Short-term air pollution exposure associated with death from kidney diseases: a nationwide time-stratified case-crossover study in China from 2015 to 2019

Background: Long-term exposure to air pollution has been associated with the onset and progression of kidney diseases, but the association between short-term exposure to air pollution and mortality of kidney diseases has not yet been reported. Methods: A nationally representative sample of 101,919 deaths from kidney diseases was collected from the Chinese Center for Disease Control and Prevention from 2015 to 2019. A time-stratified case-crossover study was applied to determine the associations. Satellite-based estimates of air pollution were assigned to each case and control day using a bilinear interpolation approach and geo-coded residential addresses. Conditional logistic regression models were constructed to estimate the associations adjusting for nonlinear splines of temperature and relative humidity. Results: Each 10 µg/m³ increment in lag 0–1 mean concentrations of air pollutants was associated with a percent increase in death from kidney disease: 1.33% (95% confidence interval [CI]: 0.57% to 2.1%) for PM₁, 0.49% (95% CI: 0.10% to 0.88%) for PM_2.5, 0.32% (95% CI: 0.08% to 0.57%) for PM₁₀, 1.26% (95% CI: 0.29% to 2.24%) for NO₂, and 2.9% (95% CI: 1.68% to 4.15%) for SO₂. Conclusions: Our study suggests that short-term exposure to ambient PM₁, PM_2.5, PM₁₀, NO₂, and SO₂ might be important environmental risk factors for death due to kidney diseases in China.