BACKGROUND: Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups. METHODS: We constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up. Annual averages of fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone were estimated according to the ZIP Code of residence for each enrollee with the use of previously validated prediction models. We estimated the risk of death associated with exposure to increases of 10 μg per cubic meter for PM2.5 and 10 parts per billion (ppb) for ozone using a two-pollutant Cox proportional-hazards model that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates. RESULTS: Increases of 10 μg per cubic meter in PM2.5 and of 10 ppb in ozone were associated with increases in all-cause mortality of 7.3% (95% confidence interval [CI], 7.1 to 7.5) and 1.1% (95% CI, 1.0 to 1.2), respectively. When the analysis was restricted to person-years with exposure to PM2.5 of less than 12 μg per cubic meter and ozone of less than 50 ppb, the same increases in PM2.5 and ozone were associated with increases in the risk of death of 13.6% (95% CI, 13.1 to 14.1) and 1.0% (95% CI, 0.9 to 1.1), respectively. For PM2.5, the risk of death among men, blacks, and people with Medicaid eligibility was higher than that in the rest of the population. CONCLUSIONS: In the entire Medicare population, there was significant evidence of adverse effects related to exposure to PM2.5 and ozone at concentrations below current national standards. This effect was most pronounced among self-identified racial minorities and people with low income. (Supported by the Health Effects Institute and others.).
BACKGROUND: Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups. METHODS: We constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up. Annual averages of fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone were estimated according to the ZIP Code of residence for each enrollee with the use of previously validated prediction models. We estimated the risk of death associated with exposure to increases of 10 μg per cubic meter for PM2.5 and 10 parts per billion (ppb) for ozone using a two-pollutant Cox proportional-hazards model that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates. RESULTS: Increases of 10 μg per cubic meter in PM2.5 and of 10 ppb in ozone were associated with increases in all-cause mortality of 7.3% (95% confidence interval [CI], 7.1 to 7.5) and 1.1% (95% CI, 1.0 to 1.2), respectively. When the analysis was restricted to person-years with exposure to PM2.5 of less than 12 μg per cubic meter and ozone of less than 50 ppb, the same increases in PM2.5 and ozone were associated with increases in the risk of death of 13.6% (95% CI, 13.1 to 14.1) and 1.0% (95% CI, 0.9 to 1.1), respectively. For PM2.5, the risk of death among men, blacks, and people with Medicaid eligibility was higher than that in the rest of the population. CONCLUSIONS: In the entire Medicare population, there was significant evidence of adverse effects related to exposure to PM2.5 and ozone at concentrations below current national standards. This effect was most pronounced among self-identified racial minorities and people with low income. (Supported by the Health Effects Institute and others.).
Authors: Rob Beelen; Ole Raaschou-Nielsen; Massimo Stafoggia; Zorana Jovanovic Andersen; Gudrun Weinmayr; Barbara Hoffmann; Kathrin Wolf; Evangelia Samoli; Paul Fischer; Mark Nieuwenhuijsen; Paolo Vineis; Wei W Xun; Klea Katsouyanni; Konstantina Dimakopoulou; Anna Oudin; Bertil Forsberg; Lars Modig; Aki S Havulinna; Timo Lanki; Anu Turunen; Bente Oftedal; Wenche Nystad; Per Nafstad; Ulf De Faire; Nancy L Pedersen; Claes-Göran Östenson; Laura Fratiglioni; Johanna Penell; Michal Korek; Göran Pershagen; Kirsten Thorup Eriksen; Kim Overvad; Thomas Ellermann; Marloes Eeftens; Petra H Peeters; Kees Meliefste; Meng Wang; Bas Bueno-de-Mesquita; Dorothea Sugiri; Ursula Krämer; Joachim Heinrich; Kees de Hoogh; Timothy Key; Annette Peters; Regina Hampel; Hans Concin; Gabriele Nagel; Alex Ineichen; Emmanuel Schaffner; Nicole Probst-Hensch; Nino Künzli; Christian Schindler; Tamara Schikowski; Martin Adam; Harish Phuleria; Alice Vilier; Françoise Clavel-Chapelon; Christophe Declercq; Sara Grioni; Vittorio Krogh; Ming-Yi Tsai; Fulvio Ricceri; Carlotta Sacerdote; Claudia Galassi; Enrica Migliore; Andrea Ranzi; Giulia Cesaroni; Chiara Badaloni; Francesco Forastiere; Ibon Tamayo; Pilar Amiano; Miren Dorronsoro; Michail Katsoulis; Antonia Trichopoulou; Bert Brunekreef; Gerard Hoek Journal: Lancet Date: 2013-12-09 Impact factor: 79.321
Authors: D W Dockery; C A Pope; X Xu; J D Spengler; J H Ware; M E Fay; B G Ferris; F E Speizer Journal: N Engl J Med Date: 1993-12-09 Impact factor: 91.245
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