Long-term exposure to air pollution and increased risk of atrial fibrillation prevalence in China

Background: Atrial fibrillation (AF) is the most common type of treated heart arrhythmia contributing to adverse cardiovascular events. The association between short-term air pollution exposure and AF episodes has been recognized. But the evidence of the association between long-term air pollution exposure and AF was limited, especially in developing countries.Methods: We performed a nationwide cross-sectional study among 1,374,423 individuals aged >= 35 years from 13 health check-up centers. Using logistic regression models, we assessed the association between long-term exposure to single air pollution and AF prevalence, including particulate matter (PM2.5 and PM10), ozone (O3) and PM2.5 compositions, which were estimated by high-resolution and high-quality spatiotemporal datasets of ground-level air pollutants for China. The quantile g-computation model was used to explore the joint effect of all exposures to air pollution and the contribution of an individual component to the mixture.Results: In single-pollutant models, an increase of 10 mu g/m3 in PM2.5 (OR 1.031[95%CI 1.010,1.053]) and PM10 (OR = 1.021 [95%CI 1.009,1.033]) was positively associated with AF prevalence. The stratified analyses revealed that these associations were significantly stronger in females, people <65 years old, and those with hypertension and diabetes. In the further exploration of the joint effect of PM2.5 compositions (OR 1.060 [95%CI 1.022,1.101]) per quintile increase in all five PM2.5 components), we found that PM2.5 sulfate contributed the most.Conclusions: These findings provide important evidence for the positive relationship between long-term exposure to air pollution and AF prevalence in China and identify sulfate particles of PM2.5 as having the highest contribution to the overall mixture effects among all PM2.5 chemical constituents.