Abstract
Background
Cardiovascular disease (CVD) is the predominant cause of global mortality, has been growingly linked to air pollution, which paradoxically aligns with economic growth. This study aims to examine the trends and patterns in CVD mortality caused by air pollution.
Methods
This study uses data from the State-Level Disease Burden Initiative in India, from 1990 to 2019. Age-standardized death rates were examined through the application of joinpoint regression analysis, while the impact of air pollution on CVD mortality was assessed by estimating the combined effects of age, period, and cohort using age-period-cohort (APC) analysis.
Results
Relative risks are notably low across genders at younger ages, with males at 0.09 (95% CI: 0.08-0.10) and females at 0.11 (95% CI: 0.10-0.12) at 25-29 years, which increases with age, with individuals aged 85-95 years facing the highest risk. Period effect shows that the risk of deaths due to air pollution increased in 2015-19 compared to 2000-04. Deaths attributable to ambient particulate matter pollution exhibit a net increasing trend with an average annual percent change (AAPC) of 1.13 (95% CI 0.98-1.3). Deaths from household air pollution consistently show a significant downward trend, with an AAPC of -3.62 (95% CI -3.79 to -3.4).
Conclusion
Enhanced and region-specific air quality management strategies, including ambient and household air pollution controls, can provide substantial public health benefits and aid in the country's economic advancement.
Keywords:
global burden of disease study, GBD, air pollution, cardiovascular disease, age-period-cohort, joinpoint regression, IndiaReferences
World Health Organization. Cardiovascular diseases (CVDs). Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds); 2021. Accessed July 2, 2024.
Rajagopalan S, Landrigan PJ. Pollution and the Heart. N Engl J Med. 2021;385(20):1881-92.
World Health Organization. Household air pollution.ed 15 December 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health; 2023. Accessed July 2, 2024.
Collaborators GBDRF. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2162-203.
Collaborators GBDRF. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49.
India State-Level Disease Burden Initiative Air Pollution C. Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019. Lancet Planet Health. 2021;5(1):e25-e38.
Chakraborty P, Gadhavi H, Prithiviraj B, Mukhopadhyay M, Khuman SN, Nakamura M, et al. Passive Air Sampling of PCDD/Fs, PCBs, PAEs, DEHA, and PAHs from Informal Electronic Waste Recycling and Allied Sectors in Indian Megacities. Environ Sci Technol. 2021;55(14):9469-78.
Chandra S, Chakraborty P. Air-water exchange and risk assessment of phthalic acid esters during the early phase of COVID-19 pandemic in tropical riverine catchments of India. Chemosphere. 2023;341:140013.
GBD MAPS Working Group. Burden of Disease Attributable to Major Air pollution Sources in India. Boston, Massachusetts: Health Effects Institute; 2018.
Ye W, Thangavel G, Pillarisetti A, Steenland K, Peel JL, Balakrishnan K, et al. Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India. Environ Res. 2022;208:112756.
Arku RE, Birch A, Shupler M, Yusuf S, Hystad P, Brauer M. Characterizing exposure to household air pollution within the Prospective Urban Rural Epidemiology (PURE) study. Environ Int. 2018;114:307-17.
Balakrishnan K, Sankar S, Parikh J, Padmavathi R, Srividya K, Venugopal V, et al. Daily average exposures to respirable particulate matter from combustion of biomass fuels in rural households of southern India. Environ Health Perspect. 2002;110(11):1069-75.
Kalra A, Jose AP, Prabhakaran P, Kumar A, Agrawal A, Roy A, et al. The burgeoning cardiovascular disease epidemic in Indians - perspectives on contextual factors and potential solutions. Lancet Reg Health Southeast Asia. 2023;12:100156.
Sajith Kumar S, Sasidharan A, Bagepally BS. Air Pollution and Cardiovascular Disease Burden: Changing Patterns and Implications for Public Health in India. Heart Lung Circ. 2023;32(1):90-4.
Nicolaou L, Underhill L, Hossen S, Simkovich S, Thangavel G, Rosa G, et al. Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial. Environ Res. 2022;214(Pt 4):114121.
Motairek I, Ajluni S, Khraishah H, AlAhmad B, Al-Dulaimi S, Abi Khalil C, et al. Burden of cardiovascular disease attributable to particulate matter pollution in the eastern Mediterranean region: analysis of the 1990-2019 global burden of disease. Eur J Prev Cardiol. 2023;30(3):256-63.
