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Respiratory epidemiology
Original research
Air pollution associated with incidence and progression trajectory of chronic lung diseases: a population-based cohort study
  1. Xiaojie Wang1,
  2. Lan Chen1,
  3. Miao Cai1,
  4. Fei Tian1,
  5. Hongtao Zou1,
  6. Zhengmin (Min) Qian2,
  7. Zilong Zhang1,
  8. Haitao Li3,
  9. Chongjian Wang4,
  10. Steven W Howard5,
  11. Yang Peng6,7,
  12. Li’e Zhang6,7,
  13. Elizabeth Bingheim2,
  14. Hualiang Lin1,
  15. Yunfeng Zou7,8
  1. 1 Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
  2. 2 Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
  3. 3 Department of Social Medicine and Health Service Management, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
  4. 4 College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
  5. 5 Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
  6. 6 Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
  7. 7 Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
  8. 8 Department of Toxicology, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
  1. Correspondence to Dr Hualiang Lin, Department of Epidemiology, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China; linhualiang{at}mail.sysu.edu.cn; Professor Yunfeng Zou, Department of Toxicology, Guangxi Medical University, Nanning, Guangxi, People's Republic of China; zouyunfeng{at}gxmu.edu.cn

Abstract

Background No prior study has examined the effects of air pollution on the progression from healthy to chronic lung disease, subsequent chronic lung multimorbidity and further to death.

Methods We used data from the UK Biobank of 265 506 adults free of chronic lung disease at recruitment. Chronic lung multimorbidity was defined as the coexistence of at least two chronic lung diseases, including asthma, chronic obstructive pulmonary disease and lung cancer. The concentrations of air pollutants were estimated using land-use regression models. Multistate models were applied to assess the effect of air pollution on the progression of chronic lung multimorbidity.

Results During a median follow-up of 11.9 years, 13 863 participants developed at least one chronic lung disease, 1055 developed chronic lung multimorbidity and 12 772 died. We observed differential associations of air pollution with different trajectories of chronic lung multimorbidity. Fine particulate matter showed the strongest association with all five transitions, with HRs (95% CI) per 5 µg/m3 increase of 1.31 (1.22 to 1.42) and 1.27 (1.01 to 1.57) for transitions from healthy to incident chronic lung disease and from incident chronic lung disease to chronic lung multimorbidity, and 1.32 (1.21 to 1.45), 1.24 (1.01 to 1.53) and 1.91 (1.14 to 3.20) for mortality risk from healthy, incident chronic lung disease and chronic lung multimorbidity, respectively.

Conclusion Our study provides the first evidence that ambient air pollution could affect the progression from free of chronic lung disease to incident chronic lung disease, chronic lung multimorbidity and death.

  • COPD epidemiology
  • asthma epidemiology
  • lung cancer

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/thorax-2022-219489

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors XW: formal analysis, writing—original draft, writing—review and editing. LC: writing—review and editing. MC: writing—review and editing. FT: writing—review and editing. HZ: writing—review and editing. ZMQ: writing—review and editing. ZZ: writing—review and editing. HL: supervision, project administration. CW: writing—review and editing. SWH: writing—review and editing. YP: writing—review and editing. LZ: writing—review and editing. EB: writing—review and editing. HL: conceptualisation, writing—original draft, writing—review and editing. YZ: writing—review and editing. HL is responsible for the overall content as the guarantor.

    • Funding This study is supported by the National Natural Science Foundation of China (82041021).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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