Diet is a modifiable risk factor for cognitive decline, yet evidence regarding the association between plant-based diets and cognitive aging remains limited. We examined the association between plant-based diets and cognitive decline among older adults from China. A total of 6,721 participants (mean age: 81.41 ± 10.40 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Dietary intake was assessed using a simplified food frequency questionnaire to derive the plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). Global cognitive function and six specific domains were assessed using the Mini-Mental State Examination (MMSE). Z-scores were calculated using baseline mean and standard deviation. Linear mixed-effects models and Cox proportional hazards models were used to evaluate the associations between plant-based diet indices and cognitive decline and impairment. Over 6.07 years of follow-up, 1,580 participants developed cognitive impairment. Participants in the highest tertiles of PDI and hPDI exhibited 32.04

Nickel exposure may increase the risk of adverse health outcome, but population-based data linking it to mortality in older adults are inconsistent and limited, especially neurological mortality. We enrolled 9727 adults aged 60 years and older from two cohorts. Urinary nickel levels were quantified via inductively coupled plasma mass spectrometry (ICP-MS). Participants (enrolled 2017/2018) were followed until death or December 31, 2024. The Kaplan-Meier (KM) method was used to analyze survival associations between urinary nickel and mortality. Cox proportional hazards models were applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Restricted cubic splines (RCS) were used to assess dose-response relationships, and subgroup analyses were performed to identify susceptible populations and potential effect modifiers. Over 4.75 years (mean follow-up), 2740 deaths (28.7%) occurred (1344 cardiovascular, 288 cancer, 312 respiratory, 163 neurological). A positive association was observed between higher urinary nickel levels and elevated risks of all-cause mortality (2.0% [0.8%-3.2%] per 1 μg/L increase) and neurological mortality (12.3% [8.4%-16.3%]). Dose-response analyses revealed a nonlinear inverted J-shaped pattern for all-cause and a non-monotonic upward pattern for neurological mortality. Subgroup analyses identified the oldest-old, women, and Han Chinese individuals as particularly susceptible to all-cause mortality, while neurological mortality risks were elevated across sexes, with the oldest-old and Han Chinese at higher risk. Refined neurological mortality analysis confirmed that each 1 μg/L increase in urinary nickel was significantly associated with higher mortality risks from AD (HR = 1.164, 95% CI: 1.029-1.316), other neurodegenerative diseases (NDD; HR = 1.120, 95% CI: 1.078-1.164), and non-NDD neurological diseases (HR = 1.135, 95% CI: 1.014-1.271). In conclusion, higher urinary nickel levels were associated with increased all-cause and neurological mortality, supporting nickel's role as a neurotoxicant. These findings demonstrate the public health risks of nickel exposure in aging populations, necessitating targeted interventions to reduce exposure in vulnerable groups.

Lower socioeconomic status (SES) is associated with various adverse health outcomes, but its association with healthy ageing is less known, and whether adherence to a healthy lifestyle at late-life years can reduce socioeconomic disparities in health requires further investigation. In a 20-year cohort of 33,541 older adults aged ≥65 years across 23 provinces in China, we investigated socioeconomic disparities in mortality and unhealthy ageing considering physical, cognitive, mental, visual, and hearing functions, and evaluated whether adherence to a healthy lifestyle at late-life years can reduce these health disparities. We categorized SES into low, medium, or high using latent class analysis based on education level, financial status, and occupation, and established the healthy lifestyle score by never smoking, no heavy alcohol consumption, regular physical and leisure activity, and a healthy diet. Compared with older adults of high SES, those of low SES had increased risks of all-cause mortality and unhealthy ageing, with adjusted hazard ratios (HR) and 95% confidence intervals (CI) of 1.25 (1.17, 1.33) and 1.46 (1.33, 1.60), respectively. Overall, a healthy lifestyle mediated 20.5% (16.4, 24.7) and 16.4% (12.0, 20.9) of socioeconomic inequity in all-cause mortality and unhealthy ageing, respectively. In low, medium, and high SES subpopulations, the healthiest lifestyle group had 3.18 (2.69, 3.67), 3.76 (2.85, 4.67), and 5.65 (3.75, 7.55) more years of total life expectancy, and 1.40 (1.06, 1.74), 2.73 (2.09, 3.37), and 3.90 (2.64, 5.16) more years of healthy life expectancy at age 65, respectively, compared to the least healthy group. The findings underscored the urgent need for tailored, accessible interventions in low-SES populations to mitigate health inequities and reinforced the importance of healthy lifestyle promotion, even at late-life years, for healthy ageing and longevity.

