Are Diabetics and the Neurologically Impaired at Increased Risk from Air Pollutant Exposures? A National Analysis

EPA Grant Number: R834900
Title: Are Diabetics and the Neurologically Impaired at Increased Risk from Air Pollutant Exposures? A National Analysis
Investigators: Zanobetti, Antonella , Dominici, Francesca , Schwartz, Joel , Koutrakis, Petros , Wang, Yun
Institution: Harvard University
EPA Project Officer: Chung, Serena
Project Period: April 1, 2011 through March 31, 2014 (Extended to March 31, 2015)
Project Amount: $299,903
RFA: Exploring New Air Pollution Health Effects Links in Existing Datasets (2010) RFA Text |  Recipients Lists
Research Category: Air Quality and Air Toxics , Air


Long- and short-tenn exposures to ambient air pollution are associated with adverse acute and chronic mortality, but less is known about who is susceptible. We will focus this project on two susceptible populations: individuals with neurological disorders and individuals with diabetes, a risk factor of cardiovascular disease. We hypothesize that short and long-tenn exposure to individual air pollutants increase pollutionassociated mortality risk among elderly who had a history of hospitalization for neurological disorders or diabetes. Moreover we hypothesize that these effects are differentially impacted by measures of risk modifiers associated with susceptibility and vulnerability, including individualand area-level and socio-economic factors, environmental characteristics as percent of green space, and county altitude, climate conditions, and housing characteristics such as air conditioning (AC) prevalence. We will also test whether these effects vary by geographic regions, PM composition and by the pollutant mixture-based groupings.


We will use the largest available collection of national datasets including: 1) a cohort of 20 million Medicare enrollees followed prospectively for cause specific hospital admissions and death during the period 1999 to 2008; 2) exposures to individual pollutants, mixtures, and PM components; 3) a comprehensive collection of individual and arealevel modifying factors. We will: 1) estimate county-specific health risks associated with longtenn exposure (e.g. yearly averages) to individual pollutants in two cohorts of persons with neurological disorders or diabetes using a novel approach that minimizes cross-sectional confounding; 2) conduct a case-crossover study to estimate the mortality risks associated with short-tenn exposures to individual pollutants in a susceptible population defined as persons 65 or older with at least one Medicare covered hospital admission for diabetes or neurological disorders. 3) use the city specific effects detennined in 1) and 2) to investigate individual and area-level modifiers.

Expected Results:

We will assess whether diabetics and individuals with neurological disorders are at increased mortality risk from short- and long-tenn air pollutant exposures. We will address which individual and area-level factors, measuring vulnerability, susceptibility, and individual air pollutants, components and multi-pollutants mixtures, are the major detenninants in explaining temporal and geographical variability of the health risks, allowing us to identify subpopulations at increased risk for hannful effects of air pollution.

Publications and Presentations:

Publications have been submitted on this project: View all 19 publications for this project

Journal Articles:

Journal Articles have been submitted on this project: View all 11 journal articles for this project

Supplemental Keywords:

Air pollution, PM components, multi-pollutant mixtures, diabetes, neurological disorders, susceptibility, vulnerability

Progress and Final Reports:

  • 2011 Progress Report
  • 2012 Progress Report
  • 2013 Progress Report
  • Final Report