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. 2023 Feb 1;6(2):e230561.
doi: 10.1001/jamanetworkopen.2023.0561.

Association of Long-term Exposure to Particulate Air Pollution With Cardiovascular Events in California

Stacey E Alexeeff  1 , Kamala Deosaransingh  1 , Stephen Van Den Eeden  1 , Joel Schwartz  2 , Noelle S Liao  1 , Stephen Sidney  1
Affiliations

Association of Long-term Exposure to Particulate Air Pollution With Cardiovascular Events in California

Stacey E Alexeeff et al. JAMA Netw Open. .

Abstract

Importance: Long-term exposure to fine particulate air pollution (PM2.5) is a known risk factor for cardiovascular events, but controversy remains as to whether the current National Ambient Air Quality Standard (12 μg/m3 for 1-year mean PM2.5) is sufficiently protective.

Objective: To evaluate the associations between long-term fine particulate air pollution and cardiovascular events using electronic health record and geocoded address data.

Design, setting, and participants: This retrospective cohort study included adults in the Kaiser Permanente Northern California integrated health care system during 2007 to 2016 and followed for up to 10 years. Study participants had no prior stroke or acute myocardial infarction (AMI), and lived in Northern California for at least 1 year. Analyses were conducted January 2020 to December 2022.

Exposure: Long-term exposure to PM2.5. Individual-level time-varying 1-year mean PM2.5 exposures for every study participant were updated monthly from baseline through the end of follow-up, accounting for address changes.

Main outcomes and measures: Incident AMI, ischemic heart disease (IHD) mortality, and cardiovascular disease (CVD) mortality. Cox proportional hazards models were fit with age as time scale, adjusted for sex, race and ethnicity, socioeconomic status, smoking, body mass index, baseline comorbidities, and baseline medication use. Associations below the current regulation limit were also examined.

Results: The study cohort included 3.7 million adults (mean [SD] age: 41.1 [17.2] years; 1 992 058 [52.5%] female, 20 205 [0.5%] American Indian or Alaskan Native, 714 043 [18.8%] Asian, 287 980 [7.6%] Black, 696 796 [18.4%] Hispanic, 174 261 [4.6%] multiracial, 1 904 793 [50.2%] White). There was a 12% (95% CI, 7%-18%) increased risk of incident AMI, a 21% (95% CI, 13%-30%) increased risk of IHD mortality, and an 8% (95% CI, 3%-13%) increased risk of CVD mortality associated with a 10 μg/m3 increase in 1-year mean PM2.5. PM2.5 exposure at moderate concentrations (10.0 to 11.9 μg/m3) was associated with increased risks of incident AMI (6% [95% CI, 3%-10%]) and IHD mortality (7% [95% CI, 2%-12%]) compared with low concentrations (less than 8 μg/m3).

Conclusions and relevance: In this study, long-term PM2.5 exposure at moderate concentrations was associated with increased risks of incident AMI, IHD mortality, and CVD mortality. This study's findings add to the evidence that the current regulatory standard is not sufficiently protective.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schwartz reported receiving grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of 1-Year Mean PM2.5 Across the 35-County Study Region in Northern California for 2007
Figure 2.
Figure 2.. Relative Risk of Incident Acute Myocardial Infarction (AMI), Ischemic Heart Disease (IHD) Mortality, and Cardiovascular Disease (CVD) Mortality Associated With 1-Year Mean Particulate Air Pollution Exposure, Overall And by Neighborhood Education Level, Among 3.7 Million Participants in the Particulate Air Pollution, Cardiovascular Events, and Susceptibility Factors Cohort
Adjusted for age, sex, race and ethnicity, socioeconomic status, smoking, body mass index, baseline comorbidities, baseline medication use. P values are for interaction with neighborhood education. SES indicates socioeconomic status, which was measured by neighborhood education.
Figure 3.
Figure 3.. Relative Risk of Cardiovascular Disease (CVD) Mortality, Ischemic Heart Disease (IHD) Mortality, and Incident Acute Myocardial Infarction (AMI) Associated With 1-Year Mean PM2.5 Exposure, in Categories Above and Below the Regulation Limit, Among 3.7 Million Participants in the Particulate Air Pollution, Cardiovascular Events, and Susceptibility Factors Cohort
PM2.5 indicates particulate air pollution less than 2.5 microns in diameter.
See this image and copyright information in PMC

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