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PubMed: 33611922 DOI: 10.1161/CIRCULATIONAHA.120.050252
Long-Term Association of Air Pollution and Hospital Admissions Among Medicare Participants Using a Doubly Robust Additive Model.
Circulation 143(16):1584-1596
Authors: Mahdieh Danesh Yazdi, Yan Wang, Qian Di, Yaguang Wei, Weeberb J Requia, Liuhua Shi, Matthew Benjamin Sabath, Francesca Dominici, Brent A Coull, John S Evans, Petros Koutrakis, Joel D Schwartz
Affiliations
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y. Y.W. Q.D. Y.W. W.J.R. L.S. J.S.E. P.K. J.D.S.).
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y. Y.W. Q.D. Y.W. W.J.R. L.S. J.S.E. P.K. J.D.S.). Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W. M.B.S. F.D. B.A.C.).
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y. Y.W. Q.D. Y.W. W.J.R. L.S. J.S.E. P.K. J.D.S.). Vanke School of Public Health, Tsinghua University, Beijing, China (Q.D.). Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA (Q.D. J.D.S.).
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (L.S.).
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W. M.B.S. F.D. B.A.C.).
- Vanke School of Public Health, Tsinghua University, Beijing, China (Q.D.).
Abstract
BACKGROUND
Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures.
METHODS
We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM), NO, and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups.
RESULTS
Long-term exposure to fine PM was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086-0.0097) increase in the risk of stroke for each 1-µg/m increase in annual levels. This translated to 2536 (95% CI, 2383-2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039-0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114-0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376-0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes.
CONCLUSIONS
Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.
MeSH
Stroke, Environment, Epidemiology, Myocardial Infarction, Cardiovascular System, Risk, Blood Circulation, Pneumonia, Atrial Fibrillation, Particulate Matter, Environmental Pollutants, Air Pollution, Environmental Pollution, Medicare
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