Air pollution exposure and death from different subtypes of kidney diseases: A nationwide, individual-level, case-crossover study in China
Yalan Xiao, Fanna Liu, Ya Gao, Renjie Chen, Su Shi, Xinyue Li, Xia Meng, Haidong Kan, Maigeng ZhouAbstract
Background:
The association between air pollution and various subtypes of kidney disease remains unclear, and the primary pollutants involved are inconclusive. This study aimed to assess the impact of multiple air pollutants on death from kidney disease and its subtypes.
Methods:
An individual-level, time-stratified case-crossover design was used, encompassing all deaths from kidney disease records in China between 2013 and 2019. Daily average concentrations predicted by high-resolution air pollutant models were matched to the residential address of each decedent. Conditional logistic regression models were used to evaluate the association between short-term exposure to four air pollutants and kidney disease mortality.
Results:
The study included 466,543 deaths from kidney diseases. An interquartile range (IQR) increase in fine particulate matter (PM 2.5 ) and ozone (O 3 ) at lag 0–2 days was associated with a 1.95% (95% confidence interval [CI]: 1.22%, 2.69%) and 2.05% (95% CI: 1.05%, 3.07%) increase in the odds of death from kidney diseases, respectively; an IQR increase in coarse PM (PM 2.5–10 ) and nitrogen dioxide (NO 2 ) at lag 0–3 days was associated with a 2.40% (95% CI: 1.58%, 3.23%) and 3.62% (95% CI: 2.47%, 4.78%) increase in the odds of death, respectively. Of the four pollutants, NO 2 showed the strongest association with kidney disease mortality. Among the disease subtypes, death from renal failure and glomerular diseases showed significantly higher association with all four air pollutants, while that from renal tubulointerstitial diseases showed association only with O 3 . No significant associations were observed for urolithiasis and other disorders of the kidney and ureter.
Conclusions:
Short-term exposure to air pollution could significantly elevate the risk of death from kidney diseases, with renal failure being the most affected subtype, followed by glomerular diseases. This study underscores the urgent need for effective air pollution control measures to reduce mortality from kidney disease.