Cited by 1,510Air Quality and Health ImpactsIndoor Air Quality and Microbial ExposureEnvironmental Justice and Health Disparities

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Air Pollution and Mortality in the Medicare Population

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Di, Qian, Wang, Yan, Zanobetti, Antonella, Wang, Yun, Koutrakis, Petros, Choirat, Christine, Dominici, Francesca, Schwartz, Joel D.·2017·New England Journal of Medicine

DOI 10.1056/nejmoa1702747PMC PMC5766848

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Abstract

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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Spatiotemporal trends in life expectancy and impacts of economic growth and air pollution in 134 countries: A Bayesian modeling study
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Long-term exposure to fine particle matter and all-cause mortality and cause-specific mortality in Japan: the JPHC Study
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High temporal and spatial resolution PM2.5 dataset acquisition and pollution assessment based on FY-4A TOAR data and deep forest model in China
Song, Z., Chen, B., Zhang, P., Guan, X., Wang, X., Ge, J., Hu, X., Zhang, X., & Wang, Y. (2022) · Atmospheric Research · doi:10.1016/j.atmosres.2022.106199 · Cited by 26
Recommendations on the measurement techniques of atmospheric pollutants from in situ and satellite observations: a review
Rahman, M. M. (2023) · Arabian Journal of Geosciences · doi:10.1007/s12517-023-11410-4 · Cited by 25
Effect of Ambient Fine Particulate Matter Air Pollution and Colder Outdoor Temperatures on High-Density Lipoprotein Function
Mathew, A. V., Yu, J. E., Guo, Y., Byun, J., Chen, Y. E., Wang, L., Liu, M., Bard, R. L., Morishita, M., Huang, W. Y., et al. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.04.061 · Cited by 25
Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke
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Leukocyte Traits and Exposure to Ambient Particulate Matter Air Pollution in the Women’s Health Initiative and Atherosclerosis Risk in Communities Study
Gondalia, R., Holliday, K. M., Baldassari, A., Justice, A. E., Stewart, J. D., Liao, D., Yanosky, J. D., Engel, S. M., Jordahl, K. M., Bhatti, P., et al. (2020) · Environmental Health Perspectives · doi:10.1289/ehp5360 · Cited by 26
Air Pollution and Mortality in the Medicare Population
Majeed, H., & Majeed, H. (2017) · New England Journal of Medicine · doi:10.1056/nejmc1709849 · Cited by 29
Combining Community Engagement and Scientific Approaches in Next-Generation Monitor Siting: The Case of the Imperial County Community Air Network
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“In particular, exposure to particulate matter (PM) has been found to be associated with an increased risk of mortality and excess hospitalization even at levels below regulatory limits [2,3].”
Background
Spatio-Temporal Differences in Health Effect of Ambient PM2.5Pollution on Acute Respiratory Infection Between Children and Adults
Xia, X., & Yao, L. (2019) · IEEE Access · doi:10.1109/access.2019.2900539 · Cited by 25
“5, even at concentrations which are not much greater than normal background concentration, leads to increased risk of mortality [30], [31].”
Background
Long-term exposure to ambient fine particulate matter and fasting blood glucose level in a Chinese elderly cohort
Zhang, Y., Li, T., Ma, R., Yin, Z., Wang, J., He, M. Z., Xu, D., Gao, X., Wang, Q., Kraus, V. B., et al. (2020) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2020.137191 · Cited by 24
“We used the following formula(Di et al., 2017) to determine whether the risk estimates of PM2.”
