevention.
Scott W. Delaney, Lauren Mock, Veronica A. Wang et al.· Environmental Epidemiology· 0 citations
A marginally increased risk for PD is observed after higher levels of exposure to O 3 (OR 1.03, 95% CI 1.00-1.06 per IQR) for exposure 6–16 years before the index date, suggesting a possible role of ozone in PD development even at low exposure levels, which requires further studies.
I. Rumrich, A. Korhonen, L. Frohn et al.· npj Parkinson's Disease· 0 citations
INTRODUCTION
Air pollution is a leading environmental risk factor for cardiovascular disease (CVD), yet its relationship with metabolic syndrome (MetS) and its components in sub-Saharan Africa are unclear. This study aimed to examine the association between long-term PM2.5 exposure and MetS (and its component conditions) in a Ghanaian adult cohort.
METHODS
We performed a cross-sectional analysis of 1,833 adults (40-60 years) from the Awi-Gen study. Long-term PM2.5 exposure (2007-2015) was estimated via a satellite-based model. MetS was defined using harmonized criteria. We used multivariable logistic regression with sequential adjustment for covariates.
RESULTS
A positive association was observed between PM2.5 and hypertension, while no association was found for MetS overall or its component conditions. Each 1 μg/m3 increase in PM2.5 was associated with 6% higher odds of hypertension (OR: 1.06, 95% CI: 1.02-1.11). PM2.5 quartiles also showed a dose-response relationship with hypertension (p-trend=0.003), with the highest exposure linked to a 50% greater likelihood of hypertension. The calculated population attributable fraction for PM2.5 and hypertension was 18.6%.
INTERPRETATION
In this rural Ghanaian population, long-term PM2.5 exposure was associated with hypertension but not with metabolic syndrome or its other components. These findings provide important evidence from an understudied sub-Saharan African population and support the integration of air quality management into cardiovascular disease prevention strategies.
Ali Moro, E. Nonterah, Godfred Agongo et al.· Environmental Research· 0 citations
The study on DM-2 incidence does not support the previously identified associations between environmental exposures and DM-2 prevalence, and a wide range of environmental exposures were not associated with DM-2 incidence.
A. P. Smit, B. Loef, J. Klompmaker et al.· Environmental Research· 0 citations
