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Association of Short-term Exposure to Air Pollution With Mortality in Older Adults
Open accessAbstract
Importance: The US Environmental Protection Agency is required to reexamine its National Ambient Air Quality Standards (NAAQS) every 5 years, but evidence of mortality risk is lacking at air pollution levels below the current daily NAAQS in unmonitored areas and for sensitive subgroups. Objective: To estimate the association between short-term exposures to ambient fine particulate matter (PM2.5) and ozone, and at levels below the current daily NAAQS, and mortality in the continental United States. Design, Setting, and Participants: Case-crossover design and conditional logistic regression to estimate the association between short-term exposures to PM2.5 and ozone (mean of daily exposure on the same day of death and 1 day prior) and mortality in 2-pollutant models. The study included the entire Medicare population from January 1, 2000, to December 31, 2012, residing in 39 182 zip codes. Exposures: Daily PM2.5 and ozone levels in a 1-km × 1-km grid were estimated using published and validated air pollution prediction models based on land use, chemical transport modeling, and satellite remote sensing data. From these gridded exposures, daily exposures were calculated for every zip code in the United States. Warm-season ozone was defined as ozone levels for the months April to September of each year. Main Outcomes and Measures: All-cause mortality in the entire Medicare population from 2000 to 2012. Results: During the study period, there were 22 433 862 million case days and 76 143 209 control days. Of all case and control days, 93.6% had PM2.5 levels below 25 μg/m3, during which 95.2% of deaths occurred (21 353 817 of 22 433 862), and 91.1% of days had ozone levels below 60 parts per billion, during which 93.4% of deaths occurred (20 955 387 of 22 433 862). The baseline daily mortality rates were 137.33 and 129.44 (per 1 million persons at risk per day) for the entire year and for the warm season, respectively. Each short-term increase of 10 μg/m3 in PM2.5 (adjusted by ozone) and 10 parts per billion (10-9) in warm-season ozone (adjusted by PM2.5) were statistically significantly associated with a relative increase of 1.05% (95% CI, 0.95%-1.15%) and 0.51% (95% CI, 0.41%-0.61%) in daily mortality rate, respectively. Absolute risk differences in daily mortality rate were 1.42 (95% CI, 1.29-1.56) and 0.66 (95% CI, 0.53-0.78) per 1 million persons at risk per day. There was no evidence of a threshold in the exposure-response relationship. Conclusions and Relevance: In the US Medicare population from 2000 to 2012, short-term exposures to PM2.5 and warm-season ozone were significantly associated with increased risk of mortality. This risk occurred at levels below current national air quality standards, suggesting that these standards may need to be reevaluated.
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TL;DR
In a case-crossover analysis of the entire US Medicare population from 2000–2012, short-term PM2.5 and warm-season ozone exposures were significantly associated with increased all-cause mortality, including at concentrations below current daily NAAQS. The authors conclude that current air quality standards may need reevaluation.
Key findings
- Among 22,433,862 case days and 76,143,209 control days across 39,182 zip codes, each 10 μg/m3 increase in lag 01-day PM2.5 (adjusted for ozone) was associated with a 1.05% (95% CI: 0.95%, 1.15%) increase in daily mortality rate; ARD was 1.42 (95% CI: 1.29, 1.56) per 1 million persons at risk per day.
- Each 10 ppb increase in warm-season ozone (adjusted for PM2.5) was associated with a 0.51% (95% CI: 0.41%, 0.61%) increase in daily mortality rate; ARD was 0.66 (95% CI: 0.53, 0.78) per 1 million persons at risk per day.
- Associations remained significant below current daily standards: for PM2.5 <25 μg/m3, RR was 1.61% (95% CI: 1.48%, 1.74%) and ARD 2.17 (95% CI: 2.00, 2.34); for ozone <60 ppb, RR was 0.58% (95% CI: 0.46%, 0.70%) and ARD 0.74 (95% CI: 0.59, 0.90).
- Higher PM2.5-associated mortality was observed in Medicaid-eligible individuals, those above 70 years, and females; exposure-response curves were almost linear with no evidence of a threshold.
Methods
- Case-crossover design with conditional logistic regression, comparing each person’s date of death (case day) with matched control days on the same day of week, in the same month, and before/after the case day.
- Included all Medicare deaths in the continental US from January 1, 2000 to December 31, 2012, residing in 39,182 zip codes; exposures were daily PM2.5 and ozone estimated on a 1 km × 1 km grid using validated prediction models.
- Two-pollutant models estimated PM2.5 (adjusted for ozone) and warm-season ozone (adjusted for PM2.5) associations using lag 01-day exposure, with natural splines for air and dew point temperature; subgroup and low-exposure analyses were also conducted.
