Benefits of active commuting on cardiovascular health modified by ambient fine particulate matter in China: A prospective cohort study

Background: Active commuting as a contributor to daily physical activity is beneficial for cardiovascular health, but leads to more chances of exposure to ambient air pollution. This study aimed to investigate associations between active commuting to work with cardiovascular disease (CVD), mortality and life expectancy among general Chinese adults, and to further evaluate the modification effect of fine particulate matter (PM) exposure on these associations. Methods: We included 76,176 Chinese adults without CVD from three large cohorts of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project. Information about commuting mode and physical activity were collected by unified questionnaire. Satellite-based PM concentrations at 1-km spatial resolution was used for estimating PM exposure of participants. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence, mortality and all-cause mortality were estimated using Cox proportional hazards regression models. Multiplicative interaction term of commuting mode and PM level was tested to investigate potential effect modification. Results: During 448,499 person-years of follow-up, 2230 CVD events and 2777 all-cause deaths were recorded. Compared with the non-active commuters, the multivariable-adjusted HRs (95% CIs) of CVD incidence and all-cause mortality were 0.95(0.85–1.05) and 0.79(0.72–0.87) for walking commuters, respectively. Corresponding HRs (95% CIs) for cycling commuters were 0.71(0.62–0.82) and 0.67(0.59–0.76). Active commuters over 45 years old were estimated to have more CVD-free years and life expectancy than non-active commuters under lower PM concentration. However, these beneficial effects of active commuting were alleviated or counteracted by long-term exposure to high PM concentration. Significant multiplicative interaction of commuting mode and PM level was showed in all-cause mortality, with the lowest risk observed in cycling participants exposed to lower level of PM. Conclusions: Active commuting was associated with lower risk of CVD, all-cause mortality, and longer life expectancy among Chinese adults under ambient settings with lower PM level. It will be valuable to encourage active commuting among adults and develop stringent strategies on ambient PM pollution control for prevention of CVD and prolongation of life expectancy.