Association of PM2.5, O3 and greenness exposure with risk of cardiometabolic multimorbidity: a prospective cohort study.
There is less evidence on the association between long-term PM2.5, O3, greenness exposure and cardiometabolic multimorbidity (CMM), and the aim of this study was to investigate the combined effects of PM2.5, O3 and greenness exposure on the risk of developing CMM.Our findings demonstrated that a 10 µg/m³ rise in PM2.5 concentration led to a 23.8% increased CMM risk (HR = 1.238, 95%CI: 1.202,1.275). A 0.1 increase in NDVI reduced CMM risk by 18.9% (HR = 0.811, 95% CI: 0.779,0.845). A 10 µg/m³ O3 concentration increase surprisingly lowered CMM risk by 30.8% (HR = 0.692, 95% CI: 0.649,0.738). Positive interactions were seen between high PM2.5+low O3 and low O3 + low NDVI, while high PM2.5+low NDVI had negative interactions regarding CMM. PM2.5 mediated the link between NDVI and CMM, heart disease, and stroke.This study emphasizes that long-term high PM2.5 exposure ups CMM risk in Chinese middle-aged and older adults, yet NDVI exposure reduces it, with PM2.5 as a mediator. The O3-CMM relationship remains unclear.