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. 2026 Apr 15;16(4):e108349. doi: 10.1136/bmjopen-2025-108349.

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. PM_2.5(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. PM_2.5 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. PM_2.5, 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 PM_2.5, PM₁₀ and NO₂ can increase the risk of developing PE, especially in females. The effects of PM_2.5 and PM₁₀ exposure were more significant in cold seasons and in North China.

PMID:41985957 | PMC:PMC13084851 | DOI:10.1136/bmjopen-2025-108349