Association between fine particulate matter and heart failure hospitalizations: a time-series analysis in Yancheng, China



Heart failure (HF) is a global public health problem of increasing importance. The association between acute exposure to air pollution and HF has been well established in developed countries, but little evidence is available in developing countries where air pollution levels are much higher.


To explore the associations between PM2.5 and HF hospitalizations in Yancheng, China.


In this time-series study, daily HF hospitalizations admitted in three major hospitals in Yancheng from May 1, 2015 to Apr 30, 2020 were collected. We used a generalized additive model with quasi-Poisson regression to investigate the association between PM2.5 and HF hospitalizations. The robustness of the associations was tested using two-pollutant models, and we examined the potential effect modification by age, gender, and season via stratification analyses. Lastly, we pooled the concentration-response curves.


A total of 10,466 HF hospitalizations were recorded, with a daily average of 6 cases. We observed the most robust estimates on lag 0 day, and the associated increment in HF was 1.28% (95% CI 0.45%, 2.11%) for a 10-μg/m3 increase of PM2.5. The association remained after adjustment of O3, but not for NO2, CO, and SO2. The PM2.5-HF associations were positive in females, patients aged ≥ 65 years, and in cold season. The C-R relationship curve was generally increasing below 30 μg/m3.


This study provided evidence on the association of PM2.5 with acute exacerbation of chronic heart failure, which may benefit future prevention strategy and policymaking.

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Fig. 1
Fig. 2

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to agreement with the hospital data provider but are available from the corresponding author on reasonable request.


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This work was supported by the Science and Technology Project of Yancheng Science and Technology Bureau (YK2018001 to Jingyan Cao), China Postdoctoral Science Foundation (2020M681185 to Cong Liu), and China National Postdoctoral Program for Innovative Talents (BX20200088 to Cong Liu).

Author information




XL analyzed and collated the data, which was the main contributor to the manuscript. HC collected relevant data on heart failure patients in three hospitals in Yancheng. YF, GC, and GQ helped collect the health data and interpret the results. RC collected the exposure data and revised the manuscript. JC and CL designed the study and took responsibility for the integrity of the data and the accuracy of the data analysis. All the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Cong Liu or Jingyan Cao.

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Ethics approval and consent to participate

The Ethics Committee of Yancheng First People's Hospital approved the study protocol (NO. 2020-K033).

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Not applicable.

Competing interests

The authors declare that they have no competing interests

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Li, X., Cheng, H., Fang, Y. et al. Association between fine particulate matter and heart failure hospitalizations: a time-series analysis in Yancheng, China. Environ Sci Pollut Res (2021).

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  • Air pollution
  • PM2.5
  • Heart failure
  • Hospitalization
  • Time-series study