Exposure to Neighborhood Greenness and Hypertension Incidence in Adults: A Longitudinal Cohort Study in Taiwan.

BACKGROUND: There are few studies on the health effects of long-term exposure to neighborhood greenness in a longitudinal setting, especially in Asian countries with high population densities. OBJECTIVES: This study investigates the association between long-term exposure to neighborhood greenness and hypertension among adults in Taiwan. METHODS: We selected 125,537 participants (≥18 years of age) without hypertension from Taiwan who had joined the standard medical examination program between 2001 and 2016. Neighborhood greenness was estimated using the normalized difference vegetation index (NDVI), derived from satellite images at a resolution of 250 m2. The 2-y average NDVI value within a 500-m circular buffer around participants' residences was calculated. A time-varying Cox regression model was used to investigate the association between neighborhood greenness and incident hypertension. Mediation analyses were performed to examine whether the association was explained by air pollution, leisure-time physical exercise, or body mass index (BMI). RESULTS: Compared with living in areas within the first quartile of neighborhood greenness, living in areas within the second, third, and fourth quartiles of neighborhood greenness was found to be associated with a lower risk of hypertension, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.95 (95% CI: 0.91, 1.00), 0.95 (95% CI: 0.90, 0.99), and 0.93 (95% CI: 0.88, 0.97), respectively. Each 0.1-unit increase in the NDVI was associated with a 24% lower risk of developing hypertension (HR=0.76; 95% CI: 0.66, 0.87), with this associations being stronger among males and those with higher education levels. This association was slightly mediated by BMI but not by air pollution or leisure-time physical exercise. DISCUSSION: Our findings suggest the protective effects of neighborhood greenness on hypertension development, especially in males and well-educated individuals. Our results reinforced the importance of neighborhood greenness for supporting health. https://doi.org/10.1289/EHP13071.

Life-course exposure to ambient fine particulate matter and hypertension in adulthood: a longitudinal cohort study.

PM2.5-hypertension association were well documented in adults, while the effects of life-course exposure to PM2.5 on adulthood hypertension remained unclear. This study aimed to investigate the associations between life-course exposure to ambient PM2.5 and incident hypertension in adulthood in Asia. We included 4272 participants with 17,814 medical visits from two open cohorts in Taiwan and Hong Kong between 2000 and 2018. We used a satellite-based model to assess 2-year average PM2.5 exposure at a resolution of 1 km2. A linear mixed model was used to examine the association with blood pressure. A Cox regression model with time-dependent covariates was used to examine the overall association with the development of hypertension in adulthood. Life-course mixed models were used to examine the effects of PM2.5 exposure at different life stages on blood pressure and hypertension. For every 10 µg/m3 increase in PM2.5, the overall risk of adulthood hypertension increased by 40% (95% confidence interval [CI] 8-80%). The health effects of PM2.5 exposure at different life-stages on incident hypertension were generally independent of each other. In critical model, the risk of developing hypertension increased 23%, 27%, and 55% for each 10 µg/m3 increase in PM2.5 exposure during school age, adolescence, and adulthood, respectively. Similar associations were found between life-course PM2.5 exposure and blood pressure. Association between PM2.5 and adulthood hypertension can be traced back to childhood. Our study suggests that life-course control of air pollution exposure should be implemented to alleviate the huge burden of adulthood hypertension.

Cardiovascular Mortality, Habitual Exercise, and Particulate Matter 2.5 Exposure: A Longitudinal Cohort Study.

INTRODUCTION: Habitual exercise may amplify the respiratory uptake of air pollutants in the lung, exacerbating the adverse effects of air pollution. However, it is unclear whether this can reduce the health benefits of habitual exercise (referred to as leisure-time exercise). Thus, the combined effects of habitual exercise and chronic exposure to ambient fine particulate matter 2.5 on cardiovascular mortality were examined among adults in Taiwan. METHODS: A total of 384,128 adults were recruited between 2001 and 2016 and followed up to May 31, 2019. Participants' vital status was obtained by matching their unique identification numbers with records of cardiovascular death in the National Death Registry of Taiwan. A time-varying Cox regression model was used to analyze the data. Analyses were conducted in 2021. RESULTS: Cardiovascular death risks were inversely associated with habitual exercise and positively associated with chronic exposure to particulate matter 2.5. The beneficial effects of habitual exercise on cardiovascular mortality were not modified by chronic exposure to particulate matter 2.5. Inactive participants with high particulate matter 2.5 exposure exhibited a 123% higher risk of cardiovascular death than high-exercise-group participants exposed to low levels of particulate matter 2.5 (95% CI=89, 163). CONCLUSIONS: High level of habitual exercise combined with low exposure level of ambient particulate matter 2.5 is associated with the lowest risk of cardiovascular death. A higher level of habitual exercise is associated with a lower risk of cardiovascular death at all levels of particulate matter 2.5 exposure studied. The results indicate that habitual exercise is a safe health promotion strategy even for people residing in relatively polluted regions.

