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Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Epidemiology 2016 ; 27 (2): 221-7 Nephropedia Template TP
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PM2 5 and mortality in 207 US cities: Modification by temperature and city characteristics #MMPMID26600257
Kioumourtzoglou MA; Schwartz J; James P; Dominici F; Zanobetti A
Epidemiology 2016[Mar]; 27 (2): 221-7 PMID26600257show ga
Background: The reported estimated effects between long-term PM2.5 exposures and mortality vary spatially. We assessed whether community-level variables, including socioeconomic status (SES) indicators and temperature, modify this association. Methods: We used data from >35 million Medicare enrollees from 207 U.S. cities (2000?2010). For each city, we calculated annual PM2.5 averages, measured at ambient central monitoring sites. We used a variation of a causal modeling approach and fitted city-specific Cox models, which we then pooled using a random effects meta-regression. In this second stage, we assessed whether temperature and city-level variables, including smoking and obesity rates, poverty, education and greenness, modify the long-term PM2.5?mortality association. Results: We found an association between long-term PM2.5 and survival (HR = 1.2; 95%CI: 1.1?1.3 per 10 µg/m3 increase in the annual PM2.5 average concentrations). We observed elevated estimates in the Southeastern, South and Northwestern U.S. (HR = 1.9; 95%CI: 1.7?2.2, 1.4; 95%CI: 1.2?1.7 and 1.4; 95%CI: 1.1?1.9 respectively). We observed a higher association between long-term PM2.5 exposure and mortality in warmer cities. Furthermore, we observed increasing estimates with increasing obesity rates, %residents and families in poverty, %black residents and %population without a high school degree, and lower effects with increasing median household income and %white residents. Conclusions: To our knowledge, this is the first study to assess modification by temperature and community-level characteristics on the long-term PM2.5?survival association. Our findings suggest that living in cities with high temperatures and low SES is associated with higher effect estimates.