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Air pollution and serious bleeding events in high-risk older adults
Despite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution. To measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events. Retrospective...
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| Published in: | Environmental research 2024-06, Vol.251 (Pt 1), p.118628, Article 118628 |
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| container_issue | Pt 1 |
| container_start_page | 118628 |
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| creator | Fayyad, Rindala Josey, Kevin Gandhi, Poonam Rua, Melanie Visaria, Aayush Bates, Benjamin Setoguchi, Soko Nethery, Rachel C. |
| description | Despite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution.
To measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events.
Retrospective cohort study (2008–2016).
Nationwide Medicare population.
A 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events.
Fine particulate matter (PM2.5) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin).
The outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM2.5 exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM2.5 exposure and anticoagulant use.
The study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM2.5 exposure 8.81 μg/m3). A 10 μg/m3 increase in PM2.5 was associated with a 48% (95% CI: 45%–52%), 58% (95% CI: 49%–68%) and 55% (95% CI: 37%–76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM2.5 exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding.
Among older adults at high risk for cardiovascular and thromboembolic events, increasing PM2.5 exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM2.5 exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM2.5 concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.
•We studied impacts of air pollution on severe bleeding in older adults in Medicare.•PM2.5 increases risk of severe nose, gastrointestinal, and intracranial bleeding.•PM2.5-related bleeding risks are exacerbated in anticoagulant users.•High-risk older adults should limit outdoor air pollution exposure.•Further research on environmental and drug exposure syne |
| doi_str_mv | 10.1016/j.envres.2024.118628 |
| format | article |
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To measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events.
Retrospective cohort study (2008–2016).
Nationwide Medicare population.
A 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events.
Fine particulate matter (PM2.5) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin).
The outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM2.5 exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM2.5 exposure and anticoagulant use.
The study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM2.5 exposure 8.81 μg/m3). A 10 μg/m3 increase in PM2.5 was associated with a 48% (95% CI: 45%–52%), 58% (95% CI: 49%–68%) and 55% (95% CI: 37%–76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM2.5 exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding.
Among older adults at high risk for cardiovascular and thromboembolic events, increasing PM2.5 exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM2.5 exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM2.5 concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.
•We studied impacts of air pollution on severe bleeding in older adults in Medicare.•PM2.5 increases risk of severe nose, gastrointestinal, and intracranial bleeding.•PM2.5-related bleeding risks are exacerbated in anticoagulant users.•High-risk older adults should limit outdoor air pollution exposure.•Further research on environmental and drug exposure synergies is needed.</description><identifier>ISSN: 0013-9351</identifier><identifier>ISSN: 1096-0953</identifier><identifier>EISSN: 1096-0953</identifier><identifier>DOI: 10.1016/j.envres.2024.118628</identifier><identifier>PMID: 38460663</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Air Pollutants - adverse effects ; Air Pollutants - analysis ; Air pollution ; Air Pollution - adverse effects ; Anticoagulant use ; Anticoagulants - adverse effects ; Bleeding events ; Causal inference ; Environmental Exposure - adverse effects ; Female ; Fine particulate matter ; Gastrointestinal Hemorrhage - chemically induced ; Gastrointestinal Hemorrhage - epidemiology ; Hemorrhage - chemically induced ; Hemorrhage - epidemiology ; Hospitalization - statistics & numerical data ; Humans ; Male ; Medicare ; Particulate Matter - adverse effects ; Particulate Matter - analysis ; Retrospective Studies ; United States - epidemiology</subject><ispartof>Environmental research, 2024-06, Vol.251 (Pt 1), p.118628, Article 118628</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c311t-9153348669b763e48619663b4534cb83afacc105e1df639003d5bbd9649b91c53</cites><orcidid>0000-0003-0939-829X ; 0009-0003-7326-8171 ; 0000-0001-9895-1477 ; 0000-0002-1583-752X ; 0000-0002-1221-4028</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38460663$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fayyad, Rindala</creatorcontrib><creatorcontrib>Josey, Kevin</creatorcontrib><creatorcontrib>Gandhi, Poonam</creatorcontrib><creatorcontrib>Rua, Melanie</creatorcontrib><creatorcontrib>Visaria, Aayush</creatorcontrib><creatorcontrib>Bates, Benjamin</creatorcontrib><creatorcontrib>Setoguchi, Soko</creatorcontrib><creatorcontrib>Nethery, Rachel C.</creatorcontrib><title>Air pollution and serious bleeding events in high-risk older adults</title><title>Environmental research</title><addtitle>Environ Res</addtitle><description>Despite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution.
To measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events.
Retrospective cohort study (2008–2016).
Nationwide Medicare population.
A 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events.
Fine particulate matter (PM2.5) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin).
The outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM2.5 exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM2.5 exposure and anticoagulant use.
The study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM2.5 exposure 8.81 μg/m3). A 10 μg/m3 increase in PM2.5 was associated with a 48% (95% CI: 45%–52%), 58% (95% CI: 49%–68%) and 55% (95% CI: 37%–76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM2.5 exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding.
Among older adults at high risk for cardiovascular and thromboembolic events, increasing PM2.5 exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM2.5 exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM2.5 concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.
•We studied impacts of air pollution on severe bleeding in older adults in Medicare.•PM2.5 increases risk of severe nose, gastrointestinal, and intracranial bleeding.•PM2.5-related bleeding risks are exacerbated in anticoagulant users.•High-risk older adults should limit outdoor air pollution exposure.•Further research on environmental and drug exposure synergies is needed.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Air Pollutants - adverse effects</subject><subject>Air Pollutants - analysis</subject><subject>Air pollution</subject><subject>Air Pollution - adverse effects</subject><subject>Anticoagulant use</subject><subject>Anticoagulants - adverse effects</subject><subject>Bleeding events</subject><subject>Causal inference</subject><subject>Environmental Exposure - adverse effects</subject><subject>Female</subject><subject>Fine particulate matter</subject><subject>Gastrointestinal Hemorrhage - chemically induced</subject><subject>Gastrointestinal Hemorrhage - epidemiology</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - epidemiology</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medicare</subject><subject>Particulate Matter - adverse effects</subject><subject>Particulate Matter - analysis</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><issn>0013-9351</issn><issn>1096-0953</issn><issn>1096-0953</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kMtOwzAQRS0EoqXwBwh5ySbBjh-NN0io4iVVYgNrK7YnrUuaFDupxN_jKoUlq5mR7sy9cxC6piSnhMq7TQ7tPkDMC1LwnNJSFuUJmlKiZEaUYKdoSghlmWKCTtBFjJs0UsHIOZqwkksiJZuixYMPeNc1zdD7rsVV63CE4LshYtMAON-uMOyh7SP2LV771ToLPn7irnEQcOWGpo-X6KyumghXxzpDH0-P74uXbPn2_Lp4WGaWUdpnKpkzXkqpzFwySB1VKYPhgnFrSlbVlbWUCKCulkwRwpwwxinJlVHUCjZDt-PdXei-Boi93vpooWmqFlJgXSjB5_OCi3mS8lFqQxdjgFrvgt9W4VtTog_49EaP-PQBnx7xpbWbo8NgtuD-ln55JcH9KID0595D0NF6aG0CFcD22nX-f4cfmHCBeg</recordid><startdate>20240615</startdate><enddate>20240615</enddate><creator>Fayyad, Rindala</creator><creator>Josey, Kevin</creator><creator>Gandhi, Poonam</creator><creator>Rua, Melanie</creator><creator>Visaria, Aayush</creator><creator>Bates, Benjamin</creator><creator>Setoguchi, Soko</creator><creator>Nethery, Rachel C.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0939-829X</orcidid><orcidid>https://orcid.org/0009-0003-7326-8171</orcidid><orcidid>https://orcid.org/0000-0001-9895-1477</orcidid><orcidid>https://orcid.org/0000-0002-1583-752X</orcidid><orcidid>https://orcid.org/0000-0002-1221-4028</orcidid></search><sort><creationdate>20240615</creationdate><title>Air pollution and serious bleeding events in high-risk older adults</title><author>Fayyad, Rindala ; Josey, Kevin ; Gandhi, Poonam ; Rua, Melanie ; Visaria, Aayush ; Bates, Benjamin ; Setoguchi, Soko ; Nethery, Rachel C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-9153348669b763e48619663b4534cb83afacc105e1df639003d5bbd9649b91c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Air Pollutants - adverse effects</topic><topic>Air Pollutants - analysis</topic><topic>Air pollution</topic><topic>Air Pollution - adverse effects</topic><topic>Anticoagulant use</topic><topic>Anticoagulants - adverse effects</topic><topic>Bleeding events</topic><topic>Causal inference</topic><topic>Environmental