Association between ambient air pollution exposure levels and the risk of developing pulmonary embolism in the Chinese population: findings from the Chinese Cardiovascular Association (CCA) Database-Chest Pain Centre

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but confidence intervals exclude null

• Effect Size: PM2.5 RR 1.033 (lag 1), PM10 RR 1.038 (lag 0), NO2 RR 1.039 (lag 0)

• Primary Outcome: Risk of developing pulmonary embolism

• Nnt Or Sensitivity: Small relative risks suggest large numbers needed to harm; absolute risk increases not reported

• Confidence Interval: PM2.5: 95% CI 1.007-1.058; PM10: 95% CI 1.016-1.059; NO2: 95% CI 1.009-1.068

Clinical Application

Limited direct clinical application; more relevant for public health policy and patient counselling Moderate relevance - Australian air quality generally better than Chinese cities, but findings may apply to high-pollution areas and vulnerable patients. Could inform TGA environmental health assessments and RACGP patient education materials Urban populations with significant air pollution exposure, particularly in industrial settings

Abstract

OBJECTIVE: To analyse the associations between exposure to different air pollutants and the morbidity of pulmonary embolism (PE). DESIGN: Time series study with a distribution lag non-linear model. SETTING: 275 cities in China, 1 January 2015 to 31 March 2022. PARTICIPANTS: 27 369 cases of PE. MAIN OUTCOME MEASURES: The associations between exposure to different air pollutants and the morbidity of PE. RESULTS: During the study period, 27 369 cases of PE were recorded. PM2.5(Particulate Matter 2.5), PM10(Particulate Matter 10) and NO2(Nitrogen Dioxide) exposure levels were associated with an increased risk of developing PE in the single-pollutant model. PM2.5 exposure caused the greatest risk of developing PE at lag 1 in the single-day lag model, with a relative risk (RR) value of 1.033 (95% CI 1.007 to 1.058). PM10 and NO2 exposure had the greatest effects at lag 0, with RR values of 1.038 (95% CI 1.016 to 1.059) and 1.039 (95% CI 1.009 to 1.068), respectively. No associations were found between CO(Carbon Monoxide), O3(Ozone) or SO2(Sulfur Dioxide) exposure levels and the risk of developing PE. PM2.5, PM10 and NO2 exposure levels were most strongly associated with the development of PE at lag 01 in the cumulative lag model, with RR values of 1.052 (95% CI 1.009 to 1.095), 1.053 (95% CI 1.020 to 1.086) and 1.058 (95% CI 1.005 to 1.111), respectively. CONCLUSIONS: Short-term exposure to PM2.5, PM10 and NO2 can increase the risk of developing PE, especially in females. The effects of PM2.5 and PM10 exposure were more significant in cold seasons and in North China.

References

1. 1.Bao, Y., Hu, Z., Wei, S., Huo, Y., & Wang, G. (2026). Association between ambient air pollution exposure levels and the risk of developing pulmonary embolism in the Chinese population: findings from the Chinese Cardiovascular Association (CCA) Database-Chest Pain Centre. BMJ Open. https://doi.org/10.1136/bmjopen-2025-108349