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Journal Article Journal Article Journal Article Ppublish 61 citations

PubMed: 36283157 DOI: 10.1016/j.envint.2022.107594

Associations between long-term air pollution exposure and the incidence of cardiovascular diseases among American older adults.

Environ Int 170:107594

Authors: Tingfan Jin, Qian Di, Weeberb J Réquia, Mahdieh Danesh Yazdi, Edgar Castro, Tszshan Ma, Yifan Wang, Haisu Zhang, Liuhua Shi, Joel Schwartz

Affiliations

  • Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Vanke School of Public Health, Tsinghua University, Beijing, China.
  • School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
  • Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, NY, USA.
  • Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Abstract

BACKGROUND & AIM

Numerous studies have linked air pollution with cardiovascular diseases. Fewer studies examined the associations at low concentration levels or assessed potential modifiers. Some investigations only examined hospitalizations, which can miss incident cases. This study aims to address these gaps through a nationwide cohort study of Medicare enrollees.

METHODS

Our study cohort comprise all Medicare enrollees (≥65 years old) continuously enrolled in the fee-for-service program and both Medicare part A and B across the contiguous U.S. from 2000 to 2016. We examined the associations of population-weighted ZIP code-level annual average PM, NO, and warm-season O (May-October), with the first diagnoses of atrial fibrillation (AF), congestive heart failure (CHF), and stroke. We fit multi-pollutant Cox proportional hazards models adjusted for individual demographic characteristics and area-level covariates. We further examined these associations at low pollutant concentration levels and the potential effect modifications by race/ethnicity and comorbidities (diabetes, hypertension, hyperlipidemia).

RESULTS

Elevated PM and NO levels were associated with increased incidence of AF, CHF, and stroke. For each 1 μg/m increase in annual PM, hazard ratios (HRs) were 1.0059 (95%CI: 1.0054-1.0064), 1.0260 (95%CI: 1.0256-1.0264), and 1.0279 (95%CI: 1.0274-1.0284), respectively. For each1 ppb increase in annual NO, HRs are 1.0057 (95%CI: 1.0056-1.0059), 1.0112 (95%CI: 1.0110-1.0113), and 1.0095 (95%CI: 1.0093-1.0096), respectively. For warm-season O, each 1 ppb increase was associated with increased incidence of CHF (HR=1.0035, 95%CI: 1.0033-1.0037) and stroke (HR=1.0026, 95%CI: 1.0023-1.0028). Larger magnitudes of HRs were observed when restricted to pollutants levels lower than NAAQS standards. Generally higher risks were observed for Black people and diabetics.

CONCLUSIONS

Long-term exposure to PM, NO, and warm-season O were associated with increased incidence of cardiovascular diseases, even at low pollutant concentration levels. Black people and people with diabetes were found to be vulnerable populations.

MeSH

Diabetes Mellitus, Stroke, Incidence, Environmental Pollutants, Air Pollution, Cardiovascular Diseases, Cohort Studies, Air, Environmental Pollution, Environmental Health

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