ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1694321
Effects of Air Quality Index and Meteorological Factors on Cardiovascular and Cerebrovascular Mortality in Huizhou, China: A Time-Series Analysis Using Distributed Lag Nonlinear Models
Provisionally accepted
Yangling Zhou1Qiaoer Lin1Binhua Qin1Zhiwen Zheng1Xulin Chen1Renzhao Pang1Jingrong Huang2Yuanbin He1Shiyuan Shen3Qili Chen1Liuqing Peng3Shuai Jiang1
Caiming Li3*- 1The First Clinical Medical College of Huizhou, Guangdong Medical University, Huizhou, Guangdong, China
- 2The First Clinical Medical College of Huizhou,Guangdong Medical University, Huizhou, Guangdong,, China
- 3First People's Hospital of Huizhou City, Huizhou, China
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Background Air pollution exposure is recognized to exacerbate cardiovascular and cerebrovascular diseases (CVDs). This study investigated the association between the Air Quality Index (AQI) and CVD mortality in Huizhou, China, focusing on population-specific lag effects and interactions with meteorological factors. Methods Daily CVD mortality data (2015–2021) from Huizhou were analyzed using distributed lag nonlinear models (DLNMs) and generalized additive models (GAMs) to assess AQI's relationship with mortality, with subgroup analyses by gender and age. Poisson regression, based on interaction theory, clarified joint effects of AQI and meteorological factors. Results AQI ≥80 was associated with increased CVD mortality risk with lag effects. Cumulative lag peaks varied: total population (2 days, RR=1.00156, 95% CI:1.00077–1.00235), males (3 days, RR=1.00188), females (1 day, RR=1.00130), ≥65 years (1 day, RR=1.00098), and <65 years (3 days, RR=1.00455). Mean wind speed showed an antagonistic interaction with AQI (IRR=0.92749, 95% CI:0.89575–0.96035), reducing risk, while mean humidity had a synergistic effect (IRR=1.05124, 95% CI:1.01395–1.08989), exacerbating risk. Conclusions AQI is positively associated with CVD mortality, with lag effects differing by population. Wind speed mitigates, and humidity amplifies, AQI-related risks. These findings support targeted early warning systems and preventive strategies for CVDs.
Keywords: cardiovascular diseases and cerebrovascular diseases, Air Quality Index, mortality risk, Lag effects, Meteorological factors
Received: 28 Aug 2025; Accepted: 21 Oct 2025.
Copyright: © 2025 Zhou, Lin, Qin, Zheng, Chen, Pang, Huang, He, Shen, Chen, Peng, Jiang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Caiming Li, caiminglee@21cn.com
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