Joint effects of air pollution and compound dry-hot extremes on cardiovascular disease risk across adults: a cohort study in China
- 1The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Zhejiang, 311200 China
- 2School of Geographic Science, East China Normal University, Shanghai, 200241 China
Abstract
Background: Compound dry-hot extremes (CDHEs) and ambient air pollution are growing public health threats under global climate change, yet their joint impacts on cardiovascular disease (CVD) risk remain poorly understood.
Methods: We conducted a nationwide longitudinal cohort study using data from the China Family Panel Studies (CFPS), including 9,265 Chinese adults aged ≥ 18 years with 69,297 repeated observations between 2010 and 2018. We evaluated the independent, joint and heterogeneous effects of multi-dimensional CDHE metrics (accumulated days, frequency and average severity) and key air pollutants (e.g., PM2.5) on incident CVD. Mixed-effects Cox models, interaction analyses and stratified analyses were performed to examine the study objectives.
Results: Per interquartile range (IQR) increment in CDHE cumulative days and PM2.5 concentration were associated with 30% (HR = 1.30, 95% CI: 1.20–1.41) and 54% (HR = 1.54, 95% CI: 1.42–1.67) higher CVD risk, respectively, with CDHE accumulated days rather than event frequency or intensity driving the long-term cardiovascular damage. Both exposures showed the strongest risk elevations for coronary heart disease, with 72% (HR = 1.72, 95% CI: 1.44–2.07) and 75% (HR = 1.75, 95% CI: 1.46–2.11) risk increments per IQR for CDHE cumulative days and PM2.5, respectively. Critically, concurrent high exposure to CDHEs and PM2.5 induced synergistic elevated CVD risk, with the joint hazard ratio reaching 1.92 (95% CI: 1.67–2.21), and this synergistic pattern was consistent across PM1, PM10, NO2 and O3. Stratified analyses further revealed that older adults, males, urban residents, smokers, drinkers, physically inactive and overweight individuals were more susceptible to these environmental risks.
Conclusions: Compound dry-hot extremes and ambient air pollution are independent risk factors for incident CVD in Chinese adults. Concurrent exposure to these two environmental stressors induces synergistic cardiovascular damage, with CDHE accumulated days being the primary driver. These findings pointing to the necessity for integrated public health strategies that simultaneously target air quality improvement and climate resilience.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28927-4.
Related
- Asymmetric intensification of heatwave-ozone compound extremes across China at 1 km resolution from 2000 to 2023
- Compound climate extremes, socioeconomic conditions and human mobility influence dengue dynamics heterogeneously across Vietnam
- Compound climate extremes predict dengue risk at operational lead times across Brazil
- Air pollution, neighbourhood walkability and cerebrovascular small vessel disease in patients with cardiovascular disorders along the heart-brain axis.
- Joint Impacts of Ambient Air Pollution and Temperature on Cardiovascular Disease in West Florida
BibTeX
@article{shi2026joint,
title = {{Joint effects of air pollution and compound dry-hot extremes on cardiovascular disease risk across adults: a cohort study in China}},
author = {Qianhui Shi and Wen Ding and Jinqiong Fang and Kaiyu Hua and Hao Wu and Zherui Fu and Ying Hua},
journal = {BMC Public Health},
year = {2026},
month = aug,
doi = {10.1186/s12889-026-28927-4},
url = {https://doi.org/10.1186/s12889-026-28927-4},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Joint effects of air pollution and compound dry-hot extremes on cardiovascular disease risk across adults: a cohort study in China
AU - Qianhui Shi
AU - Wen Ding
AU - Jinqiong Fang
AU - Kaiyu Hua
AU - Hao Wu
AU - Zherui Fu
AU - Ying Hua
PY - 2026
DA - 2026/08/07
JO - BMC Public Health
DO - 10.1186/s12889-026-28927-4
UR - https://doi.org/10.1186/s12889-026-28927-4
AB - Background: Compound dry-hot extremes (CDHEs) and ambient air pollution are growing public health threats under global climate change, yet their joint impacts on cardiovascular disease (CVD) risk remain poorly understood. Methods: We conducted a nationwide longitudinal cohort study using data from the China Family Panel Studies (CFPS), including 9,265 Chinese adults aged ≥ 18 years with 69,297 repeated observations between 2010 and 2018. We evaluated the independent, joint and heterogeneous effects of multi-dimensional CDHE metrics (accumulated days, frequency and average severity) and key air pollutants (e.g., PM2.5) on incident CVD. Mixed-effects Cox models, interaction analyses and stratified analyses were performed to examine the study objectives. Results: Per interquartile range (IQR) increment in CDHE cumulative days and PM2.5 concentration were associated with 30% (HR = 1.30, 95% CI: 1.20–1.41) and 54% (HR = 1.54, 95% CI: 1.42–1.67) higher CVD risk, respectively, with CDHE accumulated days rather than event frequency or intensity driving the long-term cardiovascular damage. Both exposures showed the strongest risk elevations for coronary heart disease, with 72% (HR = 1.72, 95% CI: 1.44–2.07) and 75% (HR = 1.75, 95% CI: 1.46–2.11) risk increments per IQR for CDHE cumulative days and PM2.5, respectively. Critically, concurrent high exposure to CDHEs and PM2.5 induced synergistic elevated CVD risk, with the joint hazard ratio reaching 1.92 (95% CI: 1.67–2.21), and this synergistic pattern was consistent across PM1, PM10, NO2 and O3. Stratified analyses further revealed that older adults, males, urban residents, smokers, drinkers, physically inactive and overweight individuals were more susceptible to these environmental risks. Conclusions: Compound dry-hot extremes and ambient air pollution are independent risk factors for incident CVD in Chinese adults. Concurrent exposure to these two environmental stressors induces synergistic cardiovascular damage, with CDHE accumulated days being the primary driver. These findings pointing to the necessity for integrated public health strategies that simultaneously target air quality improvement and climate resilience. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28927-4.
SN - 1471-2458
ER -