Associations of long-term exposure to nitrogen oxides with all-cause and cause-specific mortality

Siru Yang, Mengmeng Li, Cui Guo, Weeberb J. Requia, Mohammad Javad Zare Sakhvidi, Kaili Lin, Qiongyu Zhu, Zhaoyue Chen, Peihua Cao, Lei Yang, Dan Luo and Jun Yang ()
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Siru Yang: The First Affiliated Hospital of Guangzhou Medical University
Mengmeng Li: Sun Yat-sen University Cancer Center
Cui Guo: the University of Hong Kong
Weeberb J. Requia: Fundação Getúlio Vargas
Mohammad Javad Zare Sakhvidi: Yazd Medical University
Kaili Lin: Guangzhou Medical University
Qiongyu Zhu: Guangzhou Medical University
Zhaoyue Chen: ISGLOBAL
Peihua Cao: Southern Medical University
Lei Yang: Guangzhou Medical University
Dan Luo: Guangzhou Medical University
Jun Yang: The First Affiliated Hospital of Guangzhou Medical University

Nature Communications, 2025, vol. 16, issue 1, 1-12

Abstract: Abstract Associations between long-term exposure to nitrogen oxides (NOx) and cause-specific mortality remain insufficiently explored. This study utilizes data from 502,040 participants registered in the UK Biobank. Time-varying Cox regression is used to estimate mortality risks associated with NOx. Cause-specific mortality risks, including non-accidental, accidental and 15 major disease categories across 103 subcategories, are assessed for each 10 μg/m3 increase in NOx. Positive associations are observed between NOx and mortality from all-cause (HR: 1.036; 95% CI: 1.024, 1.049) and non-accidental diseases (HR: 1.032; 95% CI: 1.019, 1.045). We further identify 20 specific diseases related to NOx, notably respiratory diseases, mental and behavioral disorders, and circulatory diseases, with generally linear exposure-response relationships. Sex and residential areas are potential modifiers of the observed associations. Our findings suggest long-term exposure to NOx may increase mortality risks from a range of diseases, emphasizing the urgent need for clean air policies to alleviate the health burden.

Date: 2025
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DOI: 10.1038/s41467-025-56963-y

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