The contribution of improved air quality to reduced cardiovascular mortality: Declines in socioeconomic differences over time

Wyatt, Lauren; Peterson, Geoffrey Colin Lee; Wade, Timothy J.; Neas, Lucas M.; Rappold, Ana G.

doi:10.1016/j.envint.2019.105430

Cited by 10 publications

(11 citation statements)

References 64 publications

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“…It is unclear if cardiovascular mortality rates increase quickly or plateau over this region; both conclusions are consistent with our results. Our conclusions generally agree with those reported in Wyatt et al (2020a), but our flexible approach to estimation and principled approach to inference ensure that the conclusions are not the result of statistical bias.…”

Section: Effect Of Fine Particulate Matter On Cardiovascular Mortalitysupporting

confidence: 88%

“…Pope et al, 2009;Correia et al, 2013;Roth et al, 2017;Corrigan et al, 2018). Wyatt et al (2020a) recently conducted an observational study to investigate the association between particulate matter less than 2.5 microns in diameter (PM 2.5 ) and cardiovascular mortality and cardiovascular mortality rate after adjusting for socioeconomic characteristics using regression models.…”

Section: Effect Of Fine Particulate Matter On Cardiovascular Mortalitymentioning

confidence: 99%

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Debiased inference for a covariate-adjusted regression function

Takatsu¹,

Westling²

2022

Preprint

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In this article, we study nonparametric inference for a covariate-adjusted regression function. This parameter captures the average association between a continuous exposure and an outcome after adjusting for other covariates. In particular, under certain causal conditions, this parameter corresponds to the average outcome had all units been assigned to a specific exposure level, known as the causal dose-response curve. We propose a debiased local linear estimator of the covariate-adjusted regression function, and demonstrate that our estimator converges pointwise to a mean-zero normal limit distribution. We use this result to construct asymptotically valid confidence intervals for function values and differences thereof. In addition, we use approximation results for the distribution of the supremum of an empirical process to construct asymptotically valid uniform confidence bands. Our methods do not require undersmoothing, permit the use of data-adaptive estimators of nuisance functions, and our estimator attains the optimal rate of convergence for a twice differentiable function. We illustrate the practical performance of our estimator using numerical studies and an analysis of the effect of air pollution exposure on cardiovascular mortality.

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Section: Effect Of Fine Particulate Matter On Cardiovascular Mortalitysupporting

confidence: 88%

Section: Effect Of Fine Particulate Matter On Cardiovascular Mortalitymentioning

confidence: 99%

Debiased inference for a covariate-adjusted regression function

Takatsu¹,

Westling²

2022

Preprint

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“…Though short-term elevations in PM 2.5 have deleterious acute cardiovascular effects [14,15], studies suggest that residing in areas with higher long-term average PM 2.5 levels is associated with an even greater effect on cardiovascular health [16]. Indeed, reductions in annual PM 2.5 averages have been associated with decreased cardiovascular mortality rates, even when accounting for socioeconomic status [17]. Thus, we utilized average annual PM 2.5 levels as published by CDC in an effort to study the cardiovascular effects of long-term exposure to PM 2.5 .…”

Section: Exposure Of Interestmentioning

confidence: 99%

Particulate matter 2.5, metropolitan status, and heart failure outcomes in US counties: A nationwide ecologic analysis

