System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Research Support, U.S. Gov't, P.H.S. Ppublish 98 citations

PubMed: 36961127 DOI: 10.1056/NEJMsa2300523

Air Pollution and Mortality at the Intersection of Race and Social Class.

N Engl J Med 388(15):1396-1404

Authors: Kevin P Josey, Scott W Delaney, Xiao Wu, Rachel C Nethery, Priyanka DeSouza, Danielle Braun, Francesca Dominici

Affiliations

  • From the Departments of Biostatistics (K.P.J. R.C.N. D.B. F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.).

Abstract

BACKGROUND

Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM pollution than high-income Americans. Because information is lacking on exposure-response curves for PM exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM standards.

METHODS

We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible).

RESULTS

Lower PM exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM levels decreased. For example, the hazard ratio associated with decreasing PM from 12 μg per cubic meter to 8 μg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation.

CONCLUSIONS

Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).

MeSH

Mortality, Income, Air Pollution, Environmental Pollution, Social Class

Cited by