Air Pollution and Cardiovascular and Thromboembolic Events in Older Adults With High-Risk Conditions

Abstract Little epidemiologic research has focused on pollution-related risks in medically vulnerable or marginalized groups. Using a nationwide 50% random sample of 2008–2016 Medicare Part D–eligible fee-for-service participants in the United States, we identified a cohort with high-risk conditions...

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Bibliographic Details
Published in:American journal of epidemiology 2023-08, Vol.192 (8), p.1358-1370
Main Authors: Nethery, Rachel C, Josey, Kevin, Gandhi, Poonam, Kim, Jung Hyun, Visaria, Aayush, Bates, Benjamin, Schwartz, Joel, Robinson, David, Setoguchi, Soko
Format: Article
Language:English
Subjects:
Aged
Air Pollutants - adverse effects
Air Pollutants - analysis
Air pollution
Air Pollution - adverse effects
Air Pollution - analysis
Cardiovascular diseases
Comorbidity
Congestive heart failure
Demographic variables
Diameters
Environmental Exposure - adverse effects
Epidemiology
Female
Humans
Ischemia
Ischemic Attack, Transient - chemically induced
Male
Medicare
Native Americans
Older people
Original Contribution
Particulate emissions
Particulate matter
Particulate Matter - adverse effects
Particulate Matter - analysis
Random sampling
Risk
Social factors
Structural models
Subgroups
Suspended particulate matter
Thromboembolism
Transient ischemic attack
United States - epidemiology
Venous Thromboembolism
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Summary:Abstract Little epidemiologic research has focused on pollution-related risks in medically vulnerable or marginalized groups. Using a nationwide 50% random sample of 2008–2016 Medicare Part D–eligible fee-for-service participants in the United States, we identified a cohort with high-risk conditions for cardiovascular and thromboembolic events (CTEs) and linked individuals with seasonal average zip-code–level concentrations of fine particulate matter (particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5)). We assessed the relationship between seasonal PM2.5 exposure and hospitalization for each of 7 CTE-related causes using history-adjusted marginal structural models with adjustment for individual demographic and neighborhood socioeconomic variables, as well as baseline comorbidity, health behaviors, and health-service measures. We examined effect modification across geographically and demographically defined subgroups. The cohort included 1,934,453 individuals with high-risk conditions (mean age = 77 years; 60% female, 87% White). A 1-μg/m3 increase in PM2.5 exposure was significantly associated with increased risk of 6 out of 7 types of CTE hospitalization. Strong increases were observed for transient ischemic attack (hazard ratio (HR) = 1.039, 95% confidence interval (CI): 1.034, 1.044), venous thromboembolism (HR = 1.031, 95% CI: 1.027, 1.035), and heart failure (HR = 1.019, 95% CI: 1.017, 1.020). Asian Americans were found to be particularly susceptible to thromboembolic effects of PM2.5 (venous thromboembolism: HR = 1.063, 95% CI: 1.021, 1.106), while Native Americans were most vulnerable to cerebrovascular effects (transient ischemic attack: HR = 1.093, 95% CI: 1.030, 1.161).
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kwad089