Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study

Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study

Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings. We collected data on individual and environmental risk factors for a multiethnic cohort...

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Published in:PloS one Vol. 17; no. 6; p. e0269650
Main Authors: Hadley, Michael B, Nalini, Mahdi, Adhikari, Samrachana, Szymonifka, Jackie, Etemadi, Arash, Kamangar, Farin, Khoshnia, Masoud, McChane, Tyler, Pourshams, Akram, Poustchi, Hossein, Sepanlou, Sadaf G, Abnet, Christian, Freedman, Neal D, Boffetta, Paolo, Malekzadeh, Reza, Vedanthan, Rajesh
Format: Journal Article
Language:English
Published: San Francisco Public Library of Science 24-06-2022
Public Library of Science (PLoS)
Subjects:
Air pollution
Analysis
Biology and Life Sciences
Cancer
Cardiovascular disease
Cardiovascular diseases
Diabetes
Ecology and Environmental Sciences
Engineering and Technology
Enrollments
Environmental factors
Environmental risk
Ethnicity
Evaluation
Exposure
Frailty
Fuels
Geospatial data
Health aspects
Heart
Hypertension
Income
Land use
Medicine and Health Sciences
Mortality
Particulate matter
Patient outcomes
Physical Sciences
Population density
Risk analysis
Risk factors
Socioeconomic factors
Stroke
Survival
Traffic
Ventilation
Iran
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Summary:Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings. We collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran. Environmental risk factors included: ambient fine particular matter air pollution; household fuel use and ventilation; proximity to traffic; distance to percutaneous coronary intervention (PCI) center; socioeconomic environment; population density; local land use; and nighttime light exposure. We developed a spatial survival model to estimate the independent associations between these environmental exposures and all-cause and cardiovascular mortality. Several environmental factors demonstrated associations with mortality after adjusting for individual risk factors. Ambient fine particulate matter air pollution predicted all-cause mortality (per [mu]g/m.sup.3, HR 1.20, 95% CI 1.07, 1.36) and cardiovascular mortality (HR 1.17, 95% CI 0.98, 1.39). Biomass fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.23, 95% CI 0.99, 1.53) and cardiovascular mortality (HR 1.36, 95% CI 0.99, 1.87). Kerosene fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.09, 95% CI 0.97, 1.23) and cardiovascular mortality (HR 1.19, 95% CI 1.01, 1.41). Distance to PCI center predicted all-cause mortality (per 10km, HR 1.01, 95% CI 1.004, 1.022) and cardiovascular mortality (HR 1.02, 95% CI 1.004, 1.031). Additionally, proximity to traffic predicted all-cause mortality (HR 1.13, 95% CI 1.01, 1.27). In a separate validation cohort, the multivariable model effectively predicted both all-cause mortality (AUC 0.76) and cardiovascular mortality (AUC 0.81). Population attributable fractions demonstrated a high mortality burden attributable to environmental exposures.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0269650