Objective:This study aimed to evaluate the relationships of white blood cell (WBC) count, platelet (PLT) count, and PLT-to-WBC ratio (PWR) with muscle mass in Chinese older adults. Methods:This cross-sectional analysis involved 4,033 Chinese older adults aged ≥ 65 years from the Healthy Ageing and Biomarkers Cohort Study. Muscle mass and total skeletal muscle mass index (TSMI) were measured by bioelectric impedance analysis. WBC, PLT, and PWR were measured using standard methods. Multivariate linear regression was used to examine the associations of WBC count, PLT count, and PWR with TSMI. Results:High WBC count, PLT count, and PWR were associated with low TSMI, with coefficients of -0.0091 (95% confidence interval [ CI]: -0.0142 to -0.0041), -0.0119 (95% CI: -0.0170 to -0.0068), and -0.0051 (95% CI: -0.0102 to -0.0001). The associations between the three inflammatory indices and TSMI were linear. Stratified analyses indicated that the relationship between inflammatory markers and TSMI was more evident in male participants and in individuals aged < 80 years than in their counterparts. Conclusion:Elevated WBC count, PLT count, and PWR correlated with muscle mass loss. This study highlights the importance of regular monitoring of inflammatory markers as a potential strategy for the screening and management of sarcopenia in older adults.

Body mass index(BMI)is widely recognized as a reasonably good measure of general adiposity and an important predictor of mortality risk[1].Meta-analyses of cohort studies[2]have demon-strated a"U"or"J"-shaped correlation,wherein both low and high BMI values are associated with an increased risk of mortality.

What is already known about this topic?:Antimony (Sb) has been identified as a new neurotoxicant that impacts neurological functions in animal studies. However, its effects on the human population remain unknown. What is added by this report?:The study reveals that there is an association between exposure to Sb and a higher incidence of cognitive impairment in older adults. The dose-response curve demonstrates that the risk of cognitive impairment consistently increased with higher levels of Sb exposure without a discernible threshold. What are the implications for public health practice?:Reducing exposure to Sb may have a beneficial effect in delaying or preventing the onset of cognitive impairment. This intervention has the potential to significantly decrease the disease burden associated with cognitive impairment, ultimately contributing to social development.

Objective The associations between plasma vitamin B 12 level and anemia under different dietary patterns in elderly Chinese people are poorly understood. We aimed to examine the associations between plasma vitamin B 12 levels and anemia under different dietary patterns in adults aged 65 years and older in nine longevity areas in China. Methods A total of 2405 older adults completed a food frequency questionnaire at the same time as a face-to-face interview. The dietary diversity score (DDS) was assessed based on the food frequency questionnaire, with the low DDS group referring to participants with a DDS score ≤ 4 points. Vitamin B 12 levels were divided into two groups of high (>295 pg/mL) and low (≤ 295 pg/mL) with the median used as the cut-off point. Sub-analyses were also performed on older adults divided into tertiles of vitamin B 12 levels: low (< 277 pg/mL), medium (277–375 pg/mL) and high (> 375 pg/mL) to study the association of these levels with anemia. Results Six hundred ninety-five (28.89%) of these people were diagnosed with anemia and had a mean age of 89.3 years. Higher vitamin B 12 levels were associated with a decreased risk of anemia (multi-adjusted OR, 0.59, [95% CI, 0.45 ~ 0.77] P < 0.001) in older adults with a low DDS, whereas no significant association between vitamin B 12 levels and anemia was found in older adults with a high DDS in a full-model after adjustment for various confounding factors (multi-adjusted OR, 0.88, [95% CI, 0.65 ~ 1.19], P = 0.41). Conclusion The relationship between vitamin B 12 levels and the prevalence of anemia was significant only when the level of dietary diversity in the older adults was relatively low. The dietary structure of the population should be taken into consideration in combination in order to effectively improve anemia status by supplementing vitamin B 12 .

