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

Abstract

Although it is widely acknowledged that environmental concerns can reduce PM2.5 pollution, few studies have empir-ically 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 ex-plore the association between PM2.5 exposure and onset time to cardiovascular events, and the mitigation effect of en-vironmental concerns. Every 1 mu g/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 envi-ronmental concerns, as well as their synergistic effect decreased PM2.5 pollution by 0.32 %, 0.25 % and 0.46 %, respec-tively; 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 cardiovas-cular events, suggesting that other mediation pathways were also possible. Associations of PM2.5 exposure and environ-mental 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.