(P19-035-24) Lifestyle, Air Pollution and Risk of All-Cause and Cause-Specific Mortality

Objectives: We aimed to investigate the interactions between combined lifestyle factors and ambient air pollution with all-cause and cause-specific mortality risk.

Methods: This prospective study included 385324 participants in the UK Biobank who had complete data on lifestyles and air pollution at baseline. A healthy lifestyle score that included non-current smokers, moderate alcohol consumption, regular physical activity, healthy diet, normal weight, adequate sleep duration and less sedentary time was calculated based on baseline self-reported information and categorized to 5 levels (0–2, 3, 4, 5, 6–7). A weighted air pollution score involving five air pollutants (PM_2.5, PM_10, PM_2.5-10, NO₂ and NO_x) was calculated using the annual average concentration of the five air pollutants estimated based on residential addresses, and further categorized into low, moderate, and high air pollution levels according to population tertiles. The Cox model was used to investigate the independent, interactive, and joint associations of combined lifestyle and air pollution with all-cause and cause-specific mortality. 

Results: During a median follow-up of 13.6 years, 27018 deaths were documented (cancer: 13746; cardiovascular disease (CVD): 5270; respiratory disease: 1838; neurodegenerative disease: 1790; digestive disease:1014; COVID-19: 798; other causes: 2562). Combined healthy lifestyle score was inversely associated with all mortality outcomes (except neurodegenerative disease mortality) at all air pollution levels. Unhealthy lifestyles and air pollution synergistically enhanced total mortality (relative excess risk due to interaction (RERI), 0.35; 95%CI, 0.20-0.51; HR multiplicative, 1.26; 95%CI,1.13-1.42) and CVD mortality (RERI, 0.70; 95%CI, 0.39-1.01; HRmultiplicative,1.72; 95%CI,1.31-2.26). Attenuated associations between air pollution and all-cause mortality and CVD mortality among participants were observed with a healthier lifestyle compared to an unhealthier lifestyle (P-interaction < 0.001).

Conclusions: Unhealthy lifestyles and air pollution increased total and CVD mortality synergistically. Adopting a favorable lifestyle may reduce high air pollution related all-cause and CVD mortality risk.

Funding Sources: This study was supported by National Natural Science Foundation of China 82103809.