Isolated systolic or diastolic hypertension and mortality risk in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline: a longitudinal cohort study.

BACKGROUND: Little is known regarding the health effects of different hypertension phenotypes including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH) defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline among young adults. We conducted this longitudinal study using time-varying analyses to evaluate the relationship between cardiovascular/all-natural mortality risk and different hypertension phenotypes in young adults. METHODS: A total of 284 597 young adults (aged 18-39 years) were recruited between 1996 and 2016. Participants were classified into eight mutually exclusive BP groups: normal blood pressure (BP), elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH. The outcomes were cardiovascular and all-natural mortality. RESULTS: After a median follow-up of 15.8 years, 2341 all-natural deaths with 442 cardiovascular deaths were observed. When compared with individuals with normal BP, the multivariable adjusted hazard ratios (95% confidence interval) of cardiovascular mortality was 1.39 (1.01-1.93) for elevated BP, 2.00 (1.45-2.77) for stage 1 IDH, 1.66 (1.08-2.56) for stage 1 ISH, 3.08 (2.13-4.45) for stage 1 SDH, 2.85 (1.76-4.62) for stage 2 IDH, 4.30 (2.96-6.25) for stage 2 ISH, and 6.93 (4.99-9.61) for stage 2 SDH, respectively. In consideration to all-natural mortality, similar results were observed for stage 1 SDH, stage 2 ISH, and stage 2 SDH; but not for elevated BP, stage 1 IDH, stage 1 ISH, and stage 2 IDH. CONCLUSION: Young adults with stage 1 or stage 2 ISH, IDH, and SDH are at increased risk of cardiovascular death than those with normal BP. Regardless of BP stage, SDH was associated with a higher cardiovascular mortality risk than IDH and ISH.

Associations between long-term exposure to multiple air pollutants and age at menopause: a longitudinal cohort study.

BACKGROUND: To investigate the associations between long-term exposure to ambient air pollution and age at menopause and the risk of early menopause in two Asian cohorts. METHODS: A total of 53,167 female adults were enrolled from two ongoing cohorts, one each in Taiwan and Hong Kong, between 2003 and 2018, yielding 200,000 person-years of follow-up. We performed a Cox regression model with time-dependent covariates to investigate associations between air pollution and menopause. RESULTS: The mean age at baseline and at natural menopause was 34.4 and 51.0 years, respectively. In the single-pollutant models, we found that increase in PM2.5 and NO2 was associated a younger age at menopause [hazard ratios (HRs) (95% confidence interval, CI): 1.16 (1.09-1.23) and 1.04 (1.01-1.06), respectively, for each 10 µg/m3 increase in air pollution]. In the multiple-pollutant models, the NO2-menopause associations were attenuated after adjusting for PM2.5 and O3, whereas the associations of menopause with PM2.5 and O3 remained stable. Similar associations were observed for the risk of early menopause (age at menopause ≤ 45 years). CONCLUSIONS: Long-term exposure to ambient air pollution was associated with the age at menopause and the risk of early menopause. More effective strategies to mitigate air pollution are required.

Multi-pollutant air pollution and renal health in Asian children and adolescents: An 18-year longitudinal study.