et al. 2022

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The relationship between particulate matter with a diameter of 2.5 micrometers or less (PM2.5) and heart failure (HF) hospitalizations and mortality in the US is unclear. Prior studies are limited to studying the effects of daily PM2.5 exposure on HF hospitalizations in specific geographic regions. Because PM2.5 can vary by geography, this study examines the effects of annual ambient PM2.5 exposure on HF hospitalizations and mortality at a county-level across the US. A cross-sectional analysis of county-level ambient PM2.5 concentration, HF hospitalizations, and HF mortality across 3135 US counties nationwide was performed, adjusting for county-level demographics, socioeconomic factors, comorbidities, and healthcare-associated behaviors. There was a moderate correlation between county PM2.5 and HF hospitalization among Medicare beneficiaries (r = 0.41) and a weak correlation between county PM2.5 and HF mortality (r = 0.08) (p-values < 0.01). After adjustment for various county level covariates, every 1 ug/m3 increase in annual PM2.5 concentration was associated with an increase of 0.51 HF Hospitalizations/1,000 Medicare Beneficiaries and 0.74 HF deaths/100,000 residents (p-values < 0.05). In addition, the relationship between PM2.5 and HF hospitalizations was similar when factoring in metropolitan status of the counties. In conclusion, increased ambient PM2.5 concentration level was associated with increased incidence of HF hospitalizations and mortality at the county level across the US. This calls for future studies exploring policies that reduce ambient particulate matter pollution and their downstream effects on potentially improving HF outcomes.

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“…The main goal is to reduce air pollution–induced morbidity and mortality, most notably from cardiopulmonary diseases, which account for the largest portion of events . This general premise is plausible given the sound evidence linking reduced air pollution exposures with improved all-cause and cardiopulmonary mortality . To this end, daily AQIs (which are universally driven by fine particulate matter <2.5 μm [PM 2.5 ] or ozone levels in the US) have undergone progressive updates to meet the increasingly stringent US National Ambient Air Quality Standards based on advancing scientific evidence over time .…”

Section: Introductionmentioning

confidence: 99%

Public Health Relevance of US EPA Air Quality Index Activity Recommendations

Brook,

Rajagopalan,

Al-Kindi

2024

JAMA Netw Open

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ImportanceReducing exposure to fine particulate matter (&lt;2.5 μm [PM2.5]) air pollution improves cardiopulmonary morbidity and mortality. However, the public health relevance of air quality index (AQI) activity guidelines under present-day environmental conditions in the US has not been critically assessed.ObjectiveTo evaluate the public health relevance of following PM2.5 AQI activity guidance in preventing serious atherosclerotic cardiovascular disease (ASCVD) and pulmonary events among adults in the US.Design, Setting, and ParticipantsThis cross-sectional modeling study involved the general adult population and sensitive individuals as designated by the US Environmental Protection Agency (EPA), including adults with preexisting ASCVD or lung disease (asthma or chronic obstructive pulmonary disease). The study was conducted between August 1, 2023, and January 31, 2024.ExposuresDaily AQI strata for PM2.5 and the corresponding activity recommendations.Main Outcomes and MeasuresThe main outcome was the number needed to treat (NNT) per day by following activity guidance across daily AQI strata to prevent 1 serious ASCVD or pulmonary event among relevant populations. To calculate PM2.5-induced excess disease event rates per day, estimated baseline disease-specific daily event rates for each group were multiplied by the increase in risks due to PM2.5 levels at each AQI stratum. The number of events prevented per day was calculated by multiplying each excess disease event rate by the percentage in exposure reduction plausibly incurred by following population-specific activity guidance at each AQI level. The NNT is the reciprocal of the number of events prevented.ResultsThe NNT to prevent ASCVD events was high for the general population and for patients with ASCVD across all AQI strata. The range of values was comparatively lower to prevent pulmonary events among adults with lung disease. During most days (96%) when activity recommendations were promulgated due to elevated PM2.5 (AQI, 101-200), the NNT to prevent a serious disease event remained very high for the general population (&gt;18 million), patients with ASCVD (approximately 1.6-5 million), and adults with lung disease (approximately 66 000-202 000).Conclusions and RelevanceThese findings suggest that existing PM2.5 AQI activity recommendations are of questionable public health relevance in present-day conditions and merit consideration for updating to improve their potential effectiveness.

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The contribution of improved air quality to reduced cardiovascular mortality: Declines in socioeconomic differences over time

Cited by 10 publications

References 64 publications

Debiased inference for a covariate-adjusted regression function

Debiased inference for a covariate-adjusted regression function

Particulate matter 2.5, metropolitan status, and heart failure outcomes in US counties: A nationwide ecologic analysis

Public Health Relevance of US EPA Air Quality Index Activity Recommendations

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