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Associations between environmental quality and cardiovascular hospital admissions within the Medicare Population
Citation:
DeflorioBarker, S., C. Gray, A. Krajewski, M. Jimenez, K. Rappazzo, A. Patel, J. Jagai, S. Hoffman, W. Cascio, AND D. Lobdell. Associations between environmental quality and cardiovascular hospital admissions within the Medicare Population. SER, Minneapolis, Minnesota, June 18 - 21, 2019.
Impact/Purpose:
This study utilized the EPA created Environmental Quality Index to examine the impact overall environment has on cardiovascular hospital admissions.
Description:
Cardiovascular disease (CVD) and diabetes have been identified as conditions that may be associated with environmental factors through a variety of pathways. Air pollution in particular has been demonstrated to be associated with atherosclerosis, which can increase the likelihood of CVD events. Having diabetes can also accelerate the progression of atherosclerosis. We examined the relationship between environmental quality and major cardiovascular event (MACE) hospitalizations among Medicare recipients 65 and older from 2006-2010 with and without diagnosed diabetes. 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 multilevel logistic models to estimate odds ratios (ORs) and 95% confidence intervals (CI) for quintiles of cumulative EQI, as well as domain-specific EQI indices. All models controlled for age, sex, race, and climate region, and accounted for clustering at the county level. We observed no association between overall environmental quality and MACE hospitalizations. However, there were positive associations for MACE hospitalizations for the air domain (OR=1.09 (95% CI: 1.07, 1.12)), the built domain (1.12 (1.09, 1.14)), and the sociodemographic domain (1.24 (1.22, 1.27)), when comparing the quintiles with the worst to the best environmental quality. Associations did not differ based on diabetes status. Hospitalizations for MACE among 65 and older may be associated with environmental quality. This abstract does not necessarily reflect EPA policy.