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Associations of air pollutant exposures with Cardio-Kidney-Metabolic syndrome in Chinese middle-aged and older adults: a cross-sectional study based on CHARLS.

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  • Author(s): Pan Y;Pan Y; Bi J; Bi J; Bi J; Sun Z; Sun Z; Xin J; Xin J; He X; He X
  • Source:
    BMC public health [BMC Public Health] 2025 Nov 26; Vol. 25 (1), pp. 4323. Date of Electronic Publication: 2025 Nov 26.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Metabolic Syndrome*/epidemiology ; Metabolic Syndrome*/chemically induced ; Air Pollutants*/analysis ; Air Pollutants*/adverse effects ; Environmental Exposure*/adverse effects ; Environmental Exposure*/analysis ; Environmental Exposure*/statistics & numerical data ; Air Pollution*/adverse effects ; Air Pollution*/analysis ; Kidney Diseases*/epidemiology ; Cardiovascular Diseases*/epidemiology; China/epidemiology ; Particulate Matter/analysis ; Particulate Matter/adverse effects ; Humans ; Cross-Sectional Studies ; Male ; Female ; Middle Aged ; Aged ; Longitudinal Studies ; East Asian People
    • Abstract:
      Background: Cardio-Kidney-Metabolic (CKM) syndrome is a prevalent systemic disorder, but evidence linking it to air pollution is scarce. We investigated the association between long-term exposure to multiple air pollutants and CKM syndrome severity in Chinese adults.
      Methods: In this cross-sectional study of 3,937 participants from the China Health and Retirement Longitudinal Study (CHARLS), we estimated long-term (2013-2015) residential exposures to PM₁, PM₂.₅, PM₁₀, NO₂, O₃, and SO₂. CKM syndrome was staged per American Heart Association criteria. We used ordered logistic, Weighted Quantile Sum (WQS), and restricted cubic spline regression to assess associations.
      Results: After full adjustment, each one-standard-deviation (SD) increase in pollutant concentration was significantly associated with higher odds of a more advanced CKM stage. The association was strongest for PM₁₀ (per 33.3 µg/m³ SD increase; OR = 1.16, 95% CI: 1.07-1.27), with significant positive associations also found for SO₂, PM₂.₅, NO₂, and O₃. The overall pollutant mixture was also positively associated with CKM progression (OR = 1.20, 95% CI: 1.02-1.41 per quartile increase in the WQS index). Older adults (≥ 60 years) and residents of eastern China were identified as particularly susceptible subgroups (P for interaction < 0.05).
      Conclusion: Long-term exposure to ambient air pollutants, individually and as a mixture, is associated with advanced CKM syndrome in Chinese adults. Our findings identify air pollution as a critical modifiable factor and underscore the need for targeted public health interventions to mitigate the burden of this multisystem disease, especially for vulnerable populations.
      (© 2025. The Author(s).)
    • Abstract:
      Declarations. Ethics approval and consent to participate: The CHARLS study was approved by the Biomedical Ethics Committee of Peking University (approval number: IRB00001052-11015). All participants provided written informed consent before participating in the survey. Competing interests: The authors declare no competing interests.
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    • Grant Information:
      (Grant No. 62272327 and 12371527) National Natural Science Foundation of China
    • Contributed Indexing:
      Keywords: Air pollution; Cardio-Kidney-Metabolic syndrome; Environmental epidemiology; Pollutant mixture; Weighted quantile sum regression
    • Accession Number:
      0 (Air Pollutants)
      0 (Particulate Matter)
    • Publication Date:
      Date Created: 20251127 Date Completed: 20251230 Latest Revision: 20260101
    • Publication Date:
      20260130
    • Accession Number:
      PMC12752344
    • Accession Number:
      10.1186/s12889-025-25654-0
    • Accession Number:
      41299503