BACKGROUND AND AIMS:Emerging evidence has raised an obesity paradox in observational studies of body mass index (BMI) and health among the oldest-old (aged ≥80 years), as an inverse relationship of BMI with mortality was reported. This study was to investigate the causal associations of BMI, waist circumference (WC), or both with mortality in the oldest-old people in China. METHODS:A total of 5306 community-based oldest-old (mean age 90.6 years) were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 1998 and 2018. Genetic risk scores were constructed from 58 single-nucleotide polymorphisms (SNPs) associated with BMI and 49 SNPs associated with WC to subsequently derive causal estimates for Mendelian randomization (MR) models. One-sample linear MR along with non-linear MR analyses were performed to explore the associations of genetically predicted BMI, WC, and their joint effect with all-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality. RESULTS:During 24 337 person-years of follow-up, 3766 deaths were documented. In observational analyses, higher BMI and WC were both associated with decreased mortality risk [hazard ratio (HR) 0.963, 95% confidence interval (CI) 0.955-0.971 for a 1-kg/m2 increment of BMI and HR 0.971 (95% CI 0.950-0.993) for each 5 cm increase of WC]. Linear MR models indicated that each 1 kg/m2 increase in genetically predicted BMI was monotonically associated with a 4.5% decrease in all-cause mortality risk [HR 0.955 (95% CI 0.928-0.983)]. Non-linear curves showed the lowest mortality risk at the BMI of around 28.0 kg/m2, suggesting that optimal BMI for the oldest-old may be around overweight or mild obesity. Positive monotonic causal associations were observed between WC and all-cause mortality [HR 1.108 (95% CI 1.036-1.185) per 5 cm increase], CVD mortality [HR 1.193 (95% CI 1.064-1.337)], and non-CVD mortality [HR 1.110 (95% CI 1.016-1.212)]. The joint effect analyses indicated that the lowest risk was observed among those with higher BMI and lower WC. CONCLUSIONS:Among the oldest-old, opposite causal associations of BMI and WC with mortality were observed, and a body figure with higher BMI and lower WC could substantially decrease the mortality risk. Guidelines for the weight management should be cautiously designed and implemented among the oldest-old people, considering distinct roles of BMI and WC.

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Abstract Background: Residual Cholesterol (RC), similar to triglycerides, is recognized as an underlying mortality risk factor in the general adults,but it is unknown whether risks also increase with advancing age. Evidence regarding the effect of RC on cause-specific mortality risk among older adults, specifically the oldest old (80 years and above), are lacking. Methods: We encompassed 4,289 Chinese older adults from the Healthy Aging and Biomarkers Cohort Study (a prospective, community-based cohort study, 2008–2021). RC was calculated using the formula of fasting total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. The Cox proportional hazards models and Fine-Gray’s semi-parametric method for competing risks analysis were used to estimate the association between RC and all-cause and cause-specific mortality risk, respectively. Results: As compared with participants in the lowest tertile RC group, the adjusted hazard ratio (HR) for those in the highest tertile were 0.868 (95% CI: 0.784–0.960) for all-cause mortality. A significant inverse linear relationship between RC levels and the risk of all-cause mortality, indicating a consistent decrease in risk until a threshold of 0.88 mmol/L is reached. An increment of 0.1 mmol/L of RC was associated with a reduction of 3.4% in all-cause mortality risk and a 5.6% decrease in non-CVD mortality. The inverse linear association remained significant for the oldest old, but not younger older adults. Conclusions: In the oldest old, a higher concentration of RC was associated with a lower risk of all-cause and non-CVD mortality. The paradoxical association between higher RC and lower risk of mortality risk among the oldest old suggests that cholesterol-lowering therapy should be carefully considered for the oldest old with elevated concentrations of RC, as it may provide little to no benefit and could even be potentially harmful.

