Science Inventory

Cardiovascular hospitalizations and associations with environmental quality


Deflorio-Barker, S., K. Rappazzo, C. Gray, M. Jimenez, A. Patel, L. Messer, L. Neas, AND D. Lobdell. Cardiovascular hospitalizations and associations with environmental quality. Society for Epidemiology Research, Seattle, Washington, June 20 - 23, 2017.


To evaluate the potential association between environmental quality and hospitalizations among Medicare recipients for cardiovascular disease.


Cardiovascular disease has been identified as a condition that may be associated with environmental factors. Air pollution in particular has been demonstrated to be associated with cardiovascular disease and atherosclerosis, which can increase the likelihood of cardiovascular events. We examined the relationship between environmental quality and cardiovascular hospitalizations among Medicare recipients for 2010. Daily counts of hospitalizations for cardiovascular disease from the Center for Medicare and Medicare Services were used to calculate the proportion of Medicare recipients from U.S. counties (n=3,140) who were hospitalized due to any cardiovascular outcome in 2010. Cumulative environmental quality for 2000-2005 was characterized by five domain indices of the Environmental Quality Index (EQI): air, water, land, built, and sociodemographic domains. We used linear regression to estimate county-level prevalence differences in cardiovascular hospitalizations and 95% confidence intervals for quintiles of the overall EQI, as well as domain-specific EQI indices, all models controlled for county population percent minority and were clustered by climate region. We observed a negative prevalence difference (-0.28% [-0.46, -0.11]) for the overall EQI when comparing the quintiles with the worst environmental quality to the best environmental quality. However, when examining domain-specific measures, we observed a positive prevalence difference within the air domain (1.16% [0.97, 1.35]), the land domain (0.15% [-0.05, 0.35]), and the built environment domain (0.36% [0.19, 0.53]), when comparing worst environmental quality to the best environmental quality. The other domains, water and sociodemographic, had strongly negative associations with cardiovascular hospitalizations. Hospitalizations for cardiovascular disease among Medicare recipients may be associated with some factors related to environmental quality.This abstract does not necessarily reflect EPA policy.

Record Details:

Product Published Date: 06/22/2017
Record Last Revised: 08/18/2017
OMB Category: Other
Record ID: 337285