Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis
Background: Patients with rheumatoid arthritis (RA) have a significantly elevated risk of developing cardiovascular disease (CVD), the leading cause of their death. However, the impact of environmental factors on RA progression remains unclear. This study aimed to explore the link between long-term...
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Elsevier
2025-05-01
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| Series: | Ecotoxicology and Environmental Safety |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0147651325005238 |
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| author | Yu-Xuan Zhang Bin-Bin Feng Ma Ruo-Wei Lin Zhu Yong-Yong Liu Yu-Ye Zuo Hai-Feng Pan Guo-Cui Wu |
| author_facet | Yu-Xuan Zhang Bin-Bin Feng Ma Ruo-Wei Lin Zhu Yong-Yong Liu Yu-Ye Zuo Hai-Feng Pan Guo-Cui Wu |
| author_sort | Yu-Xuan Zhang |
| collection | DOAJ |
| description | Background: Patients with rheumatoid arthritis (RA) have a significantly elevated risk of developing cardiovascular disease (CVD), the leading cause of their death. However, the impact of environmental factors on RA progression remains unclear. This study aimed to explore the link between long-term air pollution exposure and the multi-stage progression from a healthy status to RA onset, then CVD development, and finally death. Methods: Utilizing data from 326,059 participants in the UK Biobank, we used a unidirectional multi-state Markov proportional hazards model to analyze the associations between long-term exposure to air pollutants (PM2.5, PM10, NO2, and NOx) and disease progression. The models included transitions from baseline healthy state to RA onset, to subsequent CVD, and to death. Air pollution exposure was assessed using land use regression models, and hazard ratios (HRs) were calculated per interquartile range (IQR) increase in pollutant concentrations. Results: During a median follow-up of 12.69 years, 3422 participants developed RA, of whom 424 subsequently developed CVD. PM2.5 and NO2 showed the most extensive effects across transition stages. Per IQR increase in PM2.5 was associated with increased risks of RA onset (HR: 1.08; 95 %CI: 1.03, 1.12) and RA to death (HR: 1.20; 95 %CI: 1.06, 1.37), while NO2 was associated with increased risks of RA onset (HR: 1.10; 95 %CI: 1.06, 1.15) and subsequent CVD development (HR: 1.13; 95 %CI: 1.01, 1.28). Notably, valve disorders showed associations with multiple pollutants, and these effects were more pronounced in women and elderly participants. Conclusion: Long-term exposure to air pollutants was significantly associated with increased risks at multiple transition stages, from RA onset to subsequent CVD development and death, although effect sizes were modest for some transitions. Considering the widespread global exposure to air pollution, these findings emphasize the importance of air pollution control in preventing RA and its cardiovascular complications, especially among susceptible populations. |
| format | Article |
| id | doaj-art-cfa345b9a287405ebbf0f70c8a2930e6 |
| institution | DOAJ |
| issn | 0147-6513 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Ecotoxicology and Environmental Safety |
| spelling | doaj-art-cfa345b9a287405ebbf0f70c8a2930e62025-08-20T03:13:54ZengElsevierEcotoxicology and Environmental Safety0147-65132025-05-0129611818710.1016/j.ecoenv.2025.118187Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysisYu-Xuan Zhang0Bin-Bin Feng1Ma Ruo-Wei2Lin Zhu3Yong-Yong Liu4Yu-Ye Zuo5Hai-Feng Pan6Guo-Cui Wu7School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, ChinaSchool of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, ChinaSchool of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, ChinaSchool of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, ChinaSchool of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, ChinaSchool of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui 230032, China; Corresponding author at: Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China.School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui 230032, China; Corresponding author.Background: Patients with rheumatoid arthritis (RA) have a significantly elevated risk of developing cardiovascular disease (CVD), the leading cause of their death. However, the impact of environmental factors on RA progression remains unclear. This study aimed to explore the link between long-term air pollution exposure and the multi-stage progression from a healthy status to RA onset, then CVD development, and finally death. Methods: Utilizing data from 326,059 participants in the UK Biobank, we used a unidirectional multi-state Markov proportional hazards model to analyze the associations between long-term exposure to air pollutants (PM2.5, PM10, NO2, and NOx) and disease progression. The models included transitions from baseline healthy state to RA onset, to subsequent CVD, and to death. Air pollution exposure was assessed using land use regression models, and hazard ratios (HRs) were calculated per interquartile range (IQR) increase in pollutant concentrations. Results: During a median follow-up of 12.69 years, 3422 participants developed RA, of whom 424 subsequently developed CVD. PM2.5 and NO2 showed the most extensive effects across transition stages. Per IQR increase in PM2.5 was associated with increased risks of RA onset (HR: 1.08; 95 %CI: 1.03, 1.12) and RA to death (HR: 1.20; 95 %CI: 1.06, 1.37), while NO2 was associated with increased risks of RA onset (HR: 1.10; 95 %CI: 1.06, 1.15) and subsequent CVD development (HR: 1.13; 95 %CI: 1.01, 1.28). Notably, valve disorders showed associations with multiple pollutants, and these effects were more pronounced in women and elderly participants. Conclusion: Long-term exposure to air pollutants was significantly associated with increased risks at multiple transition stages, from RA onset to subsequent CVD development and death, although effect sizes were modest for some transitions. Considering the widespread global exposure to air pollution, these findings emphasize the importance of air pollution control in preventing RA and its cardiovascular complications, especially among susceptible populations.http://www.sciencedirect.com/science/article/pii/S0147651325005238Air pollutionRheumatoid arthritisCardiovascular diseaseMulti-state modelCohort study |
| spellingShingle | Yu-Xuan Zhang Bin-Bin Feng Ma Ruo-Wei Lin Zhu Yong-Yong Liu Yu-Ye Zuo Hai-Feng Pan Guo-Cui Wu Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis Ecotoxicology and Environmental Safety Air pollution Rheumatoid arthritis Cardiovascular disease Multi-state model Cohort study |
| title | Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis |
| title_full | Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis |
| title_fullStr | Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis |
| title_full_unstemmed | Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis |
| title_short | Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis |
| title_sort | long term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis a prospective cohort study using multi state model analysis |
| topic | Air pollution Rheumatoid arthritis Cardiovascular disease Multi-state model Cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S0147651325005238 |
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