Introduction: The effects of exposure to particulate matter and frailty, as well as its exposure-response relationship, have not been effectively explored. This study aimed to explore the association between long-term exposure to particulate matter and frailty state and each dimension in Chinese middle-aged and older adults, in addition to the exposure-response relationship. Methods: The data were obtained from the National Urban Air Quality Real-Time Dissemination Platform and China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by a frailty index containing 39 indicators. Annual averages of seven pollutants were calculated from hourly monitoring data. We used multilevel regression modeling to explore the association between long-term exposure to particulate matter and frailty. Meanwhile, we explored the exposure-response relationship based on a multilevel generalized summation model. We performed a sensitivity analysis using a multi-pollution model and a quantile-based g-computation (QGC) model. Results: A total of 15,611 participants were included in the analysis. We find that long-term exposure to PM2.5 was associated with an increased risk of pre-frailty and frailty (all p < 0.05). PMc and PM10 exhibited similar associations. The exposure-response relationship between PM2.5 showed a linear relationship, whereas the exposure-response relationship between PM10, PMc showed a nonlinear relationship. Elevated PM2.5 concentrations showed significant positive associations with the number of chronic disease score, IADL score, and functional limitation status score (all p < 0.05). PM10 and PMc showed similar positive correlations. These results remained robust after sensitivity analyses using a multi-pollution model and QGC model. Conclusion: Chronic exposure to particulate matter was significantly associated with increased risk of frailty. The exposure-response relationship between PM2.5 concentration and frailty showed a linear relationship, and the exposure-response relationship between PM10 and PMc showed a nonlinear relationship. Exposure to a mixture of pollutants carried a higher risk of frailty than exposure to a single pollutant.

1.
Gilardi
L
,
Marconcini
M
,
Metz-Marconcini
A
,
Esch
T
,
Erbertseder
T
.
Long-term exposure and health risk assessment from air pollution: impact of regional scale mobility
.
Int J Health Geogr
.
2023
;
22
(
1
):
11
.
2.
GBD 2019 Risk Factors Collaborators
.
Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
.
Lancet
.
2020
;
396
(
10258
):
1223
49
.
3.
Ma
L
,
Tang
Z
,
Zhang
L
,
Sun
F
,
Li
Y
,
Chan
P
.
Prevalence of frailty and associated factors in the community-dwelling population of China
.
J Am Geriatr Soc
.
2018
;
66
(
3
):
559
64
.
4.
Brivio
P
,
Paladini
MS
,
Racagni
G
,
Riva
MA
,
Calabrese
F
,
Molteni
R
.
From healthy aging to frailty: in search of the underlying mechanisms
.
Curr Med Chem
.
2019
;
26
(
20
):
3685
701
.
5.
Fang
EF
,
Xie
C
,
Schenkel
JA
,
Wu
C
,
Long
Q
,
Cui
H
, et al
.
A research agenda for ageing in China in the 21st century (2nd edition): focusing on basic and translational research, long-term care, policy and social networks
.
Ageing Res Rev
.
2020
;
64
:
101174
.
6.
Piao
MJ
,
Ahn
MJ
,
Kang
KA
,
Ryu
YS
,
Hyun
YJ
,
Shilnikova
K
, et al
.
Particulate matter 2.5 damages skin cells by inducing oxidative stress, subcellular organelle dysfunction, and apoptosis
.
Arch Toxicol
.
2018
;
92
(
6
):
2077
91
.
7.
Wang
Y
,
Xiong
L
,
Huang
X
,
Ma
Y
,
Zou
L
,
Liang
Y
, et al
.
Intermittent exposure to airborne particulate matter induces subcellular dysfunction and aortic cell damage in BALB/c mice through multi-endpoint assessment at environmentally relevant concentrations
.
J Hazard Mater
.
2022
;
424
(
Pt A
):
127169
.
8.
Kim
KH
,
Kabir
E
,
Kabir
S
.
A review on the human health impact of airborne particulate matter
.
Environ Int
.
2015
;
74
:
136
43
.
9.
Kirkwood
TB
.
Understanding the odd science of aging
.
Cell
.
2005
;
120
(
4
):
437
47
.
10.
Kirkwood
TB
.
Systems biology of ageing and longevity
.
Philos Trans R Soc Lond B Biol Sci
.
2011
;
366
(
1561
):
64
70
.
11.
Mak
JKL
,
Kuja-Halkola
R
,
Bai
G
,
Hassing
LB
,
Pedersen
NL
,
Hägg
S
, et al
.
Genetic and environmental influences on longitudinal frailty trajectories from adulthood into old age
.
J Gerontol A Biol Sci Med Sci
.
2023
;
78
(
2
):
333
41
.
12.
Cao
L
,
Zhai
D
,
Kuang
M
,
Xia
Y
.
