Long-term exposure to outdoor fine particulate and physical activity with mortality and cardiovascular events: an analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study

作者：Jun Hao, Zhiguang Liu, Bo Hu, Duolao Wang, Sumathy Rangarajan, Yang Wang, Chuangshi Wang, Lap Ah Tse, Weida Liu, Sidong Li, Minghai Yan, Qiujing Cai, Salim Yusuf, Wei Li · 发表于：The Lancet Regional Health - Western Pacific · 年份：2025 · DOI：10.1016/j.lanwpc.2025.101584 · 被引用次数：4 · 研究领域：Air Quality and Health Impacts、Health, Environment, Cognitive Aging、Urban Transport and Accessibility

Background: Long-term exposure to PM2.5 and low physical activity are independently associated with an increased risk of cardiovascular disease (CVD). However, there is limited research investigating the combined effects of PM2.5 exposure and physical activity on CVD risk. This study aims to explore these interactions related to CVD and mortality. Methods: We analysed data from the PURE-China cohort, including 39,970 adults aged 35-70 years, with a median follow-up of 11.9 years. PM2.5 exposure was estimated using a Bayesian hierarchical model. Physical activity was quantified using metabolic equivalent task (MET)-minutes per week. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty models and restricted cubic splines were used to assess associations. Interaction effects were evaluated using measures of multiplicative and additive interaction, including the relative excess risk due to interaction (RERI) and the proportion attributable to interaction (AP). Findings: ). In low-exposure areas, higher total physical activity significantly reduced the risk of composite outcome (HR: 0.84, 95% CI: 0.73-0.97, p trend = 0.012) and major cardiovascular events (HR: 0.80, 0.67-0.95, p trend = 0.022). However, in high-exposure regions, physical activity showed no protective effect for the composite outcome (HR: 0.97, 0.85-1.09, p trend = 0.551) and major cardiovascular events (HR: 0.98, 0.85-1.13, p trend = 0.864). Higher non-recreationa...