Comparison of Association Between Proximity to Major Roads and All-Cause Mortality Across a Spectrum of Cadiovascular Diseases
Aims - Traffic is a primary source of urban air pollution exposure, and is associated with adverse health outcomes. There is limited information on the impact of exposure to traffic on mortality for individuals with pre-existing disease. We used the EPA CARES resource to examine the relationship between proximity of primary residence to nearest major roadway (DTR) and mortality in heart failure (HF) patients. Methods and Results - The study cohort comprised 30,599 North Carolina (NC) residents diagnosed with HF between 2004 and 2016, who did not reside in a group home or institutional residence. Cox proportional hazards models were used to determine the association between all-cause mortality and DTR while adjusting for age, sex, race, and socioeconomic status indicators measured at the census block group: median household income, median home value, urbanicity, percent households below poverty line, and percent households receiving public assistance. Results are given in as the hazard ratio (HR) per 1 km decrease in DTR and the associated 95% confidence interval (CI). In the central, more urban, region of NC (Durham, Wake, Orange, and Chatham), DTR was associated with mortality in HF patients (HR = 1.04, CI = 1.02, 1.07). The association was slightly weaker in the entire state (HR = 1.02, CI = 1.00, 1.04). Conclusion - Residential proximity to major roadways may be a mortality risk factor for HF patients in urban regions. Given the morbidity, mortality, and healthcare costs associated with HF, it is important to understand, monitor, and communicate environmental health risks.