Effects of air pollution and habitual exercise on the risk of death: A longitudinal cohort study

Cui Guo; Tsung Yu; Ly-yun Chang; Changqing Lin; Hsiao Ting Yang; Yacong Bo; Yiqian Zeng; Tony Tam; Alexis K.H. Lau; Xiang Qian Lao

doi:10.1503/cmaj.202729

Effects of air pollution and habitual exercise on the risk of death: A longitudinal cohort study

Cui Guo
, Tsung Yu
, Ly-yun Chang
, Changqing Lin
, Hsiao Ting Yang
, Yacong Bo
, Yiqian Zeng
, Tony Tam
, Alexis K.H. Lau
, Xiang Qian Lao^*

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

23 Citations (Scopus)

2 Downloads (CityUHK Scholars)

Abstract

Background: Exercise may exacerbate the adverse health effects of air pollution by increasing the inhalation of air pollutants. We investigated the combined effects of long-term exposure to fine particle matter (PM_2.5) and habitual exercise on deaths from natural causes in Taiwan.

Methods: We recruited 384 130 adults (aged ≥ 18 yr) with 842394 medical examination records between 2001 and 2016, and followed all participants until May 31, 2019. We obtained vital data from the National Death Registry of Taiwan. We estimated PM_2.5 exposure using a satellite-based spatiotemporal model, and collected information on exercise habits using a standard self-administered questionnaire. We analyzed the data using a Cox regression model with time-dependent covariates.

Results: A higher level of habitual exercise was associated with a lower risk of death from natural causes, compared with inactivity (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.80–0.88 for the moderate exercise group; HR 0.65, 95% CI 0.62–0.68 for the high exercise groups), whereas a higher PM_2.5 exposure was associated with a higher risk of death from natural causes compared with lower exposure (HR 1.02, 95% CI 0.98–1.07, and HR 1.15, 95% CI 1.10–1.20, for the moderate and high PM_2.5 exposure groups, respectively). Compared with inactive adults with high PM_2.5 exposure, adults with high levels of habitual exercise and low PM_2.5 exposure had a substantially lower risk of death from natural causes. We found a minor, but statistically significant, interaction effect between exercise and PM_2.5 exposure on risk of death (HR 1.03 95% CI 1.01–1.06). Subgroup analyses, stratified by PM_2.5 categories, suggested that moderate and high levels of exercise were associated with a lower risk of death in each PM_2.5 stratum, compared with inactivity.

Interpretation: Increased levels of exercise and reduced PM_2.5 exposure are associated with a lower risk of death from natural causes. Habitual exercise can reduce risk regardless of the levels of PM_2.5 exposure. Our results suggest that exercise is a safe health improvement strategy, even for people residing in relatively polluted regions.

© 2021 CMA Joule Inc. or its licensors

Original language	English
Pages (from-to)	E1240-E1249
Number of pages	10
Journal	CMAJ
Volume	193
Issue number	32
DOIs	https://doi.org/10.1503/cmaj.202729
Publication status	Published - 16 Aug 2021
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2021 CMA Joule Inc. or its licensors

Funding

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ Funding: This work was supported in part by the RGC-General Research Fund (14603019) and the Environmental Health Research Fund of the Chinese University of Hong Kong (7104946). Cui Guo is supported in part by the Faculty Postdoctoral Fellowship Scheme of the Faculty of Medicine of the Chinese University of Hong Kong. Yiqian Zeng is supported by the PhD Studentship of the Chinese University of Hong Kong.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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@article{f159ae5d1c2b41688daaa0584f0f086e,

title = "Effects of air pollution and habitual exercise on the risk of death: A longitudinal cohort study",

abstract = "Background: Exercise may exacerbate the adverse health effects of air pollution by increasing the inhalation of air pollutants. We investigated the combined effects of long-term exposure to fine particle matter (PM2.5) and habitual exercise on deaths from natural causes in Taiwan. Methods: We recruited 384 130 adults (aged ≥ 18 yr) with 842394 medical examination records between 2001 and 2016, and followed all participants until May 31, 2019. We obtained vital data from the National Death Registry of Taiwan. We estimated PM2.5 exposure using a satellite-based spatiotemporal model, and collected information on exercise habits using a standard self-administered questionnaire. We analyzed the data using a Cox regression model with time-dependent covariates. Results: A higher level of habitual exercise was associated with a lower risk of death from natural causes, compared with inactivity (hazard ratio [HR] 0.84, 95\% confidence interval [CI] 0.80–0.88 for the moderate exercise group; HR 0.65, 95\% CI 0.62–0.68 for the high exercise groups), whereas a higher PM2.5 exposure was associated with a higher risk of death from natural causes compared with lower exposure (HR 1.02, 95\% CI 0.98–1.07, and HR 1.15, 95\% CI 1.10–1.20, for the moderate and high PM2.5 exposure groups, respectively). Compared with inactive adults with high PM2.5 exposure, adults with high levels of habitual exercise and low PM2.5 exposure had a substantially lower risk of death from natural causes. We found a minor, but statistically significant, interaction effect between exercise and PM2.5 exposure on risk of death (HR 1.03 95\% CI 1.01–1.06). Subgroup analyses, stratified by PM2.5 categories, suggested that moderate and high levels of exercise were associated with a lower risk of death in each PM2.5 stratum, compared with inactivity. Interpretation: Increased levels of exercise and reduced PM2.5 exposure are associated with a lower risk of death from natural causes. Habitual exercise can reduce risk regardless of the levels of PM2.5 exposure. Our results suggest that exercise is a safe health improvement strategy, even for people residing in relatively polluted regions. {\textcopyright} 2021 CMA Joule Inc. or its licensors ",

