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The contribution of improved air quality to reduced cardiovascular mortality: Declines in socioeconomic differences over time

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Major improvements in air quality since 1990, observed through reductions in fine particulate matter (PM2.s), have been associated with reduced cardiovascular mortality rates (CMR). However, it is not well understood whether the health benefit attributed to PM_ 2 5 reductions has been similar across strata of socioeconomic deprivation (SEO). Using mixed effect regression models, we estimated the PM2.s-related change in the CMR across 2,132 US counties in five SEO strata between 1990 and 2010. The analysis included annual county CMR (deaths/100,000 person-year), annual county PM2.s (µg/in3), and an index of county SEO based on socioeconomic factors from the 1990 US Census. The contribution of PM_ 2 5 reductions to decreased CMR varied by SEO strata and over time. Yearly differences resulted from varying rates of PM2.5 reduction and because of the non-linear relationship between CMR and PM2.5 concentration. In early years, PM2.s-related CMR reductions were smallest in the most deprived counties compared to all other counties (range: 0.4-0.6 vs 0.7-1.6 fewer deaths/100,000 person-year), due to slower rates of PM2.5 reduction in these counties. However, in later years, PM2.5-related CMR reductions were highest counties with moderate to high deprivation, compared to counties with the least deprivation (range: 1.0-2.2 vs 0.5-0.9 fewer deaths/100,000 person-year) due to larger CMR reductions per decrease in PM2.5. We identified that CMR reductions related to air quality improvements have become more similar over time between socioeconomic strata.

Impact/Purpose

We identified that reductions in cardiovascular mortality attributable to air quality improvements varied among communities with respect to socioeconomic status levels and that the PM2.5-related CMR reductions have become more similar over time with respect to socioeconomic strata. Overall mediation of the cardiovascular mortality trend by PM2.5 between 1990-2010 was greater in counties with moderate to high deprivation, 11% of the total cardiovascular mortality rate reduction is attributed to PM2.5 change, compared to 9% in counties with the least deprivation. The results that include non-linear dose-responses for national and socioeconomic can further inform health risk assessments by EPA.

Citation

Wyatt, L., G. Peterson, T. Wade, L. Neas, AND A. Rappold. The contribution of improved air quality to reduced cardiovascular mortality: Declines in socioeconomic differences over time. Elsevier B.V., Amsterdam, NETHERLANDS, 136:105430, (2020). [DOI: 10.1016/j.envint.2019.105430]

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DOI: The contribution of improved air quality to reduced cardiovascular mortality: Declines in socioeconomic differences over time
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Last updated on January 17, 2020
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