Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults

Background: Cardiovascular-kidney-metabolic (CKM) syndrome is identified as a medical condition with the presence of obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study assesses the associations of ambient air pollution and household fuel usage with the risk of CKM synd...

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Main Authors: Shunchang Fan, Haoyue Hu, Yucheng Li, Ying Deng, Shiao Wang, Juxian Xian, Daoqi Zhu, Minyi Zhang
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Ecotoxicology and Environmental Safety
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Online Access:http://www.sciencedirect.com/science/article/pii/S0147651325012606
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author Shunchang Fan
Haoyue Hu
Yucheng Li
Ying Deng
Shiao Wang
Juxian Xian
Daoqi Zhu
Minyi Zhang
author_facet Shunchang Fan
Haoyue Hu
Yucheng Li
Ying Deng
Shiao Wang
Juxian Xian
Daoqi Zhu
Minyi Zhang
author_sort Shunchang Fan
collection DOAJ
description Background: Cardiovascular-kidney-metabolic (CKM) syndrome is identified as a medical condition with the presence of obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study assesses the associations of ambient air pollution and household fuel usage with the risk of CKM syndrome in advanced stages among middle-aged and older adults. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 and 2015 were used. Data of ambient air pollutants (NO2, SO2, O3, PM1, PM2.5, and PM10) were derived from the ChinaHighAirPollutants (CHAP) dataset. CKM syndrome was separated into five stages (stages 0–4), with stages 3–4 being considered advanced. Logistic regression quantified the separate and joint effects of exposure to ambient air pollution and household fuel usage on advanced CKM syndrome. Multiple ambient air pollutants were evaluated using the weighted quantile sum regression, quantile-based gcomputation, and Bayesian kernel machine regression. Results: In the longitudinal analysis, 18.2 % (604/3317) of participants developed advanced CKM syndrome. For single-pollutant models, ambient air pollutants and household solid fuel use were found as the independent risk factors for advanced CKM syndrome. The highest risk occurred in individuals with combined high ambient air pollution exposure and clean-to-solid fuel use. Additionally, co-exposure to a higher level of ambient air pollutant mixture showed a consistently elevated risk of advanced CKM syndrome, with PM10 being the primary driver. Conclusion: Concurrent exposure to high levels of outdoor and indoor air pollution increases the risk of CKM syndrome in advanced stages.
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spelling doaj-art-e1eca8a634bd4c2b82a4da27c9d12ab42025-08-25T04:13:57ZengElsevierEcotoxicology and Environmental Safety0147-65132025-09-0130311891510.1016/j.ecoenv.2025.118915Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adultsShunchang Fan0Haoyue Hu1Yucheng Li2Ying Deng3Shiao Wang4Juxian Xian5Daoqi Zhu6Minyi Zhang7Department of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaReproductive Medicine Center, The Eighth Affiliated Hospital of Southern Medical University (The First People's Hospital of Shunde), Foshan 528300, ChinaDepartment of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaDepartment of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaDepartment of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaDepartment of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, ChinaDepartment of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China; Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education, Guangdong Pharmaceutical University, Guangzhou 510006, China; Correspondence to: Guangdong Pharmaceutical University, No. 280 Wai Huan Dong Road, Panyu District, Guangzhou 510006, China.Department of Epidemiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China; Correspondence to: Southern Medical University, No. 1023-1063, Shatai South Road, Baiyun District, Guangzhou 510515, China.Background: Cardiovascular-kidney-metabolic (CKM) syndrome is identified as a medical condition with the presence of obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study assesses the associations of ambient air pollution and household fuel usage with the risk of CKM syndrome in advanced stages among middle-aged and older adults. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 and 2015 were used. Data of ambient air pollutants (NO2, SO2, O3, PM1, PM2.5, and PM10) were derived from the ChinaHighAirPollutants (CHAP) dataset. CKM syndrome was separated into five stages (stages 0–4), with stages 3–4 being considered advanced. Logistic regression quantified the separate and joint effects of exposure to ambient air pollution and household fuel usage on advanced CKM syndrome. Multiple ambient air pollutants were evaluated using the weighted quantile sum regression, quantile-based gcomputation, and Bayesian kernel machine regression. Results: In the longitudinal analysis, 18.2 % (604/3317) of participants developed advanced CKM syndrome. For single-pollutant models, ambient air pollutants and household solid fuel use were found as the independent risk factors for advanced CKM syndrome. The highest risk occurred in individuals with combined high ambient air pollution exposure and clean-to-solid fuel use. Additionally, co-exposure to a higher level of ambient air pollutant mixture showed a consistently elevated risk of advanced CKM syndrome, with PM10 being the primary driver. Conclusion: Concurrent exposure to high levels of outdoor and indoor air pollution increases the risk of CKM syndrome in advanced stages.http://www.sciencedirect.com/science/article/pii/S0147651325012606Cardiovascular-kidney-metabolic syndromeAmbient air pollutionHousehold fuel useMixed effect
spellingShingle Shunchang Fan
Haoyue Hu
Yucheng Li
Ying Deng
Shiao Wang
Juxian Xian
Daoqi Zhu
Minyi Zhang
Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults
Ecotoxicology and Environmental Safety
Cardiovascular-kidney-metabolic syndrome
Ambient air pollution
Household fuel use
Mixed effect
title Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults
title_full Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults
title_fullStr Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults
title_full_unstemmed Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults
title_short Effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular-kidney-metabolic syndrome among middle-aged and older adults
title_sort effects of ambient air pollution mixtures and household fuel use on progression to advanced cardiovascular kidney metabolic syndrome among middle aged and older adults
topic Cardiovascular-kidney-metabolic syndrome
Ambient air pollution
Household fuel use
Mixed effect
url http://www.sciencedirect.com/science/article/pii/S0147651325012606
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