Introduction: About half of adults aged ≥80 years suffer from frailty. Exercise is considered effective in preventing frailty but may be inapplicable to adults aged ≥80 years due to physical limitations. As an alternative, we aimed to explore the association of leisure activities with frailty and identify potential interaction with established polygenic risk score (PRS) among adults aged ≥80 years. Methods: Analyses were performed in a prospective cohort study of 7,471 community-living older adults aged ≥80 years who were recruited between 2002 and 2014 from 23 provinces in China. Leisure activity was assessed using a seven-question leisure activity index and frailty was defined as a frailty index ≥0.25 using a validated 39-item health-related scale. The PRS was constructed using 59 single-nucleotide polymorphisms associated with frailty in a subsample of 2,541 older adults. Cox proportional hazards models were used to explore the associations of leisure activities, PRS with frailty. Results: The mean age of participants was 89.4 ± 6.6 years (range: 80–116). In total, 2,930 cases of frailty were identified during 42,216 person-years of follow-up. Each 1 unit increase in the leisure activity index was associated with 12% lower risk of frailty (hazard ratio: 0.88 [95% confidence interval, 0.85–0.91]). Participants with high genetic risk (PRS >2.47 × 10−4) suffered from 26% higher risk of frailty. Interaction between leisure activity and genetic risk was not observed. Conclusion: Evidence is presented for the independent association of leisure activities and genetic risk with frailty. Engagement in leisure activities is suggested to be associated with lower risk of frailty across all levels of genetic risk among adults aged ≥80 years.

Lead (Pb) is a widespread environmental contaminant, associated with a higher risk of functional impairment that can lead to frailty in older adults. However, few studies focused on the association of Pb exposure with frailty among the oldest old (aged ≥ 80 years). In this study, we aimed to assess the associations of Pb with frailty and its components in the oldest old. The included individuals were the oldest old aged ≥ 80 years who participated in a 2017 cross-sectional survey of the Healthy Aging and Biomarkers Cohort Study. Frailty was ascertained by the frailty index, which was created based on health deficits. We used logistic regression models to estimate the association of blood Pb with frailty and its components. The geometric mean and median of blood Pb were 38.51 μg/L and 36.27 μg/L among the oldest old, respectively. Compared with the first quartile of blood Pb, participants in the fourth quartile had higher risk of frailty and its components, the ORs are 1.71 (1.22-2.41), 1.99 (1.35-2.94), 1.91 (1.25-2.93), 1.57 (1.13-2.17) and 1.43 (1.05-1.96), for frailty, ADL disability, IADL disability, functional limitations, and hearing loss in the oldest old, respectively. There was a significant interaction between blood Pb and frailty in different age groups. In conclusion, our findings provide preliminary evidence that higher blood Pb may increase the risk of frailty among the oldest old by increasing the risk of disability in four physical functions: disability in ADL, disability in IADL, functional limitations, and hearing loss.

