Abstract
Sulfur oxides (SO(x)), particularly SO(2) emitted by coal-fired power plants, produce long-term risks for cardiovascular disease (CVD). We estimated the relative risks of CVD and ischemic heart disease (IHD) attributable to SO(x) emission globally. National SO(x) reduction achieved by emissions control systems was defined as the average SO(x) reduction percentage weighted by generating capacities of individual plants in a country. We analyzed the relative risk of CVD incidence associated with national SO(x) reduction for 13,581 coal-fired power-generating units in 79 countries. A 10% decrease in SO(x) emission was associated with 0.28% (males; 95%CI = -0.39%~0.95%) and 1.69% (females; 95%CI = 0.99%~2.38%) lower CVD risk. The effects on IHD were > 2 times stronger among males than females (2.78%, 95%CI = 1.99%~3.57% vs. 1.18%, 95%CI = 0.19%~2.17%). Further, 1.43% (males) and 8.00% (females) of CVD cases were attributable to suboptimal SOx reduction. Thus, enhancing regulations on SO(x) emission control represents a target for national and international intervention to prevent CVD.