Associations between Long-Term PM2.5 Exposure and Cardiovascular Outcomes Are Modified by Neighborhood Socioeconomic Effects in an Urban Area of North Carolina

摘要

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 >23 (CAD) at the time of the index visit as determined by 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 lxl 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.