Long-term exposure to outdoor fine particulate and physical activity with mortality and cardiovascular events: an analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study
Bibliographic record
Abstract
Background: Long-term exposure to PM2.5 and low physical activity are independently associated with an increased risk of cardiovascular disease (CVD). However, there is limited research investigating the combined effects of PM2.5 exposure and physical activity on CVD risk. This study aims to explore these interactions related to CVD and mortality. Methods: We analysed data from the PURE-China cohort, including 39,970 adults aged 35-70 years, with a median follow-up of 11.9 years. PM2.5 exposure was estimated using a Bayesian hierarchical model. Physical activity was quantified using metabolic equivalent task (MET)-minutes per week. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty models and restricted cubic splines were used to assess associations. Interaction effects were evaluated using measures of multiplicative and additive interaction, including the relative excess risk due to interaction (RERI) and the proportion attributable to interaction (AP). Findings: ). In low-exposure areas, higher total physical activity significantly reduced the risk of composite outcome (HR: 0.84, 95% CI: 0.73-0.97, p trend = 0.012) and major cardiovascular events (HR: 0.80, 0.67-0.95, p trend = 0.022). However, in high-exposure regions, physical activity showed no protective effect for the composite outcome (HR: 0.97, 0.85-1.09, p trend = 0.551) and major cardiovascular events (HR: 0.98, 0.85-1.13, p trend = 0.864). Higher non-recreational physical activity reduced the risks of composite outcome and major CVD in low-exposure areas but provided no benefit in high-exposure regions (p interaction = 0.011, 0.024, respectively). Significant antagonistic interaction was observed between high PM2.5 exposure and low non-recreational physical activity for the composite outcome (RERI: -0.215, 95% CI: -0.406 to -0.024; AP: -0.155, 95% CI: -0.294 to -0.017). Interpretation: Long-term exposure to high PM2.5 concentrations diminishes the cardiovascular benefits of physical activity, particularly non-recreational activities. These findings underscore the need for tailored physical activity guidelines and air quality interventions in heavily polluted regions to maximize public health benefits. Funding: Funding sources are listed at the end of the Article.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".