Exposure to Long-Term Air Pollution and Incidence of Peripheral Arterial Disease in the General Population: A National Population-Based Retrospective Cohort Study

Objective: This study aimed to evaluate the causal relationship between long-term outdoor air pollutants and incidence of peripheral arterial disease (PAD) using the National Health Insurance Service–National Sample Cohort (NHIS-NSC) database. Methods This study is retrospective study. We included 292,091 subjects from the general population who had previously not been diagnosed with PAD by the NHIS-NSC between 2008 and 2014. Hourly air pollutant data (particulate and gaseous) and climate data were collected. Correlation analysis of the collected data confirmed the relationship between air pollution and PAD incidence. Results For 1,836,965.4 person-years, incident cases of PAD were observed in 5,243 subjects (285.4/100,000 person-years). In the Cox proportional hazard analysis, there was a significant association between the incidence of PAD and long-term average concentration of SO 2 (hazard ratio [HR], 1.686; 95% confidence interval [CI], 1.108–2.565) and NO 2 (HR, 1.200; 95% CI, 1.077–1.336) after the adjustment for variables. Conclusions This study demonstrated that SO 2 and NO 2 exposure are independent risk factors for PAD. On the other hand, new-onset PAD was not affected by exposure to particulate matter such as PM 2.5 and PM 10 .