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. 2016 Dec;124(12):1840-1847.
doi: 10.1289/EHP199. Epub 2016 May 3.

Individual and Neighborhood Socioeconomic Status and the Association between Air Pollution and Cardiovascular Disease

Gloria C Chi  1 , Anjum Hajat, Chloe E Bird, Mark R Cullen, Beth Ann Griffin, Kristin A Miller, Regina A Shih, Marcia L Stefanick, Sverre Vedal, Eric A Whitsel, Joel D Kaufman
Affiliations

Individual and Neighborhood Socioeconomic Status and the Association between Air Pollution and Cardiovascular Disease

Gloria C Chi et al. Environ Health Perspect. 2016 Dec.

Abstract

Background: Long-term fine particulate matter (PM2.5) exposure is linked with cardiovascular disease, and disadvantaged status may increase susceptibility to air pollution-related health effects. In addition, there are concerns that this association may be partially explained by confounding by socioeconomic status (SES).

Objectives: We examined the roles that individual- and neighborhood-level SES (NSES) play in the association between PM2.5 exposure and cardiovascular disease.

Methods: The study population comprised 51,754 postmenopausal women from the Women's Health Initiative Observational Study. PM2.5 concentrations were predicted at participant residences using fine-scale regionalized universal kriging models. We assessed individual-level SES and NSES (Census-tract level) across several SES domains including education, occupation, and income/wealth, as well as through an NSES score, which captures several important dimensions of SES. Cox proportional-hazards regression adjusted for SES factors and other covariates to determine the risk of a first cardiovascular event.

Results: A 5 μg/m3 higher exposure to PM2.5 was associated with a 13% increased risk of cardiovascular event [hazard ratio (HR) 1.13; 95% confidence interval (CI): 1.02, 1.26]. Adjustment for SES factors did not meaningfully affect the risk estimate. Higher risk estimates were observed among participants living in low-SES neighborhoods. The most and least disadvantaged quartiles of the NSES score had HRs of 1.39 (95% CI: 1.21, 1.61) and 0.90 (95% CI: 0.72, 1.07), respectively.

Conclusions: Women with lower NSES may be more susceptible to air pollution-related health effects. The association between air pollution and cardiovascular disease was not explained by confounding from individual-level SES or NSES. Citation: Chi GC, Hajat A, Bird CE, Cullen MR, Griffin BA, Miller KA, Shih RA, Stefanick ML, Vedal S, Whitsel EA, Kaufman JD. 2016. Individual and neighborhood socioeconomic status and the association between air pollution and cardiovascular disease. Environ Health Perspect 124:1840-1847; http://dx.doi.org/10.1289/EHP199.

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Conflict of interest statement

The contents of this publication are solely the responsibility of the grantee and do not necessarily represent the official views of the U.S. EPA or the NIH. Further, the U.S. EPA does not endorse the purchase of any commercial products or services mentioned in the publication. The authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Estimated hazard ratios and 95% confidence intervals for time to first cardiovascular event associated with 5 μg/m3 higher exposure to PM2.5 according to levels of individual socioeconomic status (SES) and p-values for interactions. Models adjusted for age, race/ethnicity, smoking, body mass index, diabetes, hypertension, hypercholesterolemia, and all individual-level SES and neighborhood-level SES indicators except for the neighborhood SES score.
Figure 2
Figure 2
Estimated hazard ratios and 95% confidence intervals for time to first cardiovascular event associated with 5 μg/m3 higher exposure to PM2.5 according to levels of neighborhood socioeconomic status (NSES) and p-values for interactions. Models adjusted for age, race/ethnicity, smoking, body mass index, diabetes, hypertension, hypercholesterolemia, and all individual-level socioeconomic status and NSES indicators except for the NSES score. All NSES variables were grouped into quartiles, ranging from lowest NSES (most deprived) to highest NSES (least deprived). The NSES score model adjusted for individual-level SES indicators but no other NSES indicators.
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Comment in

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