Long-term exposure to fine particulate matter and cardiovascular disease: The mitigation role of environmental concerns

Although it is widely acknowledged that environmental concerns can reduce PM2.5 pollution, few studies have empirically estimated whether environmental concerns could bring health benefits by mitigating PM2.5 pollution. Here, we quantified government and media environmental concerns with text-mining algorithm, matched with cohort data along with high-resolution gridded PM2.5 data. Accelerated failure time model and mediation model were used to explore the association between PM2.5 exposure and onset time to cardiovascular events, and the mitigation effect of environmental concerns. Every 1 μg/m3 increase in PM2.5 exposure was associated with shortened time to stroke and heart problem, with time ratios of 0.9900 and 0.9986, respectively. Each 1 unit increase in government and media environmental concerns, as well as their synergistic effect decreased PM2.5 pollution by 0.32 %, 0.25 % and 0.46 %, respectively; and decrease PM2.5 resulted in prolonged onset time to cardiovascular events. Mediation analysis revealed that reduced PM2.5 mediated up to 33.55 % of the association between environmental concerns and onset time to cardiovascular events, suggesting that other mediation pathways were also possible. Associations of PM2.5 exposure and environmental concerns with stroke and heart problem were similar in different subgroups. Overall, environmental concerns reduce risks of cardiovascular disease by mitigating PM2.5 pollution and other pathways in a real-world data set. This study provides insights for low-and-middle-income countries to address air pollution and improve health co-benefit.