BACKGROUND: Few studies have examined the effects of multi-pollutant air pollution on renal health, especially in children and adolescents. This study investigated the association between long-term ambient air pollution exposure and renal health in Asian children and adolescents. METHODS: This study included 10,942 children and adolescents from Taiwan and Hong Kong between 2000 and 2017. PM2.5, NO2 and O3 concentrations were estimated using satellite-based spatiotemporal regression models. Two-year average concentrations, those of the year of visit and the preceding year, were used. Linear mixed models were used to examine the association between air pollution and yearly changes in estimated glomerular filtration rate (eGFR). Cox regression models with time-dependent covariates were used to examine the association between air pollution and the development of chronic kidney disease (CKD). RESULTS: Median age of the participants was 19 years (range: 2-25). The overall average concentration of PM2.5, NO2 and O3 was 26.7 µg/m3, 44.1 µg/m3 and 51.1 µg/m3, respectively. The mean yearly change in eGFR was 0.37 µL/min/1.73 m2 and the incidence rate of CKD was 6.8 per 1,000 person-years. In single-pollutant models, each 10 µg/m3 increase in PM2.5 was associated with a 0.45 µL/min/1.73 m2 [95% confidence interval (CI): 0.28-0.63] reduction in the yearly increase in eGFR and 53% [hazard ratio (HR): 1.53 (95%CI: 1.07-2.2)] greater risk of incident CKD. Each 10 µg/m3 increase in NO2 was associated with a 7% [HR (95%CI): 1.07 (1.00-1.15)] higher risk of incident CKD, while an equivalent increase in O3 was associated with a 19% [HR (95%CI): 0.81 (0.67-0.98)] lower risk. CONCLUSIONS: Long-term exposure to ambient PM2.5 and NO2 was associated with a slower growth of eGFR and a higher risk of incident CKD in children and adolescents. Our findings suggest that air pollution control in early life is imperative to improve lifelong renal health and alleviate the CKD burden.

Habitual Exercise, Air Pollution, and Pneumonia Mortality: A Longitudinal Cohort Study of Approximately 0.4 Million Adults.

In this study, we aimed to examine the combined associations of particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM2.5) and habitual exercise with pneumonia mortality. We included 384,130 persons aged ≥18 years from Taiwan, Republic of China, during 2001-2016. We followed participants until May 31, 2019, to obtain information on vital status. A time-dependent Cox regression model was used for statistical analysis. We found that risks of pneumonia mortality were reduced by 55% (hazard ratio (HR) = 0.45, 95% confidence interval (CI): 0.36, 0.55) and 36% (HR = 0.64, 95% CI: 0.52, 0.80) in participants who engaged in high and moderate levels of exercise, respectively, as compared with inactive persons. By contrast, each 10-µg/m3 increase in chronic PM2.5 exposure was associated with a 30% (HR = 1.30, 95% CI: 1.17, 1.45) higher risk of pneumonia mortality. Risk of pneumonia death was 72% lower (HR = 0.28, 95% CI: 0.20, 0.41) for persons with a high exercise level and a low PM2.5 level. Lower risk of pneumonia mortality was associated with both higher exercise and lower PM2.5 air pollution levels. For adults exposed to different levels of PM2.5, exercise benefits remained. Our findings suggest that engaging in exercise is a safe and effective strategy for alleviating the burden of pneumonia mortality, even for people who reside in a moderately polluted area.

Habitual exercise, chronic exposure to fine particulate matter and high-sensitivity C reactive protein in Asian adults.

OBJECTIVES: Exercise may increase the inhaled amount of air pollutants and exacerbate the adverse health effects. We investigated the combined effects of chronic exposure to fine particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) and habitual exercise on C reactive protein (CRP), a sensitive marker of inflammation. METHODS: We selected 40 209 Taiwanese adults who joined a standard medical screening programme between 2001 and 2016. The PM2.5 exposure was estimated at each participant's address using a satellite-based spatiotemporal model. Information on habitual exercise was collected using a standard self-administered questionnaire. Mixed-effects linear regression models were used to investigate the associations of CRP with PM2.5 and exercise. An interaction term of PM2.5 and exercise was introduced in the models to test the modifying effects. RESULTS: A greater amount of habitual exercise was associated with a decreased level of CRP, while a higher concentration of PM2.5 exposure was associated with an increased level of CRP. The inverse associations of habitual exercise with CRP were not modified by chronic exposure to PM2.5. The participants in the group with a low level of exercise and a high level of PM2.5 exposure exhibited a 19.1% higher level of CRP than those in the group with a high level of exercise and a low level of PM2.5 exposure (95% CI: 13.7% to 24.8%; p<0.001). The longitudinal and sensitivity analyses yielded similar results. CONCLUSIONS: Increased levels of exercise and reduced exposure levels of PM2.5 are associated with a lower CRP level. Habitual exercise reduces CRP level regardless of the levels of chronic PM2.5 exposure. Our results support that habitual exercise is a safe approach for reducing systemic inflammation to improve cardiovascular health even for people residing in relatively polluted areas.

