Long-term exposure to fine particulate matter and cardiovascular disease: The mitigation role of environmental...

Although it is widely acknowledged that environmental concerns can reduce PM_2.5 pollution, few studies have empirically estimated whether environmental concerns could bring health benefits by mitigating PM_2.5 pollution. Here, we quantified government and media environmental concerns with text-mining algorithm, matched with cohort data along with high-resolution gridded PM_2.5 data. Accelerated failure time model and mediation model were used to explore the association between PM_2.5 exposure and onset time to cardiovascular events, and the mitigation effect of environmental concerns. Every 1 μg/m³ increase in PM_2.5 exposure was associated with shortened time to stroke and heart problem, with time ratios of 0.9900 and 0.9986, respectively. Each 1 unit increase in government and media environmental concerns, as well as their synergistic effect decreased PM_2.5 pollution by 0.32 %, 0.25 % and 0.46 %, respectively; and decrease PM_2.5 resulted in prolonged onset time to cardiovascular events. Mediation analysis revealed that reduced PM_2.5 mediated up to 33.55 % of the association between environmental concerns and onset time to cardiovascular events, suggesting that other mediation pathways were also possible. Associations of PM_2.5 exposure and environmental concerns with stroke and heart problem were similar in different subgroups. Overall, environmental concerns reduce risks of cardiovascular disease by mitigating PM_2.5 pollution and other pathways in a real-world data set. This study provides insights for low-and-middle-income countries to address air pollution and improve health co-benefit.