Neighborhood sociodemographic effects on the associations between long-term PM2.5 exposure and cardiovascular outcomes and diabetes
Citation:
Weaver, A., L. McGuinn, L. Neas, J. Mirowsky, R. Devlin, R. Dhingra, C. Ward-Caviness, W. Cascio, W. Kraus, E. Hauser, Q. Di, J. Schwartz, AND D. Diaz-Sanchez. Neighborhood sociodemographic effects on the associations between long-term PM2.5 exposure and cardiovascular outcomes and diabetes. Journal of Exposure Science and Environmental Epidemiology . Nature Publishing Group, London, Uk, 3(1):e038, (2019). https://doi.org/10.1097/EE9.0000000000000038
Impact/Purpose:
Both fine particulate air pollution (PM2.5) and socioeconomic status (SES) are known to affect heart health and disease. It is not known whether the effects of PM2.5 on heart health are different in neighborhoods with different SES. We examined hospital records from 2192 cardiac catheterization patients at Duke University Medical Center for heart disease and diabetes outcomes. We then matched these patients to one of six distinct neighborhood clusters in Orange, Durham, and Wake counties, NC, defined by SES as well as PM2.5 exposure at their home in the prior year. We observed that PM2.5 was associated with myocardial infarction (heart attack) in all neighborhood clusters. However, PM2.5 was only associated with hypertension (high blood pressure) among patients who lived in urban neighborhood clusters with low SES and majority Black populations. This project is among the first to demonstrate different health effects of air pollution by neighborhood. This paper is relevant to environmental justice as it indicates populations that are particularly vulnerable to effects of PM2.5 air pollution on blood pressure. We plan on using procedures developed here for future studies with larger, more diverse, and more rural populations.
Description:
Introduction: Exposure to PM2.5 air pollution and neighborhood-level sociodemographic characteristics are associated with cardiovascular disease and possibly diabetes. However, the joint effect of sociodemographics and PM2.5 on these outcomes is uncertain. Methods: We examined whether clusters of sociodemographic characteristics modified effects of long-term PM2.5 exposure on coronary artery disease (CAD), myocardial infarction (MI), hypertension, and diabetes. We used medical records data from 2192 cardiac catheterization patients residing in North Carolina and assigned to one of six previously-determined clusters. For each participant, we estimated annual PM2.5 exposure at their primary residence using a hybrid model with a 1 km2 resolution. We used logistic regression models adjusted for age, sex, body mass index, and smoking status, to assess cluster-specific associations with PM2.5 and to determine if there were interactions between cluster and PM2.5 on outcomes. Results: Compared to cluster 3 (OR 0.93, 95% CI 0.82-1.07; urban, low proportion of black individuals and high socioeconomic status), we observed greater associations between PM2.5 and hypertension in clusters 1 (OR 1.22, 95% CI 0.99-1.50, pint 0.03) and 2 (OR 1.64, 95% CI 1.16-2.32, pint 0.003), which were urban, high proportion of black individuals, and low socioeconomic status. PM2.5 was associated with MI (OR 1.29, 95% CI 1.16-1.42) but not diabetes, regardless of cluster and was associated with CAD in cluster 3 (OR 1.15, 95% CI 1.00, 1.31) and overall (OR 1.07, 95% CI 0.98, 1.17). Discussion: Areas of relative disadvantage have a stronger association between PM2.5 and hypertension compared to areas of relative advantage.
URLs/Downloads:
DOI: Neighborhood sociodemographic effects on the associations between long-term PM2.5 exposure and cardiovascular outcomes and diabetes