Shih-Feng Chen  1,2, Yu-Hui Chien1, Yu-Chin Lai1, Pau-Chung Chen  This email address is being protected from spambots. You need JavaScript enabled to view it.2,3,4,5

1 Nephrology Department, New Taipei City Hospital, New Taipei City, Taiwan
2 Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
3 Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
4 Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
5 National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan

Received: January 28, 2024
Revised: April 30, 2024
Accepted: May 11, 2024

 Copyright The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.

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Cite this article:

Chen, S.F., Chien, Y.H., Lai, Y.C., Chen, P.C. (2024). Associations of Long-term PM10 Exposure with Mortality in Dialysis Patients: A Population Based Cohort Study. Aerosol Air Qual. Res. 24, 240028.


  • First-ever study regarding PM10-mortality association in dialysis population.
  • Taiwan dialysis patients’ mortality rises with one IQR-µg m–3 increase of PM10.
  • Dialysis patients show non-linear dose-mortality relation with PM10 exposure.
  • Mortality in dialysis patients rises beyond a specific PM10 threshold (43 µg m3).
  • PM10-mortality link persists despite co-exposure air pollutant adjustments.


Exposure to PM2.5 has been observed to be associated with an increased risk of mortality in dialysis patients, while sporadic studies have hinted at the adverse effects of coarse particulate matter (PM10) on kidney health. However, the impact of PM10 on survival in end-stage renal disease patients remains unclear. To address this gap, we conducted a retrospective cohort study, linking the Taiwan Air Quality-Monitoring Database (TAQMD) with the National Health Insurance Research Database (NHIRD) based on patients' zip codes. We included 34,088 adult dialysis patients living in areas with ambient measurements of PM10, NO2, CO, and SO2 between 1 January, 2000 and 31 December, 2013. We used a multivariate Cox proportional hazards model to estimate mortality risk and observed that each interquartile range (IQR) increase in the mean PM10 concentration during follow-up period was associated with a 13.2% higher risk of mortality (adjusted hazard ratio [aHR] = 1.132, 95% confidence interval [CI] = 1.097–1.169). Even in two-pollutant scenarios, the association between long-term exposure to PM10 and mortality remained significant. Spline analysis demonstrated a non-linear concentration-response relationship between PM10 and mortality, with an increase in aHR when the average PM10 exposure exceeded a threshold of 43 µg m3. Stratification analysis revealed that male patients had a significantly higher increase in mortality risk per IQR increase in PM10 compared to female patients (aHR 1.185 vs. 1.074; p-interaction < 0.001). Our study demonstrated a significant association between long-term ambient PM10 exposure and mortality risk among dialysis patients, especially in males. A non-linear concentration-response relationship between PM10 and mortality was noted, with mortality risk increasing when the mean PM10 surpassed a specific threshold. The PM10-mortality association persisted after considering co-exposures to other air pollutants. These findings strongly indicate a positive association between long-term ambient PM10 exposure and mortality among dialysis patients.

Keywords: Coarse particulate matter, TAQMD, NHIRD, Two-pollutant scenarios, Spline analysis

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