{
  "abstract": "Background: Ambient air pollution is associated with cardiovascular, metabolic, and liver diseases, but evidence for cardiovascular–liver–metabolic multimorbidity (CLMM) and pollutant mixtures is limited. We examined these associations in middle-aged and older adults in China.\n\nMethods: We analyzed 4,650 adults from 119 cities in the China Health and Retirement Longitudinal Study at the 2011 baseline and 2015 follow-up. Incident CLMM was defined as the new coexistence of at least two domains: cardiovascular disease, diabetes, and operationally defined probable metabolic dysfunction-associated steatotic liver disease. City-level concentrations of seven pollutants were obtained from the China High Air Pollutants database. Logistic generalized linear mixed models with a city-level random intercept were supplemented by weighted quantile sum (WQS) regression, interaction analyses, and city-grouped machine-learning models.\n\nResults: During follow-up, 757 participants (16.3%) developed CLMM. In fully adjusted single-pollutant models, the odds ratios per interquartile-range increase were 1.33 (95% CI 1.10–1.61) for PM₂.₅, 1.42 (1.13–1.77) for PM₁₀, 1.30 (1.08–1.56) for CO, and 1.30 (1.06–1.58) for nitrogen dioxide. Estimates were attenuated after co-pollutant adjustment: only PM₁₀ remained associated with CLMM after adjustment for CO; and no association remained statistically significant in the three-pollutant models. The positive WQS index was associated with CLMM (OR 1.25, 95% CI 1.09–1.42). No multiplicative interaction was detected by glycemic or blood-pressure status. Odds-ratio-based additive interaction signals were observed only for PM₂.₅ and CO with elevated blood pressure. In the selected random-forest model, the mean absolute Shapley additive explanations (SHAP) value was largest for CO (0.0128), followed by PM₁₀ (0.0110) and O₃ (0.0090).\n\nConclusions: Long-term exposure to PM₂.₅, PM₁₀, CO, nitrogen dioxide and the positive pollutant-mixture index was associated with incident CLMM. The findings support further evaluation of air pollution as a potentially modifiable environmental correlate of multimorbidity. Studies with finer exposure assessment and external validation are needed, particularly for adults with elevated blood pressure.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "Miyuan Wang"
    },
    {
      "name": "Fuxia Wu"
    },
    {
      "name": "Jing Zhang"
    },
    {
      "name": "Jian Yang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b5yc1matqe8c5.bib",
  "cited_by": 0,
  "doi": "10.1186/s12889-026-29891-9",
  "fulltext_url": null,
  "id": "b5yc1matqe8c5",
  "issns": [
    "1471-2458"
  ],
  "landing_url": "https://link.springer.com/10.1186/s12889-026-29891-9",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2307|Air Quality and Health Impacts"
    ]
  ],
  "openalex": "W7221548019",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-13",
  "publisher": "Springer Science and Business Media LLC",
  "ris": "https://research.draconitic.com/paper/b5yc1matqe8c5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:54Z",
      "native_id": "10.1186/s12889-026-29891-9",
      "source": "crossref",
      "url": "https://link.springer.com/10.1186/s12889-026-29891-9"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Air Quality and Health Impacts",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Long-term exposure to ambient air pollution mixtures and incident cardiovascular–liver–metabolic multimorbidity: a prospective cohort study",
  "title_text": "Long-term exposure to ambient air pollution mixtures and incident cardiovascular–liver–metabolic multimorbidity: a prospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:54Z",
  "url": "https://research.draconitic.com/paper/b5yc1matqe8c5",
  "venue": "BMC Public Health",
  "versions": []
}