Limitations
- Stated: the case-crossover design cannot estimate mortality risk from long-term exposure; exposure was assigned by residential zip code rather than exact home address or place of death, likely causing measurement error; the Medicare population is primarily older than 65, limiting generalizability to younger populations; Medicare files lack cause-specific mortality; and the most recent data were nearly 5 years old at publication.
- Evident from the text: this is an observational study, so the reported associations should not be interpreted as proving causality.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These associations remained significant when examining days below 25 μg/m3 for PM2.5 and below 60 ppb for ozone, with larger effect size estimates for both PM2.5 and ozone (RR: 1.61% [95% CI: 1.48%, 1.74%] and 0.58% [95% CI: 0.46%, 0.70%]; ARD: 2.17 [95% CI: 2.00, 2.34] and 0.74 [95% CI: 0.59, 0.90] per 1M per day)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“and females (RR: 1.20% [95% CI: 1.07%, 1.33%]; ARD: 1.56 [95% CI: 1.39, 1.72] per 1M per day, interaction: p=0.019)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“Absolute risk differences in daily mortality rate were 1.42 (95% CI: 1.29, 1.56) and 0.66 (95% CI: 0.53, 0.78) per 1 million persons at risk per day.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Abstract > Results
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In the paper
“These associations remained significant when examining days below 25 μg/m3 for PM2.5 and below 60 ppb for ozone, with larger effect size estimates for both PM2.5 and ozone (RR: 1.61% [95% CI: 1.48%, 1.74%] and 0.58% [95% CI: 0.46%, 0.70%]; ARD: 2.17 [95% CI: 2.00, 2.34] and 0.74 [95% CI: 0.59, 0.90] per 1M per day)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“No significant differences were found in the short-term associations between air pollution exposure (PM2.5 and ozone) and mortality across areas with different population density levels (Figure 2).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These associations remained significant when examining days below 25 μg/m3 for PM2.5 and below 60 ppb for ozone, with larger effect size estimates for both PM2.5 and ozone (RR: 1.61% [95% CI: 1.48%, 1.74%] and 0.58% [95% CI: 0.46%, 0.70%]; ARD: 2.17 [95% CI: 2.00, 2.34] and 0.74 [95% CI: 0.59, 0.90] per 1M per day)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“There were no significant differences in the mortality risk associated with air pollution among individuals living in urban versus rural areas.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
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In the paper
“The slope was steeper at PM2.5 levels below 25 μg/m3 (p<0.001), consistent with the low-exposure analysis (Table 2).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“The effect estimates for PM2.5 increased with age.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These associations remained significant when examining days below 25 μg/m3 for PM2.5 and below 60 ppb for ozone, with larger effect size estimates for both PM2.5 and ozone (RR: 1.61% [95% CI: 1.48%, 1.74%] and 0.58% [95% CI: 0.46%, 0.70%]; ARD: 2.17 [95% CI: 2.00, 2.34] and 0.74 [95% CI: 0.59, 0.90] per 1M per day)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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- Probably not a substantial claim. 21
- It may state two separate claims as one. 14
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The baseline daily mortality rate was 137.33 and 129.44 (per 1 million persons at risk per day) for the entire year and for the warm season, respectively.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Abstract > Results
Strength:plain· not yet calibratedn = 22,433,862Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Each 10 μg/m3 and 10 ppb increase in the lag 01 day exposure for PM2.5 and warm-season ozone was associated with an increase of 1.05% (95% confidence interval [CI]: 0.95%, 1.15%) and 0.51% (0.41%, 0.61%) in the daily mortality rate.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“Of all case and control days, 93.6% had PM2.5 levels below 25 μg/m3, during which 95% of deaths occurred (21,353,817 of 22,433,862)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Abstract > Results
Strength:plain· not yet calibratedn = 22,433,862Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During the study period, there were 22,433,862 million case days and 76,143,209 control days.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Abstract > Results
Strength:plain· not yet calibratedn = 22,433,862Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“91.1% of days had ozone levels below 60 ppb, during which 93.4% of deaths occurred (20,955,387 of 22,433,862)”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Abstract > Results
Strength:plain· not yet calibratedn = 22,433,862Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“Both PM2.5 and ozone exposure-responses were almost linear, with no indication of a mortality risk threshold at very low concentrations.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Since we estimated air pollution levels everywhere in the continental US, the number of zip codes included in this study was 39,182, resulting in a 33% increase compared to the number of zip codes with a centroid <50 km from a monitor (N = 26,115).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Methods > Environmental data
