Associations of long-term exposure to nitrogen oxides with all-cause and cause-specific mortality
Siru Yang, Mengmeng Li, Cui Guo, Weeberb J. Réquia, Mohammad Javad Zare Sakhvidi, Kaili Lin, Qiongyu Zhu, Zhaoyue Chen, Peihua Cao, Lei Yang, Dan Luo, Jun Yang
Abstract
Associations between long-term exposure to nitrogen oxides (NOx) and cause-specific mortality remain insufficiently explored. This study utilizes data from 502,040 participants registered in the UK Biobank. Time-varying Cox regression is used to estimate mortality risks associated with NOx. Cause-specific mortality risks, including non-accidental, accidental and 15 major disease categories across 103 subcategories, are assessed for each 10 μg/m3 increase in NOx. Positive associations are observed between NOx and mortality from all-cause (HR: 1.036; 95% CI: 1.024, 1.049) and non-accidental diseases (HR: 1.032; 95% CI: 1.019, 1.045). We further identify 20 specific diseases related to NOx, notably respiratory diseases, mental and behavioral disorders, and circulatory diseases, with generally linear exposure-response relationships. Sex and residential areas are potential modifiers of the observed associations. Our findings suggest long-term exposure to NOx may increase mortality risks from a range of diseases, emphasizing the urgent need for clean air policies to alleviate the health burden. There is a critical gap in understanding the full spectrum of health effects associated with NOx exposure. Here, the authors find using UK Biobank data that mortality from all-cause, non-accidental and other 20 specific diseases was significantly associated with NOx.