Birth cohort, sex and educational disparities in the trajectories of body mass index in Taiwan: a longitudinal study.

BACKGROUND: Taiwan has gone through rapid industrialization, urbanization and economic growth in the 20th and early 21st centuries. Therefore, the population has experienced significant changes in the physical and social environment during the life course, which may affect the overall adiposity. Our aim was to examine the age trajectories of height, weight and body mass index (BMI) in the Taiwanese population and to explore the influences of sex, birth cohort and education. METHODS: The sample comprised 572,358 residents between 20 and 94 years of age in Taiwan who attended at least one health examination during 1996 to 2017 in a cohort study. Repeated measures of body weight and height were collected using an auto-anthropometer. We conducted a series of linear mixed-effects growth curve models to examine the trajectory of height, weight, and BMI across the life course with stratification by sex. RESULTS: Age-related trajectories of BMI differed between men and women and stronger cohort effects were observed among men, with younger cohorts having higher BMI. After holding cohort and age variables constant, men with junior high or lower education were shorter, thinner and had higher BMI than men with university or higher education (effect sizes: - 3.138 cm, p < 0.001; - 2.277 kg, p < 0.001; 0.121 kg/m2, p < 0.001, respectively). Women with junior high or lower education were shorter, heavier and had higher BMI than women with university or higher education (effect sizes: - 2.368 cm, p < 0.001; 2.417 kg, p < 0.001; 1.691 kg/m2, p < 0.001, respectively). The educational disparities in BMI were found to be larger among women. CONCLUSIONS: Our findings suggest that younger generations, especially men, and lower educational level individuals, particularly women, have increasing levels of BMI. The influence of age and cohort effects together with sex and educational disparities on adiposity should be highlighted when designing future interventions and policies regarding overweight and obesity.

Chronic fine particulate matter exposure, habitual exercise, and dyslipidemia: A longitudinal cohort study.

BACKGROUND: Physical activity may increase the intake of air pollutants due to a higher ventilation rate, which may exacerbate the adverse health effects. This study investigated the combined effects of habitual exercise and long-term exposure to fine particulate matter (PM2.5) on the incidence of dyslipidemia in a large longitudinal cohort in Taiwan. METHODS: A total of 121,948 adults (≥18 years) who received at least two medical examinations from 2001 to 2016 were recruited, yielding 407,821 medical examination records. A satellite-based spatiotemporal model was used to estimate the 2-year average PM2.5 concentration (i.e., the year of and the year before the medical examination) at each participant's address. Information on habitual exercise within 1 month before the medical examination was collected using a standard self-administered questionnaire. A Cox regression model with time-dependent covariates was used to investigate the combined effects. RESULTS: Compared with inactivity, moderate and high levels of exercise were associated with a lower incidence of dyslipidemia, with hazard ratios (HRs) (95% confidence intervals [CIs]) of 0.91 (0.88, 0.94) and 0.73 (0.71, 0.75), respectively. Participants with a moderate (22.37-25.96 µg/m3) or high (>25.96 µg/m3) level of PM2.5 exposure had a higher incidence of dyslipidemia than those with a low level of PM2.5 exposure (≤22.37 µg/m3), with HRs (95% CIs) of 1.36 (1.32, 1.40), and 1.90 (1.81, 1.99), respectively. We observed a statistically significant, but minor, interaction effect of PM2.5 exposure and exercise on the development of dyslipidemia, with an overall hazard ratios (95% CI) of 1.08 (1.05, 1.10), indicating that an incremental increase in the level of exercise was associated with an 8% increase in the risk of dyslipidemia associated with every 10 µg/m3 increase in PM2.5 exposure. However, the negative association between habitual exercise and dyslipidemia remained, regardless of the level of PM2.5 exposure, suggesting that the benefits of increased habitual exercise outweighed the adverse effects of the increase in PM2.5 intake during exercise. CONCLUSIONS: Increased levels of exercise and reduced levels of PM2.5 exposures were associated with a lower incidence of dyslipidemia. Although an increase in habitual exercise slightly increased the risk of dyslipidemia associated with PM2.5 exposure, the benefits of the increased habitual exercise outweighed the risks. Our findings suggest that habitual exercise is an effective approach for dyslipidemia prevention, even for people residing in relatively polluted areas.

