Risk of sand and dust storms on cardiometabolic diseases: a cohort study of over 2.2 million participants

Climate change has intensified the occurrence of sand and dust storms (SDS), contributing to an increasing public health burden. However, limited evidence exists on the long-term impact of SDS exposure on the incidence of cardiometabolic diseases (CMDs). In this study, we analyzed data from a population-based cohort of 2,260,855 individuals in Northwestern China (2019-2023). Individual-level SDS exposure over a three-year period was estimated using three machine learning models, with extreme gradient boosting demonstrating the best predictive performance. An Accelerated Failure Time (AFT) model was employed to explore the association between SDS exposure and CMD risk, including dyslipidemia, diabetes mellitus, hypertension, and cardiovascular disease. Restricted cubic spline (RCS) analysis revealed a non-linear association between SDS exposure and the time to onset of CMDs. Compared to participants exposed to SDS in the first tertile, those exposed in the highest tertile experienced earlier onset of dyslipidemia (Time Ratio [TR]: 0.854, 95 % CI: 0.848-0.860), diabetes mellitus (TR: 0.784, 95 % CI: 0.776-0.793), hypertension (TR: 0.914, 95 % CI: 0.906-0.922), and cardiovascular disease (TR: 0.732, 95 % CI: 0.714-0.752). Subgroup analysis indicated that individuals aged <50 years, those with obesity (BMI > 25 kg/m²), smokers, drinkers, and individuals with a family history of CMDs were more susceptible to the adverse effects of SDS, leading to a significantly earlier onset of CMDs. These findings suggest that chronic exposure to SDS significantly elevates CMD risk, underscoring the need for public health strategies and air quality standards that address SDS-related health impacts, especially for vulnerable populations.