Method
Covid-19 Crisis and Environmental Law: Opportunities and Challenges
Norouzi, N., & Ataei, E. (2021) · Hasanuddin Law Review · doi:10.20956/halrev.v7i1.2772 · Cited by 24
The spatiotemporal trends of PM2.5- and O3-related disease burden coincident with the reduction in air pollution in China between 2005 and 2017
Wang, Q., Zhu, H., Xu, H., Lu, K., Ban, J., Ma, R., & Li, T. (2021) · Resources Conservation and Recycling · doi:10.1016/j.resconrec.2021.105918 · Cited by 24
Air Quality Index and Emergency Department Visits and Hospitalizations for Childhood Asthma
Rosser, F. J., Han, Y., Rothenberger, S. D., Forno, E., Mair, C., & Celedón, J. C. (2022) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202105-539oc · Cited by 25
Short-term PM2.5 exposure and early-readmission risk: a retrospective cohort study in North Carolina heart failure patients
Wyatt, L. H., Weaver, A. M., Moyer, J., Schwartz, J. D., Di, Q., Díaz-Sánchez, D., Cascio, W. E., & Ward-Caviness, C. K. (2022) · American Heart Journal · doi:10.1016/j.ahj.2022.02.015 · Cited by 25
Impact of airborne total suspended particles (TSP) and fine particulate matter (PM2.5)‐induced developmental toxicity in zebrafish ( Danio rerio ) embryos
Jia, Z., Zhu, C., Rajendran, R. S., Xia, Q., Liu, K., & Zhang, Y. L. (2022) · Journal of Applied Toxicology · doi:10.1002/jat.4325 · Cited by 24
“5 caused cardiopulmonary mortality by 6–13% and overall mortality by 7.3% (Di et al., 2017).”
BackgroundInfluential
Association Between Long-term Ambient PM2.5 Exposure and Cardiovascular Outcomes Among US Hemodialysis Patients
Xi, Y., Richardson, D. B., Kshirsagar, A. V., Wade, T. J., Flythe, J. E., Whitsel, E. A., & Rappold, A. G. (2022) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2022.04.008 · Cited by 24
“12,39 Last, the use of discrete time hazards models allowed for controlling for individual-level time invariant factors together with time-varying factors to better estimate the health risk associated with fluctuation in ambient PM 2.5 .”
Influential
Effects of long-term average temperature on cardiovascular disease hospitalizations in an American elderly population
Klompmaker, J. O., Laden, F., James, P., Sabath, M. B., Wu, X., Schwartz, J. D., Dominici, F., Zanobetti, A., & Hart, J. E. (2022) · Environmental Research · doi:10.1016/j.envres.2022.114684 · Cited by 24
“We temporally interpolated data for years with missing information using a moving average algorithm within each zip code, as described previously (Di et al., 2017).”
Method
Using Parametric g-Computation to Estimate the Effect of Long-Term Exposure to Air Pollution on Mortality Risk and Simulate the Benefits of Hypothetical Policies: The Canadian Community Health Survey Cohort (2005 to 2015)
Chen, C., Chen, H., van Donkelaar, A., Burnett, R. T., Martin, R. V., Chen, L., Tjepkema, M., Kirby-McGregor, M., Li, Y., Kaufman, J. S., et al. (2023) · Environmental Health Perspectives · doi:10.1289/ehp11095 · Cited by 25
“…we used long-term PM 2 : 5 concentrations in the original scale in all models as a sensitivity analysis, which assumed the same log-linear PM 2 : 5 – mortality association used in other cohorts 4,7 instead of the supralinear one supported by previous studies of di ﬀ erent cycles of the CCHS cohort.”
Air Pollution and Cardiac Diseases: A Review of Experimental Studies
Palacio, L. C., Pachajoa, D. C., Londoño, C. A. E., Sáiz, J., & Tobón, C. (2023) · Dose-Response · doi:10.1177/15593258231212793 · Cited by 26
“19 PM is considered one of the most severe air pollutants, generating a public health problem related to decreased life expectancy, 20,21 especially in people with heart and lung diseases.”