Total and differential white blood cell count and cause-specific mortality in 436 750 Taiwanese adults.

BACKGROUND AND AIMS: White blood cell (WBC) count is an easily obtainable biomarker of systematic inflammation. Our study aimed to investigate the associations of differential WBC count with all-cause and cause-specific mortality in a general Asian population. METHODS AND RESULTS: Cox proportional hazards model was used to evaluate the associations of WBC count with mortality separately for men and women, with adjustment for multiple variables including age, smoking, and other lifestyle factors. Stratified analyses by age, smoking, diabetes, and hypertension were conducted to explore potential effect modification. Elevated WBC count was significantly associated with increased mortality risk. The adjusted hazard ratios of total WBC (10th decile compared to decile of lowest risk) for all-cause mortality were 1.42 (95% CI: 1.33, 1.53) for men and 1.54 (95% CI: 1.42, 1.68) for women. Similar risks were observed for neutrophils, monocytes, and neutrophil/lymphocyte (NL) ratio. The highest deciles of neutrophils, monocytes, and NL ratio were also positively associated with risk of cardiovascular/cerebrovascular, cancer, and respiratory mortality after adjusting for covariates. Results for all-cause mortality remained statistically significant for participants who were <60 years old, non-smokers, non-diabetic, and non-hypertensive. CONCLUSIONS: Total and differential WBC counts (neutrophils, monocytes, and NL ratios) are positively associated with increased risk of all-cause mortality, cardiovascular and cerebrovascular, cancer, and respiratory mortality among Taiwanese adults.

Long-term Exposure to Fine Particulate Matter and Mortality A Longitudinal Cohort Study of 400,459 Adults.

BACKGROUND: Cohort studies on the association between long-term exposure to fine particulate matter (PM2.5) and mortality have been well established for America and Europe, but limited and inconsistent in Asia with much higher air pollution. This study aims to investigate the associations between ambient PM2.5 and all-cause and cause-specific mortality over a period of rising and then declining PM2.5. METHODS: We enrolled a total of 400,459 adults from an open cohort between 2001 and 2016, and followed them up until 31 May 2019. We obtained mortality data from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. We estimated ambient PM2.5 exposures using a satellite-based spatiotemporal model. We performed a Cox regression model with time-dependent covariates to investigate the associations of PM2.5 with deaths from all causes and specific causes. RESULTS: This study identified 14,627 deaths and had a total of 5 million person-years of follow-up. Each 10 µg/m3 increase in PM2.5 was associated with an increased hazard risk of 29% (95% confidence interval: 24%-35%) in all-cause mortality. Risk of death increased by 30% for natural causes, 20% for cancer, 42% for cardiovascular disease (CVD) causes, and 53% for influenza and pneumonia causes, for each 10 µg/m3 increase in PM2.5. Sensitivity analyses generally yielded similar results. CONCLUSION: Long-term exposure to ambient PM2.5 was associated with increased risks of all-cause mortality and deaths from cancers, natural causes, CVD, and influenza and pneumonia. Longitudinal study design should be encouraged for air pollution epidemiologic investigation.

Combined effects of chronic PM2.5 exposure and habitual exercise on cancer mortality: a longitudinal cohort study.

BACKGROUND: Exercise may increase the inhalation and deposition of air pollutants, which may counteract its beneficial effects. We thus examined the combined effects of chronic exposure to fine particulate matter (PM2.5) and habitual exercise on the risk of death from cancer in Taiwan. PATIENTS AND METHODS: A total of 384 128 adults (≥18 years of age) were recruited for a medical screening programme between 2001 and 2016, yielding 842 384 medical-examination records. All participants were followed up until 31 May 2019. Vital data were obtained from the National Death Registry of Taiwan and the ambient PM2.5 exposure was estimated using a satellite-based spatiotemporal model. Information on habitual exercise was collected using a standard self-administered questionnaire. The time-dependent Cox-regression model was used to evaluate the combined effects. RESULTS: A greater amount of habitual exercise was associated with lower risk of death from cancer, whilst a higher level of PM2.5 exposure was associated with a higher risk of death from cancer. The inverse associations of habitual exercise with death from cancer were not modified by chronic exposure to PM2.5. The participants in the group with a high level of exercise and a low level of PM2.5 exposure exhibited a 35% lower risk of death from cancer than those in the group with a low level of exercise and a high level of PM2.5 exposure (95% confidence interval: 28%, 42%). CONCLUSIONS: Increased levels of exercise and reduced exposure levels of PM2.5 are associated with a lower risk of death from cancer. Habitual exercise reduces the risk of death from cancer regardless of the levels of chronic PM2.5 exposure. Our results indicate that habitual exercise is a suitable health-promotion strategy even for people who reside in moderately polluted regions.

