Priyanka deSouza1, Danielle Braun2,3, Robbie M Parks4,5, Joel Schwartz6, Francesca Dominici2, Marianthi-Anna Kioumourtzoglou4. 1. From the Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA. 2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. 3. Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA. 4. Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. 5. The Earth Institute, Columbia University, New York, NY. 6. Department of Environmental Health, Harvard School of Public Health, Boston, MA.
Abstract
BACKGROUND: Fine particulate matter (PM2.5) has been consistently linked to cardiovascular disease (CVD). Although studies have reported modification by income, to our knowledge, no study to date has examined this relationship among adults in Medicaid, which provides health coverage to low-income and/or disabled Americans. METHODS: We estimated the association between short-term PM2.5 exposure (average of PM2.5 on the day of hospitalization and the preceding day) and CVD admissions rates among adult Medicaid enrollees in the continental United States (2000-2012) using a time-stratified case-crossover design. We repeated this analysis at PM2.5 concentrations below the World Health Organization daily guideline of 25 μg/m. We compared the PM2.5-CVD association in the Medicaid ≥65 years old versus non-Medicaid-eligible Medicare enrollees (≥65 years old). RESULTS: Using information on 3,666,657 CVD hospitalizations among Medicaid adults, we observed a 0.9% (95% CI = 0.6%, 1.1%) increase in CVD admission rates per 10 μg/m PM2.5 increase. The association was stronger at low PM2.5 levels (1.3%; 95% CI = 0.9%, 1.6%). Among Medicaid enrollees ≥65 years old, the association was 0.9% (95% CI = 0.6%, 1.3%) vs. 0.8% (95% CI = 0.6%, 0.9%) among non-Medicaid-eligible Medicare enrollees ≥65 years old. CONCLUSION: We found robust evidence of an association between short-term PM2.5 and CVD hospitalizations among the vulnerable subpopulation of adult Medicaid enrollees. Importantly, this association persisted even at PM2.5 levels below the current national standards.
BACKGROUND: Fine particulate matter (PM2.5) has been consistently linked to cardiovascular disease (CVD). Although studies have reported modification by income, to our knowledge, no study to date has examined this relationship among adults in Medicaid, which provides health coverage to low-income and/or disabled Americans. METHODS: We estimated the association between short-term PM2.5 exposure (average of PM2.5 on the day of hospitalization and the preceding day) and CVD admissions rates among adult Medicaid enrollees in the continental United States (2000-2012) using a time-stratified case-crossover design. We repeated this analysis at PM2.5 concentrations below the World Health Organization daily guideline of 25 μg/m. We compared the PM2.5-CVD association in the Medicaid ≥65 years old versus non-Medicaid-eligible Medicare enrollees (≥65 years old). RESULTS: Using information on 3,666,657 CVD hospitalizations among Medicaid adults, we observed a 0.9% (95% CI = 0.6%, 1.1%) increase in CVD admission rates per 10 μg/m PM2.5 increase. The association was stronger at low PM2.5 levels (1.3%; 95% CI = 0.9%, 1.6%). Among Medicaid enrollees ≥65 years old, the association was 0.9% (95% CI = 0.6%, 1.3%) vs. 0.8% (95% CI = 0.6%, 0.9%) among non-Medicaid-eligible Medicare enrollees ≥65 years old. CONCLUSION: We found robust evidence of an association between short-term PM2.5 and CVD hospitalizations among the vulnerable subpopulation of adult Medicaid enrollees. Importantly, this association persisted even at PM2.5 levels below the current national standards.
Authors: Robert D Brook; Sanjay Rajagopalan; C Arden Pope; Jeffrey R Brook; Aruni Bhatnagar; Ana V Diez-Roux; Fernando Holguin; Yuling Hong; Russell V Luepker; Murray A Mittleman; Annette Peters; David Siscovick; Sidney C Smith; Laurie Whitsel; Joel D Kaufman Journal: Circulation Date: 2010-05-10 Impact factor: 29.690
Authors: Edward W Gregg; Xiaohui Zhuo; Yiling J Cheng; Ann L Albright; K M Venkat Narayan; Theodore J Thompson Journal: Lancet Diabetes Endocrinol Date: 2014-08-12 Impact factor: 32.069
Authors: Bart Ostro; Brian Malig; Rachel Broadwin; Rupa Basu; Ellen B Gold; Joyce T Bromberger; Carol Derby; Steven Feinstein; Gail A Greendale; Elizabeth A Jackson; Howard M Kravitz; Karen A Matthews; Barbara Sternfeld; Kristin Tomey; Robin R Green; Rochelle Green Journal: Environ Res Date: 2014-05-08 Impact factor: 6.498
Authors: Seulkee Heo; Ji-Young Son; Chris C Lim; Kelvin C Fong; Hayon Michelle Choi; Raul U Hernandez-Ramirez; Kate Nyhan; Preet K Dhillon; Suhela Kapoor; Dorairaj Prabhakaran; Donna Spiegelman; Michelle L Bell Journal: Environ Res Lett Date: 2022-05-16 Impact factor: 6.947