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Air Pollution and Mortality in the Medicare Population
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BACKGROUNDStudies have shown that long-term exposure to air pollution increases mortality.However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards.Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups. METHODSWe constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up.Annual averages of fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM 2.5 ]) and ozone were estimated according to the ZIP Code of residence for each enrollee with the use of previously validated prediction models.We estimated the risk of death associated with exposure to increases of 10 μg per cubic meter for PM 2.5 and 10 parts per billion (ppb) for ozone using a two-pollutant Cox proportionalhazards model that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates. RESULTSIncreases of 10 μg per cubic meter in PM 2.5 and of 10 ppb in ozone were associated with increases in all-cause mortality of 7.3% (95% confidence interval [CI], 7.1 to 7.5) and 1.1% (95% CI, 1.0 to 1.2), respectively.When the analysis was restricted to person-years with exposure to PM 2.5 of less than 12 μg per cubic meter and ozone of less than 50 ppb, the same increases in PM 2.5 and ozone were associated with increases in the risk of death of 13.6% (95% CI, 13.1 to 14.1) and 1.0% (95% CI, 0.9 to 1.1), respectively.For PM 2.5 , the risk of death among men, blacks, and people with Medicaid eligibility was higher than that in the rest of the population. CONCLUSIONSIn the entire Medicare population, there was significant evidence of adverse effects related to exposure to PM 2.5 and ozone at concentrations below current national standards.This effect was most pronounced among self-identified racial minorities and people with low income.(Supported by the Health Effects Institute and others.)a bs tr ac t Air Pollution and Mortality in the Medicare Population
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“Other estimates of relative risk are even smaller; e.g., 1.02 (95% CI 1.01–1.04) [74] and 1.01 (95% CI 0.9–1.1) [75].”
From Environmental consequences of interacting effects of changes in stratospheric ozone, ultraviolet radiation, and climate: UNEP Environmental Effects Assessment Panel, Update 2024 (2025) · cites this paper as [75]
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“Di et al. (76) analyzed the entire US Medicare population of 60 million older adults from the years 2000 through 2012 and found a positive association between annual averages of ozone and all-cause mortality rate.”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [76]
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Metadata
- Authors
- Di, Q., Wang, Y., Zanobetti, A., Wang, Y., Koutrakis, P., Choirat, C., Dominici, F., & Schwartz, J. D.
- Affiliations
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-06-29
- Volume
- 376
- Issue
- 26
- Pages
- 2513-2522
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5766848
- OpenAlex
- W2725857760
- Cited by
- 1,510
- References
- 32
- Citations by year
- 2026: 117 · 2025: 141 · 2024: 147 · 2023: 171 · 2022: 189 · 2021: 196 · 2020: 216 · 2019: 182 · 2018: 124 · 2017: 25
- FWCI
- 80.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Harvard University
- Institute for Quantitative Social Science, Harvard University
- National Cancer Institute (P01CA134294, R35CA197449)
- National Institute of Environmental Health Sciences (R21ES024012, R01ES024332, P30ES000002, R01ES026217, R21ES022585, R01ES012054)
- 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
- air pollution, PM2.5, ozone, all-cause mortality, Medicare beneficiaries, low-income populations, racial minorities, Medicaid eligibility, health disparities, cohort studies, dose-response relationship, sex differences in mortality, air pollution health effects, United States, California, New York State, New Jersey
- MeSH terms
- Aged, Air Pollutants, Air Pollution, Environmental Exposure, Female, Medicare, Humans, Male, Mortality, Ozone, Risk Factors, Sex Factors, United States, Cohort Studies, Proportional Hazards Models, Racial Groups, Particulate Matter, Mortality, Premature
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