Association Between Ambient Fine Particulate Matter and Physical Functioning in Middle-Aged and Older Chinese Adults: A Nationwide Longitudinal Study

Abstract

Background Exposure to air pollution is associated with several chronic diseases and subclinical processes that could subsequently contribute to physical disability. However, whether and to what extent air pollution exposure is associated with objective measures of physical functioning remains understudied. Methods We used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and included 10,823 participants who were surveyed at least twice. Annual average exposure to fine particulate matter (PM2.5) was assessed using a state-of-the-art estimator. Physical functioning was assessed with four objective tests covering hand-grip strength, balance, repeated chair stands, and gait speed. Mixed-effects models with participants as a random term were used to estimate associations with multiple adjustments. Results We found a significant and robust association between exposure to increased PM2.5 and the reduction in hand-grip strength and balance ability. Each 10-μg/m 3 increase in annual averaged concentrations of PM2.5 was associated with a 220-g (95% confidence interval [CI]: 127, 312 g) reduction in hand-grip strength per 60 kg of body weight and a 5% risk (95% CI: 2, 7) of reduced balance ability. The estimated effect of each 10-μg/m 3 increase in PM2.5 on hand-grip strength and balance ability was equivalent to the effect of aging [1.12 (95% CI: 0.76, 1.48) and 0.98 (95% CI: 0.50, 1.50) years, respectively]. Conclusions PM2.5 may be differentially associated with various dimensions of physical functioning. Improving air quality can prevent physical disability.

Associations of Household Solid Fuel Use With Falls and Fall-Related Injuries in Middle-Aged and Older Population in China: A Cohort Study

“…Recent studies have shown that environmental pollutants such as PM2.5 are also risk factors for falls and fall-related injuries [31]. Short-term and long-term exposure to environmental pollutants may be associated with a series of adverse health outcomes of physical function, such as slower gait, balance disorders, and tremors [14,21]. Moreover, some studies have shown the relationships between the indoor use of solid fuels and respiratory diseases, cardiovascular diseases, and cognitive dysfunction in different regions [32][33][34].…”

“…Prior studies supported that people with diabetes were at a significantly higher risk of falls and injurious falls than people without diabetes across [42]. Huiyu Wang et al found that each 10 μg/m3 increase in annual averaged concentrations of PM2.5 was associated with a 5% risk of reduced balance ability [21]. In addition, some experiments have demonstrated the adverse effects of solid fuels or indoor air pollution on physical health.…”

“…A cross-sectional study from China of 12,458 adults reported that solid fuels for cooking may be associated with self-reported and performance-based declines in physical functioning in middle-aged and older populations [19], and a longitudinal study from the Netherlands of 1,763 adults aged 55-85 years reported that performance-based physical functioning decreased with increasing levels of air pollutants [20]. Another nationwide longitudinal study in China, with 10,832 participants (65-105 years of age), concluded that an increase in the annual average concentration of fine particles of 10 μg/m 3 is accompanied by a 5% reduction in balance ability and that fine particles are also separately associated with various other physical limitations [21].…”

Health benefits from the rapid reduction in ambient exposure to air pollutants after China's clean air actions: progress in efficacy and geographic equality

“…From 2013 to 2020, a 48% decrease in PM 2.5 concentration was associated with a 21% reduction in attributable deaths (1.75 [95% confidence interval 1.64–1.85] million in 2013 to 1.39 [95% confidence interval 1.27–1.51] million in 2020) [ 3 ]. CAAs were associated with improvements in multiple health indicators, including lung function [ 6 ], lung-cancer incidence [ 7 ] and survival rate [ 8 ], kidney function [ 9 ], blood lipids [ 10 ], physical functions [ 11 ], household medical expenditure [ 12 ], and mental health [ 13–15 ]. However, increases in O 3 concentrations, particularly during the first stage, increased mortality in populous eastern China [ 16 ].…”

Source-Specific Air Pollution and Loss of Independence in Older Adults Across the US

“…This study contributes to the literature by newly evaluating associations between long-term exposure to air pollution and help for health or memory problems at older ages, which may be associated with physical or cognitive functional losses due to air pollution's impacts on chronic disease development. Although related work has investigated associations with self-reported difficulties in ADL 12,35,36 and performance-based tests 14,[37][38][39] alone, to our knowledge, our outcome is novel in its capture of more severe dysfunction that requires personal care for ADL and IADL. This may make this research more directly informative of the economic burdens associated with air pollution in older adults.…”