Indoor air pollution and frailty: a cross-sectional and follow-up study among older Chinese adults
.
Environ Res
.
2022
;
204
(
Pt A
):
112006
.
13.
Veronese
N
,
Maniscalco
L
,
Matranga
D
,
Lacca
G
,
Dominguez
LJ
,
Barbagallo
M
.
Association between pollution and frailty in older people: a cross-sectional analysis of the UK biobank
.
J Am Med Dir Assoc
.
2023
;
24
(
4
):
475
81.e3
.
14.
Lee
WJ
,
Liu
CY
,
Peng
LN
,
Lin
CH
,
Lin
HP
,
Chen
LK
.
PM2.5 air pollution contributes to the burden of frailty
.
Sci Rep
.
2020
;
10
(
1
):
14478
.
15.
Shin
J
,
Han
SH
,
Choi
J
.
Exposure to ambient air pollution and cognitive impairment in community-dwelling older adults: the Korean frailty and aging cohort study
.
Int J Environ Res Public Health
.
2019
;
16
(
19
):
3767
.
16.
Guo
YF
,
Ng
N
,
Kowal
P
,
Lin
H
,
Ruan
Y
,
Shi
Y
, et al
.
Frailty risk in older adults associated with long-term exposure to ambient PM2.5 in 6 middle-income countries
.
J Gerontol A Biol Sci Med Sci
.
2022
;
77
(
5
):
970
6
.
17.
Myers
V
,
Broday
DM
,
Steinberg
DM
,
Yuval
DY
,
Gerber
Y
,
Gerber
Y
.
Exposure to particulate air pollution and long-term incidence of frailty after myocardial infarction
.
Ann Epidemiol
.
2013
;
23
(
7
):
395
400
.
18.
Hu
K
,
Keenan
K
,
Hale
JM
,
Börger
T
.
The association between city-level air pollution and frailty among the elderly population in China
.
Health Place
.
2020
;
64
:
102362
.
19.
Pakkanen
TA
,
Loukkola
K
,
Korhonen
CH
,
Aurela
M
,
Mäkelä
T
,
Hillamo
RE
, et al
.
Sources and chemical composition of atmospheric fine and coarse particles in the Helsinki area
.
Atmos Environ
.
2001
;
35
(
32
):
5381
91
.
20.
Davis
E
,
Malig
B
,
Broadwin
R
,
Ebisu
K
,
Basu
R
,
Gold
EB
, et al
.
Association between coarse particulate matter and inflammatory and hemostatic markers in a cohort of midlife women
.
Environ Health
.
2020
;
19
(
1
):
111
.
21.
Zhao
Y
,
Hu
Y
,
Smith
JP
,
Strauss
J
,
Yang
G
.
Cohort profile: the China health and retirement longitudinal study (CHARLS)
.
Int J Epidemiol
.
2014
;
43
(
1
):
61
8
.
22.
Rockwood
K
,
Mitnitski
A
.
Frailty in relation to the accumulation of deficits
.
J Gerontol A Biol Sci Med Sci
.
2007
;
62
(
7
):
722
7
.
23.
Nagi
SZ
.
An epidemiology of disability among adults in the United States
.
Milbank Mem Fund Q Health Soc
.
1976
;
54
(
4
):
439
67
.
24.
Yang
R
,
Liu
Y
,
Jiang
Y
,
Fleming
DJM
,
Fauth
EB
.
Functional limitations before and after cancer diagnosis and contributing factors: findings from the China health and retirement longitudinal study
.
BMC Geriatr
.
2022
;
22
(
1
):
415
.
25.
Wei
K
,
Liu
Y
,
Yang
J
,
Gu
N
,
Cao
X
,
Zhao
X
, et al
.
Living arrangement modifies the associations of loneliness with adverse health outcomes in older adults: evidence from the CLHLS
.
BMC Geriatr
.
2022
;
22
(
1
):
59
.
26.
Cao
X
,
Chen
C
,
Zhang
J
,
Xue
QL
,
Hoogendijk
EO
,
Liu
X
, et al
.
Aging metrics incorporating cognitive and physical function capture mortality risk: results from two prospective cohort studies
.
BMC Geriatr
.
2022
;
22
(
1
):
378
.
27.
Liu
X
,
Wang
C
,
Qiao
X
,
Si
H
,
Jin
Y
.
Sleep quality, depression and frailty among Chinese community-dwelling older adults
.
Geriatr Nurs
.
2021
;
42
(
3
):
714
20
.
28.
Zhu
Y
,
Fan
J
,
Lv
J
,
Guo
Y
,
Pei
P
,
Yang
L
, et al
.
Maintaining healthy sleep patterns and frailty transitions: a prospective Chinese study
.
