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.

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. Conclusion: 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.