The effect of living environmental factors on cardiovascular diseases in Chinese adults: results from a cross-sectional and longitudinal study

Lay Summary The aim of this study was to investigate the association between multiple living environmental risk factors and CVD in China, given that the synergistic effects of multiple environmental factors on human health were unclear. Key findingsLiving environmental risk factors included ambient PM2.5, indoor fuel use, tap water use, and residence type.Poor living environmental quality was positively dose-response to the risk of CVD. Aims This study aimed to investigate the association between multiple living environmental factors and cardiovascular diseases (CVDs). Methods and results This study was conducted on the China Health and Retirement Longitudinal Study (CHARLS), with 12 489 subjects in the cross-sectional study and 7932 subjects in the 7-year follow-up. Living environmental factors included ambient fine particulate matter (PM2.5), indoor fuel use, tap water use, and residence type. Logistic regression and Cox proportional hazard regression models were applied to explore the association between living environmental risk factors and CVD events in a cross-sectional and a cohort analysis, respectively. Compared with subjects in the low-risk groups, those in the middle-risk (odd ratio [OR], 95% confidence interval [CI]: 1.203, 0.943-1.534) and high-risk groups (OR, 95% CI: 1.616, 1.259-2.074) showed increased risks of CVD prevalence when considering the combined effects of their living environment. During the follow-up, similar associations were observed (hazard ratio [HR], 1.541, 95% CI [1.142-2.080] for the high-risk group; HR 1.296, 95% CI [0.968-1.736] for the middle-risk group); P for trend = 0.003). Conclusion An overall poor living environmental quality is a potential risk factor for CVD. Future studies should focus more on the effects of exposure to multiple factors.