ArticlePloS one2022
Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.
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Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The relationship between noise pollution and cardiovascular diseases: an umbrella review on meta-analyses.BMC cardiovascular disorders · 2025Pooled it
- A Systematic Review and Meta-Analysis on Long-Term Exposure to Particulate Matter and All-Cause and Cause-Specific Mortality in the Asia-Pacific States.Journal of Korean medical science · 2025Pooled it
- Forecasting Atherosclerotic Cardiovascular Disease in South Asia Until 2040: A Bayesian Modeling Approach.JACC. Asia · 2025Article
- Increased risk of developing cerebro-cardiovascular diseases in police officers: a nationwide retrospective cohort study.Clinical hypertension · 2024Article
- Social determinants of health and disease in companion dogs: a cohort study from the Dog Aging Project.Evolution, medicine, and public health · 2023Article
- Invited Perspective: Forward Progress in Characterizing the Mortality Burden ofEnvironmental health perspectives · 2022Article
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Authors and funding
16 authors.
Funding
Abstract
backgroundEnvironmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings.
methodsWe collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran. Environmental risk factors included: ambient fine particular matter air pollution; household fuel use and ventilation; proximity to traffic; distance to percutaneous coronary intervention (PCI) center; socioeconomic environment; population density; local land use; and nighttime light exposure. We developed a spatial survival model to estimate the independent associations between these environmental exposures and all-cause and cardiovascular mortality.
findingsSeveral environmental factors demonstrated associations with mortality after adjusting for individual risk factors. Ambient fine particulate matter air pollution predicted all-cause mortality (per μg/m3, HR 1.20, 95% CI 1.07, 1.36) and cardiovascular mortality (HR 1.17, 95% CI 0.98, 1.39). Biomass fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.23, 95% CI 0.99, 1.53) and cardiovascular mortality (HR 1.36, 95% CI 0.99, 1.87). Kerosene fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.09, 95% CI 0.97, 1.23) and cardiovascular mortality (HR 1.19, 95% CI 1.01, 1.41). Distance to PCI center predicted all-cause mortality (per 10km, HR 1.01, 95% CI 1.004, 1.022) and cardiovascular mortality (HR 1.02, 95% CI 1.004, 1.031). Additionally, proximity to traffic predicted all-cause mortality (HR 1.13, 95% CI 1.01, 1.27). In a separate validation cohort, the multivariable model effectively predicted both all-cause mortality (AUC 0.76) and cardiovascular mortality (AUC 0.81). Population attributable fractions demonstrated a high mortality burden attributable to environmental exposures.
interpretationSeveral environmental factors predicted cardiovascular and all-cause mortality, independent of each other and of individual risk factors. Mortality attributable to environmental factors represents a critical opportunity for targeted policies and programs.
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