Depressive symptoms have a significant impact on the quality-of-life among the oldest old (aged ≥ 80 years) in the population. Current research on the association of blood mercury with depressive symptoms has mainly targeted the general population. However, it is unclear whether this association is present in the oldest old. We used data from the Healthy Aging and Biomarker Cohort Study carried out in 2017–2018, with 1154 participants aged ≥ 80 years eligible for analysis. Inductively coupled plasma mass spectrometry (ICP-MS) was employed to detect blood mercury (Hg) levels, while the CES-D10 depression scale was used to assess depressive symptoms. The association between blood mercury levels and depressive symptoms was investigated using log-binomial and Poisson regression models. We also used restricted cubic splines (RCS) to assess the linear or nonlinear association of blood mercury with depressive symptoms scores. The 1154 participants ranged in age from 80 to 120 years, while the geometric mean of blood mercury concentration was 1.01 μg/L. After adjustment for covariates, log-binomial and Poisson regression analyses revealed a statistically significant, positive association of blood mercury with depressive symptoms. In comparison to the first tertile, the adjusted relative risks of blood mercury and the presence of depressive symptoms in the second and third tertiles were 1.55 (1.20–1.99) and 1.45 (1.11–1.90), respectively. The RCS model showed a linear association between blood mercury level and depressive symptoms scores. In conclusion, among the oldest old, we demonstrated that blood mercury levels were positively associated with depressive symptoms. Further surveys, especially cohort studies and clinical trials are needed to confirm these results.

BACKGROUND:The heavy metals cadmium (Cd) and mercury (Hg) are known to be widespread environmental contaminants and high occupational exposure adversely affects the risk of chronic kidney disease (CKD). However, evidence from epidemiological studies linking low Cd and Hg exposure (or non-industrial) to the risk of progression to CKD are conflicting. This study aimed to explore the association of low Cd and Hg exposure with the risk of CKD in Chinese adults aged ≥80 years. METHODS:The participants were recruited for the Healthy Aging and Biomarkers Cohort Study in 2017, an ongoing perspective survey conducted in longevity areas in China initially involving 3016 older adults. We used logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals of CKD setting Cd and Hg as categorical variables. Logistic regression with restricted cubic spline was used to characterize a dose-response relationships between Cd or Hg concentrations and the risk of CKD in the study population. RESULTS:The ORs for the risk of CKD comparing the fourth to the first quartile of blood Cd, blood Hg, urine Cd, and urine Hg were 1.77, 1.57, 2.03, and 1.50, respectively. Restricted cubic spline models showed that blood Cd and urine Hg were significantly linearly correlated with the risk of CKD, while blood Hg and urine Cd were non-linearly correlated with the risk of CKD with a steeper slope at concentrations <2.30 μg/L and 3.30 μg/g creatinine. CONCLUSIONS:Our findings suggest that even low Cd and Hg exposure (or non-industrial) were associated with increased risk of CKD in Chinese oldest old, although we did not find a significant multiplicative and additive interaction between Cd and Hg levels in relation to the risk of CKD.

