Long-term Exposure to PM2.5 and Mortality for the Older Population: Effect Modification by Residential Greenness.
Journal
Epidemiology (Cambridge, Mass.)
ISSN: 1531-5487
Titre abrégé: Epidemiology
Pays: United States
ID NLM: 9009644
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
1
4
2021
medline:
29
6
2021
entrez:
31
3
2021
Statut:
ppublish
Résumé
Although many studies demonstrated reduced mortality risk with higher greenness, few studies examined the modifying effect of greenness on air pollution-health associations. We evaluated residential greenness as an effect modifier of the association between long-term exposure to fine particles (PM2.5) and mortality. We used data from all Medicare beneficiaries in North Carolina (NC) and Michigan (MI) (2001-2016). We estimated annual PM2.5 averages using ensemble prediction models. We estimated mortality risk per 1 μg/m3 increase using Cox proportional hazards modeling, controlling for demographics, Medicaid eligibility, and area-level covariates. We investigated health disparities by greenness using the Normalized Difference Vegetation Index with measures of urbanicity and socioeconomic status. PM2.5 was positively associated with mortality risk. Hazard ratios (HRs) were 1.12 (95% confidence interval (CI) = 1.12 to 1.13) for NC and 1.01 (95% CI = 1.00 to 1.01) for MI. HRs were higher for rural than urban areas. Within each category of urbanicity, HRs were generally higher in less green areas. For combined disparities, HRs were higher in low greenness or low SES areas, regardless of the other factor. HRs were lowest in high-greenness and high-SES areas for both states. In our study, those in low SES and high-greenness areas had lower associations between PM2.5 and mortality than those in low SES and low greenness areas. Multiple aspects of disparity factors and their interactions may affect health disparities from air pollution exposures. Findings should be considered in light of uncertainties, such as our use of modeled PM2.5 data, and warrant further investigation.
Sections du résumé
BACKGROUND
Although many studies demonstrated reduced mortality risk with higher greenness, few studies examined the modifying effect of greenness on air pollution-health associations. We evaluated residential greenness as an effect modifier of the association between long-term exposure to fine particles (PM2.5) and mortality.
METHODS
We used data from all Medicare beneficiaries in North Carolina (NC) and Michigan (MI) (2001-2016). We estimated annual PM2.5 averages using ensemble prediction models. We estimated mortality risk per 1 μg/m3 increase using Cox proportional hazards modeling, controlling for demographics, Medicaid eligibility, and area-level covariates. We investigated health disparities by greenness using the Normalized Difference Vegetation Index with measures of urbanicity and socioeconomic status.
RESULTS
PM2.5 was positively associated with mortality risk. Hazard ratios (HRs) were 1.12 (95% confidence interval (CI) = 1.12 to 1.13) for NC and 1.01 (95% CI = 1.00 to 1.01) for MI. HRs were higher for rural than urban areas. Within each category of urbanicity, HRs were generally higher in less green areas. For combined disparities, HRs were higher in low greenness or low SES areas, regardless of the other factor. HRs were lowest in high-greenness and high-SES areas for both states.
CONCLUSIONS
In our study, those in low SES and high-greenness areas had lower associations between PM2.5 and mortality than those in low SES and low greenness areas. Multiple aspects of disparity factors and their interactions may affect health disparities from air pollution exposures. Findings should be considered in light of uncertainties, such as our use of modeled PM2.5 data, and warrant further investigation.
Identifiants
pubmed: 33788795
doi: 10.1097/EDE.0000000000001348
pii: 00001648-202107000-00004
pmc: PMC8159868
mid: NIHMS1680640
doi:
Substances chimiques
Air Pollutants
0
Particulate Matter
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
477-486Subventions
Organisme : NIMHD NIH HHS
ID : R01 MD012769
Pays : United States
Organisme : EPA
ID : R835871
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
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