Effects of air pollution and habitual exercise on the risk of death: a longitudinal cohort study.

BACKGROUND: Exercise may exacerbate the adverse health effects of air pollution by increasing the inhalation of air pollutants. We investigated the combined effects of long-term exposure to fine particle matter (PM2.5) and habitual exercise on deaths from natural causes in Taiwan. METHODS: We recruited 384 130 adults (aged ≥ 18 yr) with 842 394 medical examination records between 2001 and 2016, and followed all participants until May 31, 2019. We obtained vital data from the National Death Registry of Taiwan. We estimated PM2.5 exposure using a satellite-based spatiotemporal model, and collected information on exercise habits using a standard self-administered questionnaire. We analyzed the data using a Cox regression model with time-dependent covariates. RESULTS: A higher level of habitual exercise was associated with a lower risk of death from natural causes, compared with inactivity (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.80-0.88 for the moderate exercise group; HR 0.65, 95% CI 0.62-0.68 for the high exercise groups), whereas a higher PM2.5 exposure was associated with a higher risk of death from natural causes compared with lower exposure (HR 1.02, 95% CI 0.98-1.07, and HR 1.15, 95% CI 1.10-1.20, for the moderate and high PM2.5 exposure groups, respectively). Compared with inactive adults with high PM2.5 exposure, adults with high levels of habitual exercise and low PM2.5 exposure had a substantially lower risk of death from natural causes. We found a minor, but statistically significant, interaction effect between exercise and PM2.5 exposure on risk of death (HR 1.03 95% CI 1.01-1.06). Subgroup analyses, stratified by PM2.5 categories, suggested that moderate and high levels of exercise were associated with a lower risk of death in each PM2.5 stratum, compared with inactivity. INTERPRETATION: Increased levels of exercise and reduced PM2.5 exposure are associated with a lower risk of death from natural causes. Habitual exercise can reduce risk regardless of the levels of PM2.5 exposure. Our results suggest that exercise is a safe health improvement strategy, even for people residing in relatively polluted regions.

Combined effects of chronic PM2.5 exposure and habitual exercise on renal function and chronic kidney disease: A longitudinal cohort study.

BACKGROUND: We investigated the combined effects of chronic PM2.5 exposure and habitual exercise on the decline of renal function and the incidence of chronic kidney disease (CKD) in a large cohort in Taiwan. METHODS: The present data analysis included a total of 108,615 participants aged 18 years or above who were recruited between 2001 and 2016. All participants underwent at least two medical examinations. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The incident of eGFR decline ≥30% was defined as a decline in eGFR of ≥30% during the study period, while the incident CKD was defined as an eGFR <60 mL/min/1.73 m2 or a newly self-reported physician-diagnosed CKD in the subsequent visits. The satellite-based spatiotemporal model was used to estimate PM2.5 exposure at each participant's address. Information on habitual exercise was collected using a standard self-administered questionnaire. The Cox regression model with time-dependent covariates was used for data analyses. RESULTS: Higher habitual exercise was associated with lower risks of renal function decline and CKD development, whereas higher PM2.5 exposure was associated with higher risks of renal function decline and CKD development. We found no significant interaction effect between PM2.5 and habitual exercise, with an HR (95% CI) of 1.02 (0.97, 1.07) for incident eGFR decline ≥30% and 1.00 (0.95, 1.05) for CKD development. Compared to participants with inactive-exercise and high-PM2.5, participants with high-exercise and low-PM2.5 had 74% and 61% lower risks of renal function decline and CKD development, respectively. CONCLUSION: Increased habitual exercise and reduced PM2.5 exposures are associated with lower risks of renal function decline and CKD development. Habitual exercise reduces risks of renal function decline and CKD development regardless of the levels of chronic PM2.5 exposure. Our study suggests that habitual exercise is a safe approach for kidney health improvement even for people residing in relatively polluted areas and should be promoted.

