Short-Term Exposure to Ambient Air Pollution and Mortality From Myocardial Infarction

Short-term exposure to ambient air pollution has been linked to occurrence of myocardial infarction (MI); however, only a limited number of studies investigated its association with death from MI, and the results remain inconsistent. This study sought to investigate the association of short-term exposure to air pollution across a wide range of concentrations with MI mortality. A time-stratified case-crossover study was conducted to investigate 151,608 MI death cases in Hubei province (China) from 2013 to 2018. Based on each case’s home address, exposure to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide, nitrogen dioxide (NO2), carbon monoxide, and ozone on each of the case and control days was assessed as the inverse distance–weighted average concentration at neighboring air quality monitoring stations. Conditional logistic regression models were implemented to quantify exposure-response associations. Exposure to PM2.5, PM10, and NO2 (mean exposure on the same day of death and 1 day prior) was significantly associated with increased odds of MI mortality. The odds associated with PM2.5 and PM10 exposures increased steeply before a breakpoint (PM2.5, 33.3 μg/m3; PM10, 57.3 μg/m3) and flattened out at higher exposure levels, while the association for NO2 exposure was almost linear. Each 10-μg/m3 increase in exposure to PM2.5 (<33.3 μg/m3), PM10 (<57.3 μg/m3), and NO2 was significantly associated with a 4.14% (95% confidence interval [CI]: 1.25% to 7.12%), 2.67% (95% CI: 0.80% to 4.57%), and 1.46% (95% CI: 0.76% to 2.17%) increase in odds of MI mortality, respectively. The association between NO2 exposure and MI mortality was significantly stronger in older adults. Short-term exposure to PM2.5, PM10, and NO2 was associated with increased risk of MI mortality.