HomeCirculationVol. 141, No. 25Associations Between Short-Term Exposure to Fine Particulate Matter and Cardiovascular Disease Hospital Admission After Index Myocardial Infarction Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBAssociations Between Short-Term Exposure to Fine Particulate Matter and Cardiovascular Disease Hospital Admission After Index Myocardial InfarctionA Case-Crossover Study Yi Zhang, MPH, Chen Chen, MSc, Zhiying Sun, MPH, Runmei Ma, BAdmin and Tiantian Li, PhD Yi ZhangYi Zhang China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author , Chen ChenChen Chen China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author , Zhiying SunZhiying Sun China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Tianjin Centers for Disease Control and Prevention, Tianjin, China (Z.S.). Search for more papers by this author , Runmei MaRunmei Ma China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author and Tiantian LiTiantian Li Tiantian Li, PhD, China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No. 7 Panjiayuannanli, Chaoyang District, Beijing, China. Email E-mail Address: [email protected] https://orcid.org/0000-0003-2938-3917 China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author Originally published22 Jun 2020https://doi.org/10.1161/CIRCULATIONAHA.119.044149Circulation. 2020;141:2110–2112Several socioeconomic factors, including age, race, marital status, and income, and medical conditions are associated with hospital admission after index myocardial infarction (MI).1 Whether short-term exposure to ambient fine particulate matter (PM2.5) is a potential factor has not been well addressed. Therefore, we aimed to explore the association between short-term PM2.5 exposure and total cardiovascular disease (CVD) or MI admission after index MI.Hospital admission records with the main diagnosis of CVD (International Classification of Diseases, 10th Revision code: I00–I99) were collected from Beijing Municipal Commission of Health and Family Planning Information Center in Beijing, China, from January 1, 2013, to December 31, 2017. All records with MI admission (International Classification of Diseases, 10th Revision code: I21–I23) as the main diagnosis were extracted. Patients with an MI admission who had CVD admission records after the first MI admission, and lived in Beijing for more than half a year before the index MI, were included. This study used deidentified data with a waiver of individual informed consent.Air pollutant concentrations from 35 monitoring stations in Beijing were obtained from Beijing Municipal Environmental Monitoring Center. Daily PM2.5 concentration was averaged across 24 hours and 35 stations to obtain a single daily value. Daily temperature and relative humidity were collected from the Chinese Meteorologic Data Network of the Chinese Meteorologic Bureau.A time-stratified case-crossover design was used. Each patient with MI was recognized as a case during the period at CVD admission after index MI and as a matched control during the period before (or after) CVD admission. For each case, we compared the concentration of PM2.5 exposure during the short-term at and before (or after) CVD admission. We used a 3-day moving average (lag02: –2, –1, 0 [day of the case]) as the exposure window for the case period. The control periods (3 or 4 per case) were matched to the case periods on the same weekday, same month, and same year as the case period, and lag02 was used as the exposure window.2 The one-basis function in the dlnm package in R (version 3.4.2) was used to generate the basis matrices of lag02 PM2.5 concentrations (natural spline, 3 degrees of freedom). Conditional logistic regression models in the survival package in R, stratified by each CVD admission, were then used to model the nonlinear relationship between lag02 PM2.5 concentrations and subsequent CVD admissions. The basis matrices of PM2.5 concentrations (lag02) were introduced in the model as the independent variable. Daily mean temperature (natural spline, 3 degrees of freedom), daily humidity, and holiday were controlled as covariates. The association curves for PM2.5 concentration on CVD admission after index MI were drawn. In addition to the total CVD admission, we used the sensitivity cause of admission (MI) as a dependent variable to rerun the main model. In addition, we split the data set into sex (men/women) and age (<65 years, 65–74 years, 75–84 years, ≥85 years) subgroups and reran the main analysis model. To report the odds ratio value with an interquartile range increase, we reran the conditional logistic models above by using lag02 of PM2.5 concentration as a linear variable instead of the basis matrices. The level of statistical significance was set at 0.05.During the study period, 81 474 patients who lived in Beijing for more than half a year with MI hospital admission history were observed. A total of 30 346 of the patients with MI were admitted for CVD after index MI. Most of the study patients were ≥65 years old (56.3%), and there were more male patients than female patients (68.9% versus 31.1%). A total of 57 738 CVD admission records after index MI were analyzed. The median PM2.5 concentration was found to be 62 μg/m3 (interquartile range, 71 μg/m3). The association