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      Mortality in the Medicare Population and Chronic Exposure to Fine Particulate Air Pollution in Urban Centers (2000–2005)

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          Abstract

          Background

          Prospective cohort studies constitute the major source of evidence about the mortality effects of chronic exposure to particulate air pollution. Additional studies are needed to provide evidence on the health effects of chronic exposure to particulate matter ≤ 2.5 μm in aerodynamic diameter (PM 2.5) because few studies have been carried out and the cohorts have not been representative.

          Objectives

          This study was designed to estimate the relative risk of death associated with long-term exposure to PM 2.5 by region and age groups in a U.S. population of elderly, for the period 2000–2005.

          Methods

          By linking PM 2.5 monitoring data to the Medicare billing claims by ZIP code of residence of the enrollees, we have developed a new retrospective cohort study, the Medicare Cohort Air Pollution Study. The study population comprises 13.2 million participants living in 4,568 ZIP codes having centroids within 6 miles of a PM 2.5 monitor. We estimated relative risks adjusted by socioeconomic status and smoking by fitting log-linear regression models.

          Results

          In the eastern and central regions, a 10-μg/m 3 increase in 6-year average of PM 2.5 is associated with 6.8% [95% confidence interval (CI), 4.9–8.7%] and 13.2% (95% CI, 9.5–16.9) increases in mortality, respectively. We found no evidence of an association in the western region or for persons ≥ 85 years of age.

          Conclusions

          We established a cohort of Medicare participants for investigating air pollution and mortality on longer-term time frames. Chronic exposure to PM 2.5 was associated with mortality in the eastern and central regions, but not in the western United States.

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          Most cited references40

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          Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults.

          Time-series, cross-sectional, and prospective cohort studies have observed associations between mortality and particulate air pollution but have been limited by ecologic design or small number of subjects or study areas. The present study evaluates effects of particulate air pollution on mortality using data from a large cohort drawn from many study areas. We linked ambient air pollution data from 151 U.S. metropolitan areas in 1980 with individual risk factor on 552,138 adults who resided in these areas when enrolled in a prospective study in 1982. Deaths were ascertained through December, 1989. Exposure to sulfate and fine particulate air pollution, which is primarily from fossil fuel combustion, was estimated from national data bases. The relationships of air pollution to all-cause, lung cancer, and cardiopulmonary mortality was examined using multivariate analysis which controlled for smoking, education, and other risk factors. Although small compared with cigarette smoking, an association between mortality and particulate air pollution was observed. Adjusted relative risk ratios (and 95% confidence intervals) of all-cause mortality for the most polluted areas compared with the least polluted equaled 1.15 (1.09 to 1.22) and 1.17 (1.09 to 1.26) when using sulfate and fine particulate measures respectively. Particulate air pollution was associated with cardiopulmonary and lung cancer mortality but not with mortality due to other causes. Increased mortality is associated with sulfate and fine particulate air pollution at levels commonly found in U.S. cities. The increase in risk is not attributable to tobacco smoking, although other unmeasured correlates of pollution cannot be excluded with certainty.
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            Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study.

            Long-term exposure to particulate matter air pollution has been associated with increased cardiopulmonary mortality in the USA. We aimed to assess the relation between traffic-related air pollution and mortality in participants of the Netherlands Cohort study on Diet and Cancer (NLCS), an ongoing study. We investigated a random sample of 5000 people from the full cohort of the NLCS study (age 55-69 years) from 1986 to 1994. Long-term exposure to traffic-related air pollutants (black smoke and nitrogen dioxide) was estimated for the 1986 home address. Exposure was characterised with the measured regional and urban background concentration and an indicator variable for living near major roads. The association between exposure to air pollution and (cause specific) mortality was assessed with Cox's proportional hazards models, with adjustment for potential confounders. 489 (11%) of 4492 people with data died during the follow-up period. Cardiopulmonary mortality was associated with living near a major road (relative risk 1.95, 95% CI 1.09-3.52) and, less consistently, with the estimated ambient background concentration (1.34, 0.68-2.64). The relative risk for living near a major road was 1.41 (0.94-2.12) for total deaths. Non-cardiopulmonary, non-lung cancer deaths were unrelated to air pollution (1.03, 0.54-1.96 for living near a major road). Long-term exposure to traffic-related air pollution may shorten life expectancy.
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              Health effects of fine particulate air pollution: lines that connect.

              Efforts to understand and mitigate thehealth effects of particulate matter (PM) air pollutionhave a rich and interesting history. This review focuseson six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There hasbeen substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidiity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonaryhealth. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.
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                Author and article information

                Journal
                Environ Health Perspect
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                December 2008
                12 August 2008
                : 116
                : 12
                : 1614-1619
                Affiliations
                [1 ] Department of Biostatistics
                [2 ] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
                Author notes
                Address correspondence to J.M. Samet, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Suite W6041, Baltimore, MD 21205 USA. Telephone: (410) 955-3286. Fax: (410) 614-0467. E-mail: jsamet@ 123456jhsph.edu

                A.D. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We thank C. Gerczak for editorial input.

                The authors declare they have no competing financial interests.

                Article
                ehp-116-1614
                10.1289/ehp.11449
                2599753
                19079710
                2f24a7b6-9244-47d7-bc47-d7dbba998018
                This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose.
                History
                : 6 March 2008
                : 12 August 2008
                Categories
                Research

                Public health
                mortality,medicare,fine particulate matter (pm2.5),ecologic bias,heterogeneity,log-linear models,prospective studies

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