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Abstract：
BACKGROUND: PM2.5 can induce and aggravate the occurrence and development of cardiovascular diseases (CVDs). The objective of our study is to estimate the causal effect of PM2.5 on mortality rates associated with CVDs using the instrumental variables (IVs) method.
METHODS: We extracted daily meteorological, PM2.5 and CVDs death data from 2016 to 2020 in Binzhou. Subsequently, we employed the general additive model (GAM), two-stage predictor substitution (2SPS), and control function (CFN) to analyze the association between PM2.5 and daily CVDs mortality.
RESULTS: The 2SPS estimated the association between PM2.5 and daily CVDs mortality as 1.14% (95% CI: 1.04%, 1.14%) for every 10 µg/m3 increase in PM2.5. Meanwhile, the CFN estimated this association to be 1.05% (95% CI: 1.02%, 1.10%). The GAM estimated it as 0.85% (95% CI: 0.77%, 1.05%). PM2.5 also exhibited a statistically significant effect on the mortality rate of patients with ischaemic heart disease, myocardial infarction, or cerebrovascular accidents (P < 0.05). However, no significant association was observed between PM2.5 and hypertension.
CONCLUSIONS: PM2.5 was significantly associated with daily CVDs deaths (excluding hypertension). The estimates from the IVs method were slightly higher than those from the GAM. Previous studies based on GAM may have underestimated the impact of PM2.5 on CVDs.
METHODS: We extracted daily meteorological, PM2.5 and CVDs death data from 2016 to 2020 in Binzhou. Subsequently, we employed the general additive model (GAM), two-stage predictor substitution (2SPS), and control function (CFN) to analyze the association between PM2.5 and daily CVDs mortality.
RESULTS: The 2SPS estimated the association between PM2.5 and daily CVDs mortality as 1.14% (95% CI: 1.04%, 1.14%) for every 10 µg/m3 increase in PM2.5. Meanwhile, the CFN estimated this association to be 1.05% (95% CI: 1.02%, 1.10%). The GAM estimated it as 0.85% (95% CI: 0.77%, 1.05%). PM2.5 also exhibited a statistically significant effect on the mortality rate of patients with ischaemic heart disease, myocardial infarction, or cerebrovascular accidents (P < 0.05). However, no significant association was observed between PM2.5 and hypertension.
CONCLUSIONS: PM2.5 was significantly associated with daily CVDs deaths (excluding hypertension). The estimates from the IVs method were slightly higher than those from the GAM. Previous studies based on GAM may have underestimated the impact of PM2.5 on CVDs.
摘要：
背景：PM2.5可诱发和加重心血管疾病的发生和发展。我们研究的目的是使用工具变量（IVs）方法估计PM2.5对与CVD相关的死亡率的因果影响。
方法：我们提取了每日气象，滨州市2016-2020年PM2.5和CVD死亡数据。随后，我们采用了一般加法模型(GAM)，两阶段预测因子替换(2SPS)，和控制功能（CFN）分析PM2.5与每日CVD死亡率之间的关系。
结果：2SPS估计PM2.5与每日CVD死亡率之间的关联为1.14％（95％CI：1.04％，1.14%），PM2.5每增加10µg/m3。同时,CFN估计这一关联为1.05%(95%CI：1.02%，1.10%）。GAM估计为0.85%(95%CI：0.77%，1.05%）。PM2.5对缺血性心脏病患者的死亡率也表现出统计学上的显着影响，心肌梗塞,或脑血管意外(P<0.05)。然而,PM2.5与高血压之间没有显著关联.
结论：PM2.5与每日CVD死亡（不包括高血压）显著相关。IV方法的估计值略高于GAM。先前基于GAM的研究可能低估了PM2.5对CVD的影响。
方法：我们提取了每日气象，滨州市2016-2020年PM2.5和CVD死亡数据。随后，我们采用了一般加法模型(GAM)，两阶段预测因子替换(2SPS)，和控制功能（CFN）分析PM2.5与每日CVD死亡率之间的关系。
结果：2SPS估计PM2.5与每日CVD死亡率之间的关联为1.14％（95％CI：1.04％，1.14%），PM2.5每增加10µg/m3。同时,CFN估计这一关联为1.05%(95%CI：1.02%，1.10%）。GAM估计为0.85%(95%CI：0.77%，1.05%）。PM2.5对缺血性心脏病患者的死亡率也表现出统计学上的显着影响，心肌梗塞,或脑血管意外(P<0.05)。然而,PM2.5与高血压之间没有显著关联.
结论：PM2.5与每日CVD死亡（不包括高血压）显著相关。IV方法的估计值略高于GAM。先前基于GAM的研究可能低估了PM2.5对CVD的影响。