curves and odds ratios for associations between short-term exposure to PM2.5 and total CVD or MI admission are shown in the Figure.Download figureDownload PowerPointFigure. Associations between cardiovascular disease admission after index myocardial infarction and an increase of 3-day moving average (lag02) exposure to fine particulate matter (PM2.5).A and B, Odds ratios (ORs) are reported with interquartile range increase. C and D, The lines are the predicted values of the ORs for different PM2.5 concentrations vs the minimum concentration of PM2.5, and the shaded bands are the 95% CIs of the ORs.In the previous study of 5 European cities, with a 10 µg/m3 increase of PM2.5 concentration, the relative risk of cardiac readmissions was 1.02 (95% CI, 1.00–1.04)3; in a study of 26 cities in China, and with an interquartile range (47.5 µg/m3) increase, the relative risk of cardiac readmissions was 1.06 (95% CI, 1.03–1.09).4 Although our estimated odds ratio value (1.04 [95% CI, 0.99–1.10]) with an interquartile range (71 μg/m3) increase is similar to previous studies, we observed no statistically significant association by introducing PM2.5 concentration as a linear variable. However, from the association curves shown in the Figure, significant associations were observed with high concentrations of PM2.5 (about >200 μg/m3) versus the minimum concentration of PM2.5.Although this study has some limitations, such as a lack of disease history before 2013 and potential information bias based on the use of stations for the exposure assessment, this study adds evidence regarding associations between short-term exposure to PM2.5 and total CVD and MI admission after index MI.Sources of FundingThis work was funded by grants from the National Natural Science Foundation of China (91543111), the Beijing Natural Science Foundation (7172145), and the National High-level Talents Special Support Plan of China for Young Talents.DisclosuresNone.Footnoteshttps://www.ahajournals.org/journal/circThe data that were used in this study are available from the corresponding author on request.Tiantian Li, PhD, China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No. 7 Panjiayuannanli, Chaoyang District, Beijing, China. Email [email protected]comReferences1. Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Goldstein D, Forman DE, et al. Thirty-day readmission risk model for older adults hospitalized with acute myocardial infarction.Circ Cardiovasc Qual Outcomes. 2019; 12:e005320. doi: 10.1161/CIRCOUTCOMES.118.005320LinkGoogle Scholar2. Rich DQ, Kipen HM, Zhang J, Kamat L, Wilson AC, Kostis JB. Triggering of transmural infarctions, but not nontransmural infarctions, by ambient fine particles.Environ Health Perspect. 2010; 118:1229–1234. doi: 10.1289/ehp.0901624CrossrefMedlineGoogle Scholar3. von Klot S, Peters A, Aalto P, Bellander T, Berglind N, D’Ippoliti D, Elosua R, Hörmann A, Kulmala M, Lanki T, et al; Health Effects of Particles on Susceptible Subpopulations (HEAPSS) Study Group. Ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in five European cities.Circulation. 2005; 112:3073–3079. doi: 10.1161/CIRCULATIONAHA.105.548743LinkGoogle Scholar4. Liu H, Tian Y, Cao Y, Song J, Huang C, Xiang X, Li M, Hu Y. Fine particulate air pollution and hospital admissions and readmissions for acute myocardial infarction in 26 Chinese cities.Chemosphere. 2018; 192:282–288. doi: 10.1016/j.chemosphere.2017.10.123CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 23, 2020Vol 141, Issue 25 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.044149PMID: 32568587 Originally publishedJune 22, 2020 Keywordsinhalation exposurecardiovascular diseasesparticulate mattermyocardial infarctionPDF download Advertisement SubjectsCardiovascular DiseaseEpidemiologyMyocardial Infarction

Both ozone exposure and extreme temperatures are found to be significantly associated with mortality; however, inconsistent results have been obtained on the modification effects of temperature on the ozone-mortality association. In the present study, we conducted a nationwide time-series analysis in 128 counties from 2013-2018 to examine whether temperature modifies the association between short-term ozone exposure with nonaccidental and cause-specific mortality in China. First, we analyzed the effects of ozone exposure on mortality at different temperature levels. Then, we calculated the pooled effects through a meta-analysis across China. We found that high-temperature conditions (>75th percentile in each county) significantly enhanced the effects of ozone on nonaccidental, cardiovascular, and respiratory mortality, with increases of 0.44% (95% confidence interval (CI): 0.36 and 0.51%), 0.42% (95% CI: 0.32 and 0.51%) and 0.50% (95% CI: 0.31 and 0.68%), respectively, for a 10 mu g/m(3) increase in ozone at high temperatures. Stronger effects on nonaccidental and cardiovascular mortality were observed at high temperatures among elderly individuals aged 65 years and older compared with the younger people. Our findings provide evidence that health damage because of ozone may be influenced by the impacts of increasing temperatures, which point to the importance of mitigating ozone exposure in China under the context of climate change to further reduce the public health burden.