A Global Perspective on Sulfur Oxide Controls in Coal-Fired Power Plants and Cardiovascular Disease

Sulfur oxides (SO_x), particularly SO₂ emitted by coal-fired power plants, produce long-term risks for cardiovascular disease (CVD). We estimated the relative risks of CVD and ischemic heart disease (IHD) attributable to SO_x emission globally. National SO_x reduction achieved by emissions control systems was defined as the average SO_x reduction percentage weighted by generating capacities of individual plants in a country. We analyzed the relative risk of CVD incidence associated with national SO_x reduction for 13,581 coal-fired power-generating units in 79 countries. A 10% decrease in SO_x emission was associated with 0.28% (males; 95%CI = -0.39%~0.95%) and 1.69% (females; 95%CI = 0.99%~2.38%) lower CVD risk. The effects on IHD were > 2 times stronger among males than females (2.78%, 95%CI = 1.99%~3.57% vs. 1.18%, 95%CI = 0.19%~2.17%). Further, 1.43% (males) and 8.00% (females) of CVD cases were attributable to suboptimal SOx reduction. Thus, enhancing regulations on SO_x emission control represents a target for national and international intervention to prevent CVD.