Long-Term Exposure to Low-Level and Mortality Among the Elderly Population in the Southeastern United States

Overview

Journal Environ Health Perspect

Date 2021 Dec 28

PMID 34962424

Citations 17

Authors

Yaoyao Qian

Haomin Li

Andrew Rosenberg

Qiulun Li

Jeremy Sarnat

Stefania Papatheodorou

Joel Schwartz

Donghai Liang

Yang Liu

Pengfei Liu

Liuhua Shi

Affiliations

Soon will be listed here.

Abstract

Background: Mounting evidence has shown that long-term exposure to fine particulate matter [PM in aerodynamic diameter ()] and ozone () can increase mortality. However, the health effects associated with long-term exposure to nitrogen dioxide () are less clear, in particular the evidence is scarce for at low levels that are below the current international guidelines.

Methods: We constructed a population-based full cohort comprising all Medicare beneficiaries (aged , ) in the southeastern United States from 2000 to 2016, and we then further defined the below-guideline cohort that included only those who were always exposed to low-level , that is, with annual means below the current World Health Organization guidelines (i.e., ). We applied previously estimated spatially and temporally resolved concentrations and assigned annual means to study participants based on their ZIP code of residence. Cox proportional hazards models were used to examine the association between long-term exposure to low-level and all-cause mortality, adjusting for potential confounders.

Results: About 71.1% of the Medicare beneficiaries in the southeastern United States were always exposed to low-level over the study period. We observed an association between long-term exposure to low-level and all-cause mortality, with a 1.042 (95% CI: 1.040, 1.045) in single-pollutant models and a 1.047 (95% CI: 1.045, 1.049) in multipollutant models (adjusting for and ), per increase in annual concentrations. The penalized spline indicates a linear exposure-response relationship across the entire exposure range. Medicare enrollees who were White, female, and residing in urban areas were more vulnerable to long-term exposure.

Conclusion: Using a large and representative cohort, we provide epidemiological evidence that long-term exposure to , even below the national and global ambient air quality guidelines, was approximately linearly associated with a higher risk of mortality among older adults, independent of and exposure. Improving air quality by reducing emissions, therefore, may yield significant health benefits. https://doi.org/10.1289/EHP9044.

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