Wang T, Ma Y, Li R, Sun J, Huang L, Wang S, et al. Trends of ischemic heart disease mortality attributable to household air pollution during 1990-2019 in China and India: an age-period-cohort analysis. Environ Sci Pollut Res Int. 2022;29(58):87478-89.
Abdul-Rahman T, Roy P, Bliss ZSB, Mohammad A, Corriero AC, Patel NT, et al. The impact of air quality on cardiovascular health: A state of the art review. Curr Probl Cardiol. 2024;49(2):102174.
Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335-51.
Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards BK. Estimating average annual per cent change in trend analysis. Stat Med. 2009;28(29):3670-82.
Yang Y, Schulhofer-Wohl S, Fu WJ, Land KC. The intrinsic estimator for age-period-cohort analysis: what it is and how to use it. Am J Sociol. 2008;113(6):1697-736.
Li C, Yu C, Wang P. An age-period-cohort analysis of female breast cancer mortality from 1990-2009 in China. Int J Equity Health. 2015;14:76.
Taghian G, Fisher S, Chiles TC, Binagwaho A, Landrigan PJ. The Burden of Cardiovascular Disease from Air Pollution in Rwanda. Ann Glob Health. 2024;90(1):2.
Liu YH, Bo YC, You J, Liu SF, Liu MJ, Zhu YJ. Spatiotemporal trends of cardiovascular disease burden attributable to ambient PM(2.5) from 1990 to 2019: A global burden of disease study. Sci Total Environ. 2023;885:163869.
Cohen AJ, Brauer M, Burnett R, Anderson HR, Frostad J, Estep K, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet. 2017;389(10082):1907-18.
Adekoya A, Tyagi SK, Duru CN, Satia I, Paudyal V, Kurmi OP. Effects of Household Air Pollution (HAP) on Cardiovascular Diseases in Low- and Middle-Income Countries (LMICs): A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(15).
de Bont J, Jaganathan S, Dahlquist M, Persson A, Stafoggia M, Ljungman P. Ambient air pollution and cardiovascular diseases: An umbrella review of systematic reviews and meta-analyses. J Intern Med. 2022;291(6):779-800.
Nair M, Bherwani H, Mirza S, Anjum S, Kumar R. Valuing burden of premature mortality attributable to air pollution in major million-plus non-attainment cities of India. Sci Rep. 2021;11(1):22771.
David LM, Ravishankara AR, Kodros JK, Pierce JR, Venkataraman C, Sadavarte P. Premature Mortality Due to PM(2.5) Over India: Effect of Atmospheric Transport and Anthropogenic Emissions. Geohealth. 2019;3(1):2-10.
Chen R, Yin P, Meng X, Liu C, Wang L, Xu X, et al. Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities. Am J Respir Crit Care Med. 2017;196(1):73-81.
Yang BY, Qian Z, Howard SW, Vaughn MG, Fan SJ, Liu KK, et al. Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis. Environ Pollut. 2018;235:576-88.
Fougere B, Vellas B, Billet S, Martin PJ, Gallucci M, Cesari M. Air Pollution modifies the association between successful and pathological aging throughout the frailty condition. Ageing Res Rev. 2015;24(Pt B):299-303.
Yang BY, Guo Y, Morawska L, Bloom MS, Markevych I, Heinrich J, et al. Ambient PM(1) air pollution and cardiovascular disease prevalence: Insights from the 33 Communities Chinese Health Study. Environ Int. 2019;123:310-7.
Downward GS, Vermeulen R, Asia Cohort Consortium Executive B. Ambient Air Pollution and All-Cause and Cause-Specific Mortality in an Analysis of Asian Cohorts. Res Rep Health Eff Inst. 2023;2016(213):1-53.
Mumtaz A, Rehman N, Haider A, Rehman S. Long-Term Air Pollution Exposure and Ischemic Heart Disease Mortality Among Elderly in High Aging Asian Economies. Front Public Health. 2021;9:819123.
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Copyright (c) 2024 Somen Das, Neha Shri, Paromita Chakraborty, Indramani Dhada, Atin Adhikari, Krishnamurthi Kannan, Pratap Kumar Padhy
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