Exposure - adverse effects</topic><topic>Female</topic><topic>Fine particulate matter</topic><topic>Gastrointestinal Hemorrhage - chemically induced</topic><topic>Gastrointestinal Hemorrhage - epidemiology</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - epidemiology</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medicare</topic><topic>Particulate Matter - adverse effects</topic><topic>Particulate Matter - analysis</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fayyad, Rindala</creatorcontrib><creatorcontrib>Josey, Kevin</creatorcontrib><creatorcontrib>Gandhi, Poonam</creatorcontrib><creatorcontrib>Rua, Melanie</creatorcontrib><creatorcontrib>Visaria, Aayush</creatorcontrib><creatorcontrib>Bates, Benjamin</creatorcontrib><creatorcontrib>Setoguchi, Soko</creatorcontrib><creatorcontrib>Nethery, Rachel C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Environmental research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fayyad, Rindala</au><au>Josey, Kevin</au><au>Gandhi, Poonam</au><au>Rua, Melanie</au><au>Visaria, Aayush</au><au>Bates, Benjamin</au><au>Setoguchi, Soko</au><au>Nethery, Rachel C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Air pollution and serious bleeding events in high-risk older adults</atitle><jtitle>Environmental research</jtitle><addtitle>Environ Res</addtitle><date>2024-06-15</date><risdate>2024</risdate><volume>251</volume><issue>Pt 1</issue><spage>118628</spage><pages>118628-</pages><artnum>118628</artnum><issn>0013-9351</issn><issn>1096-0953</issn><eissn>1096-0953</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Despite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution.
To measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events.
Retrospective cohort study (2008–2016).
Nationwide Medicare population.
A 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events.
Fine particulate matter (PM2.5) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin).
The outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM2.5 exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM2.5 exposure and anticoagulant use.
The study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM2.5 exposure 8.81 μg/m3). A 10 μg/m3 increase in PM2.5 was associated with a 48% (95% CI: 45%–52%), 58% (95% CI: 49%–68%) and 55% (95% CI: 37%–76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM2.5 exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding.
Among older adults at high risk for cardiovascular and thromboembolic events, increasing PM2.5 exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM2.5 exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM2.5 concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.
•We studied impacts of air pollution on severe bleeding in older adults in Medicare.•PM2.5 increases risk of severe nose, gastrointestinal, and intracranial bleeding.•PM2.5-related bleeding risks are exacerbated in anticoagulant users.•High-risk older adults should limit outdoor air pollution exposure.•Further research on environmental and drug exposure synergies is needed.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>38460663</pmid><doi>10.1016/j.envres.2024.118628</doi><orcidid>https://orcid.org/0000-0003-0939-829X</orcidid><orcidid>https://orcid.org/0009-0003-7326-8171</orcidid><orcidid>https://orcid.org/0000-0001-9895-1477</orcidid><orcidid>https://orcid.org/0000-0002-1583-752X</orcidid><orcidid>https://orcid.org/0000-0002-1221-4028</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Air Pollutants - adverse effects Air Pollutants - analysis Air pollution Air Pollution - adverse effects Anticoagulant use Anticoagulants - adverse effects Bleeding events Causal inference Environmental Exposure - adverse effects Female Fine particulate matter Gastrointestinal Hemorrhage - chemically induced Gastrointestinal Hemorrhage - epidemiology Hemorrhage - chemically induced Hemorrhage - epidemiology Hospitalization - statistics & numerical data Humans Male Medicare Particulate Matter - adverse effects Particulate Matter - analysis Retrospective Studies United States - epidemiology |
| title | Air pollution and serious bleeding events in high-risk older adults |
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