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Mortality from respiratory infections and chronic obstructive pulmonary disease and associations with environmental quality.
Citation:
Rappazzo, K., Tim Wade, G. Shannon, L. Messer, J. Jagai, C. Gray, Y. Jian, AND D. Lobdell. Mortality from respiratory infections and chronic obstructive pulmonary disease and associations with environmental quality. Presented at Society for Epidemiologic Research, Miami, FL, June 21 - 24, 2016.
Impact/Purpose:
The purpose of this abstract was to examine associations between domains of the environmental quality index and chronic obstructive pulmonary disease and respiratory infections.
Description:
Respiratory infections (RI) and chronic obstructive pulmonary disease (COPD) have been identified by the World Health Organization as conditions which may be strongly influenced by environmental factors. We examined the associations between environmental quality and U.S. county mortality rates for RI and COPD. Daily data from the National Center for Health Statistics were used to calculate age-adjusted RI and COPD mortality rates per 100,000 population for years 2005-2010 for each U.S. county (n=3140). 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 rate differences (RD) and 95% confidence intervals for quintiles of EQI domain indices, adjusted for all other environmental domains and county population percent minority; models were also stratified by four levels of urban-rural setting. In the unstratified analysis, COPD death rates increased with worsening air quality (RD 5th compared to 1st quintile: 6.387 (4.565, 8.210)), and decreased with worsening sociodemographic quality (-18.020 (-20.051, -15.989)). RDs for COPD were consistently positive for worsening water quality, and negative for worsening land quality. In the stratified analyses, RDs for the sociodemographic domain were positive (RD 5th to 1st quintile: 14.456 (12.130, 16.781)) in the most urban strata, but remained negative in more suburban and rural strata. Also in the stratified analyses, COPD associations with air quality appear to be driven by most urban counties, while water associations were most influenced by suburban and rural counties. Similar patterns of association were observed with RDs for RI death. Deaths due to COPD and RI appear to have different environmental drivers across rural-urban strata, with air and water quality having adverse impacts. This abstract does not necessarily reflect EPA policy.