Estimating the short-term effect of PM2.5 on the mortality of cardiovascular diseases based on instrumental variables
Guiming Zhu1,2,3, Le Zhao1,2, Tao Lin4
1Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, 030001, China.
Background:
PM2.5 can induce and aggravate the occurrence and development of cardiovascular diseases (CVDs). The objective of our study is to estimate the causal effect of PM2.5 on mortality rates associated with CVDs using the instrumental variables (IVs) method.
Methods:
We extracted daily meteorological, PM2.5 and CVDs death data from 2016 to 2020 in Binzhou. Subsequently, we employed the general additive model (GAM), two-stage predictor substitution (2SPS), and control function (CFN) to analyze the association between PM2.5 and daily CVDs mortality.
Results:
The 2SPS estimated the association between PM2.5 and daily CVDs mortality as 1.14% (95% CI: 1.04%, 1.14%) for every 10 µg/m3 increase in PM2.5. Meanwhile, the CFN estimated this association to be 1.05% (95% CI: 1.02%, 1.10%). The GAM estimated it as 0.85% (95% CI: 0.77%, 1.05%). PM2.5 also exhibited a statistically significant effect on the mortality rate of patients with ischaemic heart disease, myocardial infarction, or cerebrovascular accidents (P < 0.05). However, no significant association was observed between PM2.5 and hypertension.
Conclusion:
PM2.5 was significantly associated with daily CVDs deaths (excluding hypertension). The estimates from the IVs method were slightly higher than those from the GAM. Previous studies based on GAM may have underestimated the impact of PM2.5 on CVDs.
Insights
Fine particulate matter (PM2.5) significantly increases cardiovascular disease (CVD) mortality. Instrumental variables methods suggest a stronger causal link than traditional models, highlighting PM2.5
Area of Science:
- Environmental Health
- Epidemiology
- Toxicology
Background:
- Particulate matter (PM2.5) exposure is a known risk factor for cardiovascular diseases (CVDs).
- Quantifying the causal impact of PM2.5 on CVD mortality is crucial for public health policy.
- Previous epidemiological studies may have underestimated PM2.5's effect due to methodological limitations.
Purpose of the Study:
- To estimate the causal effect of PM2.5 on cardiovascular disease mortality rates.
- To compare results from instrumental variables (IVs) methods with traditional statistical models.
- To investigate the association between PM2.5 and specific CVD subtypes.
Main Methods:
- Utilized daily data on meteorological factors, PM2.5 levels, and CVD mortality in Binzhou from 2016-2020.
- Employed instrumental variables methods, including two-stage predictor substitution (2SPS) and control function (CFN).
- Compared IVs results with those from a generalized additive model (GAM).
Main Results:
- The 2SPS method estimated a 1.14% increase in CVD mortality per 10 µg/m³ PM2.5 increase.
- The CFN method estimated a 1.05% increase, while the GAM estimated a 0.85% increase.
- Significant associations were found for ischaemic heart disease, myocardial infarction, and cerebrovascular accidents, but not hypertension.
Conclusions:
- PM2.5 is significantly associated with daily cardiovascular disease deaths, excluding hypertension.
- Instrumental variables methods yielded higher estimates than the generalized additive model.
- Findings suggest that traditional models may underestimate the adverse impact of PM2.5 on cardiovascular mortality.
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