Association between fine particulate matter and heart failure hospitalizations: a time-series analysis in Yancheng, China

Background Heart failure (HF) is a global public health problem of increasing importance. The association between acute exposure to air pollution and HF has been well established in developed countries, but little evidence is available in developing countries where air pollution levels are much higher. Objectives To explore the associations between PM 2.5 and HF hospitalizations in Yancheng, China. Methods In this time-series study, daily HF hospitalizations admitted in three major hospitals in Yancheng from May 1, 2015 to Apr 30, 2020 were collected. We used a generalized additive model with quasi-Poisson regression to investigate the association between PM 2.5 and HF hospitalizations. The robustness of the associations was tested using two-pollutant models, and we examined the potential effect modification by age, gender, and season via stratification analyses. Lastly, we pooled the concentration-response curves. Results A total of 10,466 HF hospitalizations were recorded, with a daily average of 6 cases. We observed the most robust estimates on lag 0 day, and the associated increment in HF was 1.28% (95% CI 0.45%, 2.11%) for a 10-μg/m 3 increase of PM 2.5 . The association remained after adjustment of O 3 , but not for NO 2 , CO, and SO 2 . The PM 2.5 -HF associations were positive in females, patients aged ≥ 65 years, and in cold season. The C-R relationship curve was generally increasing below 30 μg/m 3 . Conclusion This study provided evidence on the association of PM 2.5 with acute exacerbation of chronic heart failure, which may benefit future prevention strategy and policymaking.