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In the paper
“The mean time between case and control days was 12.55 days (range 7-28 days), with minimal differences in air and dew point temperatures between case and control days (0.003°C and 0.01°C, respectively).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
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In the paper
“During the study period, the mean concentrations of PM2.5 and ozone were 11.6 μg/m3 and 37.8 ppb, respectively.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“The present study found a similarly linear exposure-response relationship below 15 μg/m3 PM2.5 and a less steep slope above this level.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
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In the paper
“The study included the entire Medicare population from January 1, 2000 to December 31, 2012 residing in 39,182 zip codes.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Abstract > Design, Setting, and Participants
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In the paper
“Cross-validation indicated good agreement between predicted values and monitoring values (R2 = 0.84 for PM2.5, R2 = 0.76 for ozone) and at low concentrations (R2 = 0.85 when constraining to 24-hour PM2.5 <25 μg/m3; R2 = 0.75 when constraining to daily 8-hour maximum ozone <60 ppb).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Methods > Environmental data
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In the paper
“Fifth, this study used a case-crossover design that individually matched potential confounding factors by month, year, and other time-invariant variables and controlled for time-varying patterns, as demonstrated by the minimal differences in meteorological variables between case and control days.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Individual-level and zip code-level covariates that do not vary day-to-day, such as age, sex, race, socioeconomic status, smoking, and other behavioral risk factors, are not confounders in the case-crossover comparison because they remain constant between case and control days.
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In the paper
“Splines on meteorological variables with 6 and 9 degrees of freedom yielded results with a difference of less than 5% of the standard error (Figure S1).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Methods > Statistical analysis
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In the paper
“Control days were chosen (1) on the same day of week as the case day to control for potential confounding effect by day of week; (2) before and after the case day (bidirectional sampling) to control for time trend;9,10 and (3) only in the same month as the case day to control for seasonal and sub-seasonal patterns.9,11”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Methods > Study design
What the sources say
- Not checked yetcites [9] Bateson TF Schwartz J Control for seasonal variation and time trend in case-crossover studies of acute effects of environmental exposures Epidemiology 1999 10 5 539 544 10468428
- Not checked yetcites [10] Maclure M Mittleman MA Should we use a case-crossover design? Annu Rev Public Health 2000 21 193 221 10884952
- Not checked yetcites [11] Levy D Lumley T Sheppard L Kaufman J Checkoway H Referent selection in case-crossover analyses of acute health effects of air pollution Epidemiology 2001 12 2 186 192 11246579
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In the paper
“The main analysis, which used the lag 01 day exposure, yielded the lowest values of the Akaike Information Criteria values, indicating better fit to the data (Table S1).”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Methods > Statistical analysis
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In the paper
“The regression model included both pollutants as main effects, and natural splines of air and dew point temperatures with 3 degrees of freedom to control for potential residual confounding by weather.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Methods > Statistical analysis
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In the paper
“Third, the Medicare population primarily consists of individuals older than 65 years, which limits the generalizability of findings to younger populations.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
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In the paper
“Fourth, Medicare files do not report cause-specific mortality.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
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In the paper
“Third, the inclusion of more than 22 million deaths from 2000 to 2012 from the entire Medicare population provided large statistical power to detect differences in mortality rates in potentially vulnerable populations and to estimate mortality rates at very low PM2.5 and ozone concentrations.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
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None of the sources cited for this claim have been checked yet.
