Air Pollution and Blood Pressure: Evidence From Indonesia

Indonesia faces significant air quality issues due to multiple emissions sources, including rapid urbanization and peatland fires associated with agricultural land management. Limited prior research has estimated the episodic shock of intense fires on morbidity and mortality in Indonesia but has largely ignored the impact of poor air quality throughout the year on biomarkers of cardiovascular disease risk. We conducted a cross-sectional study of the association between particulate matter less than 2.5 microns in diameter (PM2.5) and blood pressure. Blood pressure measurements were obtained from the fifth wave of the Indonesian Family Life Survey (IFLS5), an ongoing population-based socioeconomic and health survey. We used the GEOS-Chem chemical transport model to simulate daily PM2.5 concentrations at 0.5 degrees x 0.625 degrees resolution across the IFLS domain. We assessed the association between PM2.5 and diastolic and systolic blood pressure, using mixed effects models with random intercepts for regency/municipality and household and adjusted for individual covariates. An interquartile range increase in monthly PM2.5 exposure was associated with a 0.234 (95% CI: 0.003, 0.464) higher diastolic blood pressure, with a greater association seen in participants age 65 and over (1.16 [95% CI: 0.24, 2.08]). For the same exposure metric, there was a 1.90 (95% CI: 0.43, 3.37) higher systolic blood pressure in participants 65 and older. Our assessment of fire-specific PM2.5 yielded null results, potentially due to the timing and locations of health data collection. To our knowledge, this is the first study to provide evidence for an association between PM2.5 and blood pressure in Indonesia. Although the association between air pollutants and cardiovascular disease risk has been widely reported, there have been few studies conducted in Indonesia, a country with both high population and air pollution burden. In this study of over 25,000 Indonesian residents, we found that participants with higher exposure to air pollution in the month before a clinical exam had higher blood pressure than participants with lower exposure to air pollution. This association was stronger in participants ages 65 and older. Exposure to PM2.5 in the preceding month was associated with higher diastolic blood pressure (DBP) in this Indonesian cohort Associations between PM2.5 and blood pressure were more pronounced in elderly participants There was no association between fire-specific PM2.5 and blood pressure; however, this may be due to the timing of health data collection