author = "Cui Guo and Tsung Yu and Ly-yun Chang and Changqing Lin and Yang, \{Hsiao Ting\} and Yacong Bo and Yiqian Zeng and Tony Tam and Lau, \{Alexis K.H.\} and Lao, \{Xiang Qian\}",

note = "Publisher Copyright: {\textcopyright} 2021 CMA Joule Inc. or its licensors",

year = "2021",

month = aug,

day = "16",

doi = "10.1503/cmaj.202729",

language = "English",

volume = "193",

pages = "E1240--E1249",

journal = "CMAJ",

issn = "0820-3946",

publisher = "Canadian Medical Association",

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T1 - Effects of air pollution and habitual exercise on the risk of death

T2 - A longitudinal cohort study

AU - Guo, Cui

AU - Yu, Tsung

AU - Chang, Ly-yun

AU - Lin, Changqing

AU - Yang, Hsiao Ting

AU - Bo, Yacong

AU - Zeng, Yiqian

AU - Tam, Tony

AU - Lau, Alexis K.H.

AU - Lao, Xiang Qian

PY - 2021/8/16

Y1 - 2021/8/16

N2 - Background: Exercise may exacerbate the adverse health effects of air pollution by increasing the inhalation of air pollutants. We investigated the combined effects of long-term exposure to fine particle matter (PM2.5) and habitual exercise on deaths from natural causes in Taiwan. Methods: We recruited 384 130 adults (aged ≥ 18 yr) with 842394 medical examination records between 2001 and 2016, and followed all participants until May 31, 2019. We obtained vital data from the National Death Registry of Taiwan. We estimated PM2.5 exposure using a satellite-based spatiotemporal model, and collected information on exercise habits using a standard self-administered questionnaire. We analyzed the data using a Cox regression model with time-dependent covariates. Results: A higher level of habitual exercise was associated with a lower risk of death from natural causes, compared with inactivity (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.80–0.88 for the moderate exercise group; HR 0.65, 95% CI 0.62–0.68 for the high exercise groups), whereas a higher PM2.5 exposure was associated with a higher risk of death from natural causes compared with lower exposure (HR 1.02, 95% CI 0.98–1.07, and HR 1.15, 95% CI 1.10–1.20, for the moderate and high PM2.5 exposure groups, respectively). Compared with inactive adults with high PM2.5 exposure, adults with high levels of habitual exercise and low PM2.5 exposure had a substantially lower risk of death from natural causes. We found a minor, but statistically significant, interaction effect between exercise and PM2.5 exposure on risk of death (HR 1.03 95% CI 1.01–1.06). Subgroup analyses, stratified by PM2.5 categories, suggested that moderate and high levels of exercise were associated with a lower risk of death in each PM2.5 stratum, compared with inactivity. Interpretation: Increased levels of exercise and reduced PM2.5 exposure are associated with a lower risk of death from natural causes. Habitual exercise can reduce risk regardless of the levels of PM2.5 exposure. Our results suggest that exercise is a safe health improvement strategy, even for people residing in relatively polluted regions. © 2021 CMA Joule Inc. or its licensors

AB - Background: Exercise may exacerbate the adverse health effects of air pollution by increasing the inhalation of air pollutants. We investigated the combined effects of long-term exposure to fine particle matter (PM2.5) and habitual exercise on deaths from natural causes in Taiwan. Methods: We recruited 384 130 adults (aged ≥ 18 yr) with 842394 medical examination records between 2001 and 2016, and followed all participants until May 31, 2019. We obtained vital data from the National Death Registry of Taiwan. We estimated PM2.5 exposure using a satellite-based spatiotemporal model, and collected information on exercise habits using a standard self-administered questionnaire. We analyzed the data using a Cox regression model with time-dependent covariates. Results: A higher level of habitual exercise was associated with a lower risk of death from natural causes, compared with inactivity (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.80–0.88 for the moderate exercise group; HR 0.65, 95% CI 0.62–0.68 for the high exercise groups), whereas a higher PM2.5 exposure was associated with a higher risk of death from natural causes compared with lower exposure (HR 1.02, 95% CI 0.98–1.07, and HR 1.15, 95% CI 1.10–1.20, for the moderate and high PM2.5 exposure groups, respectively). Compared with inactive adults with high PM2.5 exposure, adults with high levels of habitual exercise and low PM2.5 exposure had a substantially lower risk of death from natural causes. We found a minor, but statistically significant, interaction effect between exercise and PM2.5 exposure on risk of death (HR 1.03 95% CI 1.01–1.06). Subgroup analyses, stratified by PM2.5 categories, suggested that moderate and high levels of exercise were associated with a lower risk of death in each PM2.5 stratum, compared with inactivity. Interpretation: Increased levels of exercise and reduced PM2.5 exposure are associated with a lower risk of death from natural causes. Habitual exercise can reduce risk regardless of the levels of PM2.5 exposure. Our results suggest that exercise is a safe health improvement strategy, even for people residing in relatively polluted regions. © 2021 CMA Joule Inc. or its licensors

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DO - 10.1503/cmaj.202729

M3 - RGC 21 - Publication in refereed journal

C2 - 34400482

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Effects of air pollution and habitual exercise on the risk of death: A longitudinal cohort study

Abstract

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Funding

UN SDGs

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