In the paper
“Similarly, a review of toxicological studies and a recent panel study found that ozone exposure was associated with multiple adverse health outcomes.37,38”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [37] Watkinson WP Campen MJ Nolan JP Costa DL Cardiovascular and systemic responses to inhaled pollutants in rodents: effects of ozone and particulate matter Environ Health Perspect 2001 109 Suppl 4 Suppl 4 539 546 PMC1240578 11544160
- Not checked yetcites [38] Chuang KJ Chan CC Su TC Lee CT Tang CS The effect of urban air pollution on inflammation, oxidative stress, coagulation, and autonomic dysfunction in young adults Am J Respir Crit Care Med 2007 176 4 370 376 17463411
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Previous studies have found similar results in some subgroups.19,20”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [19] Zanobetti A Schwartz J Is there adaptation in the ozone mortality relationship: a multi-city case-crossover analysis Environ Health 2008 7 22 18513427 PMC2429903
- Not checked yetcites [20] Baccini M Mattei A Mealli F Bertazzi PA Carugno M Assessing the short term impact of air pollution on mortality: a matching approach Environ Health 2017 16 1 7 28187788 PMC5303266
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“First, to the best of our knowledge, this is the largest analysis of daily air pollution exposure and mortality to date, with approximately 4 times the number of deaths included in a previous large study.4”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [4] Zanobetti A Schwartz J The effect of fine and coarse particulate air pollution on mortality: a national analysis Environmental health perspectives 2009 117 6 898 903 19590680 PMC2702403
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In the paper
“One study combined exposure-response curves from 22 European cities and reported an almost linear relationship between PM2.5 and mortality.21”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [21] Samoli E Analitis A Touloumi G Estimating the exposure-response relationships between particulate matter and mortality within the APHEA multicity project Environ Health Perspect 2005 113 1 88 95 15626653 PMC1253715
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, because more than two-thirds of deaths in the US occur in people older than 65 years of age, and air pollution-related health risk rises with age, the Medicare population in this study includes most cases of air pollution-induced mortality.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
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In the paper
“An almost linear exposure-response curve for ozone was previously reported with no threshold or a threshold at very low concentrations.23”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [23] Bell ML Peng RD Dominici F The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations Environmental health perspectives 2006 114 4 532 536 16581541 PMC1440776
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To estimate the health risk of short-term exposure to air pollution for specific subgroups (e.g., underrepresented minorities and those with low socioeconomic status, such as persons eligible for Medicaid), a large population is necessary to achieve maximum accuracy and adequate statistical power.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Introduction
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In the paper
“A study from the Netherlands also concluded that if an ozone threshold exists, it does so at very low levels.24”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [24] Hoek G Schwartz JD Groot B Eilers P Effects of ambient particulate matter and ozone on daily mortality in Rotterdam, The Netherlands Archives of environmental health 1997 52 6 455 463 9541366
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Long-term risks in the same study population have been estimated elsewhere.39”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [39] Di Q Wang Y Zanobetti A Air pollution and mortality in the Medicare population N Engl J Med 2017 376 26 2513 2522 28657878 PMC5766848
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Another multi-city study reported a linear relationship down to 2 μg/m3 PM2.5.22”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
What the sources say
- Not checked yetcites [22] Schwartz J Laden F Zanobetti A The concentration-response relation between PM(2.5) and daily deaths Environmental health perspectives 2002 110 10 1025 1029 PMC1241029 12361928
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, because this study used residential zip code to ascertain exposure level rather than exact home address or place of death, some measurement error is expected.”
§ Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The authors state this as an assumption.
Individual-level and zip code-level covariates that do not vary day-to-day, such as age, sex, race, socioeconomic status, smoking, and other behavioral risk factors, are not confounders in the case-crossover comparison because they remain constant between case and control days.
“Individual-level covariates and zip code-level covariates that did not vary day-to-day (e.g., age, sex, race, socioeconomic status, smoking, and other behavioral risk factors) were not considered to be confounders as they remain constant when comparing case days vs control days.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“In addressing exposure to low-level concentrations (such as concentrations below the current air quality standard), however, 24-h average may be another relevant measure of daily exposure, at least for certain outcomes (21–24).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [22]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Case-day count is incorrectly stated in millions
MinorThe abstract says there were 22,433,862 million case days, but elsewhere gives the total number of deaths as 22,433,862. The word "million" makes the first count a million times larger.
“there were 22,433,862 million case days and 76,143,209 control days.”
“95% of deaths occurred (21,353,817 out of 22,433,862)”
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Metadata
- Authors
- Di, Q., Dai, L., Wang, Y., Zanobetti, A., Choirat, C., Schwartz, J. D., & Dominici, F.
- Affiliations
- Harvard University (US)
- Corresponding author
- Schwartz, Joel D.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2017-12-26
- Volume
- 318
- Issue
- 24
- Pages
- 2446
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5783186
- OpenAlex
- W2779159526
- Cited by
- 698
- References
- 43
- Citations by year
- 2026: 42 · 2025: 83 · 2024: 91 · 2023: 80 · 2022: 86 · 2021: 94 · 2020: 99 · 2019: 74 · 2018: 46 · 2017: 2
- FWCI
- 32.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (R35CA197449)
- National Institute of Environmental Health Sciences (R21ES024012, R01ES024332, P30ES000002, R01ES026217)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Social Sciences › Sociology and Political Science › Environmental Justice and Health Disparities
- Keywords
- short-term air pollution exposure, PM2.5, ozone, all-cause mortality, older adults, Medicare beneficiaries, National Ambient Air Quality Standards, air pollution health effects, United States, New York State, New Jersey
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Air Pollutants, Air Pollution, Environmental Exposure, Female, Medicare, Humans, Male, Mortality, Ozone, Risk, Seasons, United States, Logistic Models, Cross-Over Studies, Particulate Matter
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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