Reduced ambient PM2.5, better lung function, and decreased risk of chronic obstructive pulmonary disease.

BACKGROUND: Several studies reported that long-term exposure to fine particulate matter (PM2.5) was associated with an increased risk of chronic obstructive pulmonary disease (COPD). It remains unclear whether reduced PM2.5 can decrease the risk of COPD development. OBJECTIVE: To investigate the associations of dynamic changes (including deterioration and improvement) in long-term exposure to ambient PM2.5 with changes in lung function and the incidence of COPD. METHODS: A total of 133,119 adults (aged 18 years or older) were recruited in Taiwan between 2001 and 2014. All participants underwent at least two standard medical examinations including spirometry test. We estimated PM2.5 concentrations using a high-resolution (1 km2) satellite-based spatio-temporal model. The change in PM2.5 (ΔPM2.5) was defined as the difference in concentration of PM2.5 between the respective visit and the previous visit. We used a multivariable mixed linear model and time-varying Cox model to investigate the associations of change in PM2.5 with annual change of lung function and the incidence of COPD, respectively. RESULT: The PM2.5 concentration in Taiwan increased during 2002-2004 and began to decrease around 2005. Every 5-µg/m3/year decrease in the annual change of PM2.5 (i.e., ΔPM2.5/year of 5 µg/m3/year) was associated with an average increase of 19.93 mL/year (95 %CI: 17.42,22.43) in forced expiratory volume in 1 s (FEV1), 12.76 mL/year (95 %CI: 9.84,15.66) in forced vital capacity (FVC), 70.22 mL/s/year (95 %CI: 64.69,76.16) in midexpiratory flow between 25 and 75% of the forced vital capacity (MEF25-75), 0.27%/year (95 %CI: 0.21%, 0.32%) in FEV1/FVC/year. Every 5 µg/m3 decrease in PM2.5 (i.e., ΔPM2.5 of 5 µg/m3) was associated with a 12% (95 %CI: 7%, 17%) reduced risk of COPD development. The stratified and sensitivity analyses generally yielded similar results. CONCLUSION: An improvement in PM2.5 pollution exposure was associated with an attenuated decline in lung function parameters of FEV1, FVC, MEF25-75, and FEV1/FVC, and a decreased risk of COPD development. Our findings suggest that strategies aimed at reducing air pollution may effectively combat the risk of COPD development.

Mortality risk attributable to classification of chronic obstructive pulmonary disease and reduced lung function: A 21-year longitudinal cohort study.

AIM: The mortality risk attributable to the classifications of chronic obstructive pulmonary disease (COPD) remains unclear. We investigated the associations of mortality with COPD classifications and reduced lung function in a large longitudinal cohort in Taiwan. METHODS: A total of 388,401 adults (≥25 years of age) were recruited between 1996 and 2016 underwent 834,491 medical examinations including spirometry. We used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to establish the COPD classifications. A time-dependent Cox regression model was used to investigate the associations between the morality risk and COPD classifications. We also examined the associations between mortality and lung function. RESULTS: The mean age of the participants was 42.1 years, and the median follow-up duration was 16.2 years. We identified 28,283 natural-cause deaths, and the mortality rate was 4.7 per 1,000 person-years. The hazard ratios (HRs) [95%confidence interval (95%CI)] of mortality in the participants with restrictive spirometry pattern and COPD GOLD Ⅰ-Ⅳ were 1.31 (1.27-1.35), 1.18 (1.00-1.39), 1.43 (1.35-1.51), 1.78 (1.66-1.90), and 2.13 (1.94-2.34), respectively, with reference to the participants with normal lung function. The natural-cause mortality risk increased by 33% [HR(95%CI): 1.33 (1.28-1.39)] for participants with COPD. Reduced lung function was also associated with a higher mortality risk. CONCLUSIONS: A more advanced classification of COPD was associated with a greater increase in the mortality risk. Our study suggests that early detection of COPD and slowing the disease progress in patients with COPD are crucial for mortality prevention.

Associations of Reduced Ambient PM2.5 Level With Lower Plasma Glucose Concentration and Decreased Risk of Type 2 Diabetes in Adults: A Longitudinal Cohort Study.

