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Associations between Long-term PM2.5 Exposure and Cardiovascular Outcomes Are Modified by Neighborhood Socioeconomic Effects in an Urban Area of North Carolina
Citation:
Weaver, A., L. McGuinn, L. Neas, R. Devlin, R. Dhingra, C. Ward-Caviness, W. Cascio, W. Kraus, E. Hauser, Q. Di, J. Schwartz, AND D. Diaz-Sanchez. Associations between Long-term PM2.5 Exposure and Cardiovascular Outcomes Are Modified by Neighborhood Socioeconomic Effects in an Urban Area of North Carolina. ISES-ISEE 2018 Joint Annual Meeting, Ottawa, Ontario, CANADA, August 26 - 30, 2018.
Impact/Purpose:
PM2.5 air pollution as well as neighborhood socioeconomic status (SES) are both known to contribute to cardiovascular disease (CVD), but their combined effects are not well understood. In this study, we examined whether the effects of PM2.5 on CVD are different in areas with different SES characteristics in Wake, Durham, and Orange Counties, NC. We used data from 2192 cardiac catheterization patients at Duke University 2001-2010. We found that those who live in urban areas with relatively low SES and relatively high black populations had stronger associations between PM2.5 and hypertension. These results help to inform community members, physicians, and researchers about joint effects of neighborhood SES and PM2.5 on CVD.
Description:
Exposure to PM2.5 air pollution, as well as neighborhood socioeconomic status (SES), are associated with cardiovascular disease (CVD) and diabetes. The joint effect of SES and PM2.5 on these outcomes can aid in understanding the effects of total environment on health. In this study, we examined whether neighborhood SES modified the effects of long-term PM2.5 exposure on the following outcomes: coronary artery disease index (CAD) at the time of the index visit as determined at coronary catheterization, hypertension, and diabetes. We defined 6 neighborhood SES clusters based on a prior analysis of Ward’s Hierarchical clustering of 11 Census variables. We analyzed data from 2192 cardiac catheterization patients residing in Wake, Durham, or Orange County, North Carolina. For each patient, we estimated annual mean PM2.5 concentration using a hybrid model with a 1x1 km resolution. All outcomes were assessed from medical records. We used logistic regression models adjusted for age, sex, race, body mass index, and smoking status, to assess cluster-specific and overall associations between PM2.5 and outcomes. We used interaction terms to define interactions by SES clusters. We observed significantly 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) compared to referent cluster 3 (OR 0.93, 95% CI 0.82-1.07). Clusters 1 and 2 were urban and had relatively high proportions of black populations, impoverished, non-managerial occupations, unemployed, and single-parent homes. In contrast, Cluster 3, the referent cluster, was urban with high proportions Bachelor’s degree, and low proportions impoverished, non-managerial occupations and unemployed. In conclusion, neighborhoods of relative disadvantage have a stronger association between PM2.5 and hypertension compared with neighborhoods of relative SES advantage. This abstract does not necessarily reflect EPA policies.