BMC Med
.
2022
;
20
(
1
):
354
.
29.
Lancia
C
,
Spitoni
C
,
Anninga
J
,
Whelan
J
,
Sydes
MR
,
Jovic
G
, et al
.
Marginal structural models with dose-delay joint-exposure for assessing variations to chemotherapy intensity
.
Stat Methods Med Res
.
2019
;
28
(
9
):
2787
801
.
30.
Guo
C
,
Chang
LY
,
Wei
X
,
Lin
C
,
Zeng
Y
,
Yu
Z
, et al
.
Multi-pollutant air pollution and renal health in Asian children and adolescents: an 18-year longitudinal study
.
Environ Res
.
2022
;
214
(
Pt 4
):
114144
.
31.
Naimi
AI
,
Cole
SR
,
Kennedy
EH
.
An introduction to g methods
.
Int J Epidemiol
.
2017
;
46
(
2
):
756
62
.
32.
Keil
AP
,
Buckley
JP
,
O’Brien
KM
,
Ferguson
KK
,
Zhao
S
,
White
AJ
.
A quantile-based g-computation approach to addressing the effects of exposure mixtures
.
Environ Health Perspect
.
2020
;
128
(
4
):
47004
.
33.
Shin
J
,
Choi
J
.
Frailty related to the exposure to particulate matter and ozone: the Korean frailty and aging cohort study
.
Int J Environ Res Public Health
.
2021
;
18
(
22
):
11796
.
34.
Pun
VC
,
Kazemiparkouhi
F
,
Manjourides
J
,
Suh
HH
.
Long-term PM2.5 exposure and respiratory, cancer, and cardiovascular mortality in older US adults
.
Am J Epidemiol
.
2017
;
186
(
8
):
961
9
.
35.
Li
G
,
Huang
J
,
Wang
J
,
Zhao
M
,
Liu
Y
,
Guo
X
, et al
.
Long-term exposure to ambient PM2.5 and increased risk of CKD prevalence in China [published correction appears in J Am soc nephrol. 2021 aug;32(8):2101
.
J Am Soc Nephrol
.
2021
;
32
(
2
):
448
58
.
36.
Lo
WC
,
Ho
CC
,
Tseng
E
,
Hwang
JS
,
Chan
CC
,
Lin
HH
.
Long-term exposure to ambient fine particulate matter (PM2.5) and associations with cardiopulmonary diseases and lung cancer in Taiwan: a nationwide longitudinal cohort study
.
Int J Epidemiol
.
2022
;
51
(
4
):
1230
42
.
37.
de Zwart
F
,
Brunekreef
B
,
Timmermans
E
,
Deeg
D
,
Gehring
U
.
Air pollution and performance-based physical functioning in Dutch older adults
.
Environ Health Perspect
.
2018
;
126
(
1
):
017009
.
38.
Liu
H
.
Determining the effect of air quality on activities of daily living disability: using tracking survey data from 122 cities in China
.
BMC Public Health
.
2022
;
22
(
1
):
835
.
39.
Zhao
Q
,
Liu
X
,
Liu
Z
.
The impact of air pollution on physical disability in a middle-aged and older Chinese population using regression discontinuity design
.
Health Place
.
2023
;
79
:
102958
.
40.
Hegelund
ER
,
Mehta
AJ
,
Andersen
ZJ
,
Lim
YH
,
Loft
S
,
Brunekreef
B
, et al
.
Air pollution and human health: a phenome-wide association study
.
BMJ Open
.
2024
;
14
(
2
):
e081351
.
41.
Hoek
G
,
Krishnan
RM
,
Beelen
R
,
Peters
A
,
Ostro
B
,
Brunekreef
B
, et al
.
Long-term air pollution exposure and cardio-respiratory mortality: a review
.
Environ Health
.
2013
;
12
(
1
):
43
.
42.
Cohen
G
,
Steinberg
DM
,
Keinan-Boker
L
,
Yuval
LI
,
Chen
S
,
Chen
S
, et al
.
Preexisting coronary heart disease and susceptibility to long-term effects of traffic-related air pollution: a matched cohort analysis
.
Eur J Prev Cardiol
.
2020
;
28
(
13
):
1475
86
.
43.
Eckel
SP
,
Louis
TA
,
Chaves
PH
,
Fried
LP
,
Margolis
AH
.
Modification of the association between ambient air pollution and lung function by frailty status among older adults in the Cardiovascular Health Study
.
Am J Epidemiol
.
2012
;
176
(
3
):
214
23
.
44.
Cesaroni
G
,
Forastiere
F
,
Stafoggia
M
,
Andersen
ZJ
,
Badaloni
C
,
Beelen
R
, et al
.
Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project
.
BMJ
.
2014
;
348
:
f7412
.
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