It remains unknown whether reduced air pollution levels can prevent type 2 diabetes mellitus. In this study, we investigated the associations between dynamic changes in long-term exposure to ambient fine particulate matter, defined as particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), and changes in fasting plasma glucose (FPG) levels and incidence of type 2 diabetes. A total of 151,398 adults (ages ≥18 years) were recruited in Taiwan between 2001 and 2014. All participants were followed up for a mean duration of 5.0 years. Change in PM2.5 (ΔPM2.5) was defined as the value at a follow-up visit minus the corresponding value at the immediately preceding visit. The PM2.5 concentration in Taiwan increased during 2002-2004 and began to decrease in 2005. Compared with participants with little or no change in PM2.5 exposure, those with the largest decrease in PM2.5 had a decreased FPG level (ß = -0.39, 95% confidence interval: -0.47, -0.32) and lower risk of type 2 diabetes (hazard ratio = 0.86, 95% confidence interval: 0.80, 0.93). The sensitivity analysis and analyses stratified by sex, age, body mass index, smoking, alcohol drinking, and hypertension generally yielded similar results. Improved PM2.5 air quality is associated with a better FPG level and a decreased risk of type 2 diabetes development.

Reduced Ambient PM2.5 Was Associated with a Decreased Risk of Chronic Kidney Disease: A Longitudinal Cohort Study.

Many countries have dedicated to the mitigation of air pollution in the past several decades. However, evidence of beneficial effects of air quality improvement on chronic kidney disease (CKD) remains limited. We thus investigated the effects of dynamic changes (including deterioration and improvement) in air quality on the incidence of CKD in a longitudinal study in Taiwan. During 2001-2016, this study recruited a total of 163,197 Taiwanese residents who received at least two standard physical examinations. The level of fine particle matter (PM2.5) was estimated using a high-resolution (1 km2) satellite-based spatio-temporal model. We defined changes of PM2.5 concentrations (ΔPM2.5) as the difference between the two-year average measurements during follow-up and during the immediately preceding visit. The time-dependent Cox regression model was adopted to evaluate the relationships between ΔPM2.5 and the incidence of CKD after adjusting for a series of covariates. The concentrations of PM2.5 in Taiwan peaked around 2004 and began to decrease since 2005. We observed an approximate linear concentration-response relationship of ΔPM2.5 with CKD incidence. Every 5 µg/m3 decrease in the ambient concentration of PM2.5 was associated with a 25% reduced risk of CKD development [hazard ratio (HR): 0.75; 95% CI: 0.73, 0.78]. In conclusion, this study demonstrated that the improvement of PM2.5 air quality might be associated with a lower risk of CKD development. Our findings indicate that reducing air pollution may effectively prevent the development of CKD.

Habitual exercise is associated with reduced risk of diabetes regardless of air pollution: a longitudinal cohort study.

AIMS/HYPOTHESIS: Physical activity may increase a person's inhalation of air pollutants and exacerbate the adverse health effects. This study aimed to investigate the combined associations of chronic exposure to particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) and habitual physical activity with the incidence of type 2 diabetes in Taiwan. METHODS: We selected 156,314 non-diabetic adults (≥18 years old) who joined an ongoing longitudinal cohort between 2001 and 2016. Incident type 2 diabetes was identified at the follow-up medical examinations. Two-year mean PM2.5 exposure was estimated at each participant's address using a satellite-based spatiotemporal model. Information on physical activity and a wide range of covariates was collected using a standard self-administered questionnaire. We analysed the data using a Cox regression model with time-varying covariates. An interaction term between PM2.5 and physical activity was included to examine the overall interaction effects. RESULTS: Compared with high physical activity, moderate and inactive/low physical activity were associated with a higher risk of diabetes (HR [95% CI] 1.31 [1.22, 1.41] and 1.56 [1.46, 1.68], respectively). Participants with moderate/high PM2.5 had a higher risk of type 2 diabetes than the participants exposed to low PM2.5 (HR 1.31 [1.22, 1.40] and 1.94 [1.76, 2.14], respectively). The participants with high physical activity and low PM2.5 had a 64% lower risk of type 2 diabetes than those with inactive/low physical activity and high PM2.5. CONCLUSIONS/INTERPRETATION: Higher physical activity and lower PM2.5 exposure are associated with lower risk of type 2 diabetes. Habitual physical activity can reduce the risk of diabetes regardless of the levels of PM2.5 exposure. Our results indicate that habitual physical activity is a safe diabetes prevention strategy for people residing in relatively polluted regions.