Background
Association between multi-pollutant mixtures pollution and daily cardiovascular mortality: An exploration of exposure-response relationship
Tong, Y., Luo, K., Li, R., Pei, L., Li, A., Yang, M., & Xu, Q. (2018) · Atmospheric Environment · doi:10.1016/j.atmosenv.2018.05.034 · Cited by 24
Acrolein‐induced atherogenesis by stimulation of hepatic flavin containing monooxygenase 3 and a protection from hydroxytyrosol
Wu, X., Li, C., Mariyam, Z., Jiang, P., Zhou, M., Zeb, F., Haq, I. U., Chen, A., & Feng, Q. (2018) · Journal of Cellular Physiology · doi:10.1002/jcp.26600 · Cited by 24
“2019;234:475–485. wileyonlinelibrary.com/journal/jcp © 2018 Wiley Periodicals, Inc. Air pollution is getting more and more public attention because it is related with various diseases, such as atherosclerosis (Di et al., 2017).”
Background
Hidden danger: The long-term effect of ultrafine particles on mortality and its sociodemographic disparities in New York State
Qi, Q., Yu, F., Nair, A. A., Lau, S. S. S., Luo, G., Mithu, M. I. H., Zhang, W., Li, S., & Lin, S. (2024) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2024.134317 · Cited by 23
“[66] A large previous studies have also reported a significant association between long-term PM 2.5 exposure and increased mortality in older adults [7,56,67,68].”
Influential
Association between long-term exposure to low ambient PM2.5 and cardiovascular hospital admissions: A UK Biobank study
Vanoli, J., Quint, J. K., Rajagopalan, S., Stafoggia, M., Al-Kindi, S. G., Mistry, M., Masselot, P., Libardi, A. D. L. C., Ng, C. F. S., Madaniyazi, L., et al. (2024) · Environment International · doi:10.1016/j.envint.2024.109011 · Cited by 23
Aerosol Optical Properties and Climate Implications of Emissions from Traditional and Improved Cookstoves
Saliba, G., Subramanian, R., Bilsback, K. R., L’Orange, C., Volckens, J., Johnson, M. A., & Robinson, A. L. (2018) · Environmental Science & Technology · doi:10.1021/acs.est.8b05434 · Cited by 23
Comparisons of simple and complex methods for quantifying exposure to individual point source air pollution emissions
Henneman, L., Dedoussi, I. C., Casey, J. A., Choirat, C., Barrett, S. R. H., & Zigler, C. M. (2020) · Journal of Exposure Science & Environmental Epidemiology · doi:10.1038/s41370-020-0219-1 · Cited by 23
Seasonal and Long-Term Trend of on-Road Gasoline and Diesel Vehicle Emission Factors Measured in Traffic Tunnels
Li, X., Dallmann, T. R., May, A. A., & Presto, A. A. (2020) · Applied Sciences · doi:10.3390/app10072458 · Cited by 23
Roles of artificial intelligence in wellness, healthy living, and healthy status sensing
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Long-term exposure to moderate fine particulate matter concentrations and cause-specific mortality in an ageing society
Lim, Y.-H., Oh, J., Han, C., Bae, H.-J., Kim, S., Jang, Y., Ha, E., & Hong, Y. (2020) · International Journal of Epidemiology · doi:10.1093/ije/dyaa146 · Cited by 23
Assessment of Nitrogen Oxide Emissions and San Joaquin Valley PM2.5 Impacts From Soils in California
Guo, L., Chen, J., Luo, D., Liu, S., Lee, H. J., Motallebi, N., Fong, A., Deng, J. J., Rasool, Q. Z., Avise, J. C., et al. (2020) · Journal of Geophysical Research Atmospheres · doi:10.1029/2020jd033304 · Cited by 23
“…(NOx), including nitric oxide (NO) and nitrogen dioxide (NO2), are precursors of particulate matter and ozone, both of which are important air pollutants that pose an adverse impact on human health as well as ecological functionality (Battye et al., 2017; Caplin et al., 2019; Di et al., 2017).”
Background
Air pollution and behavioral biases: Evidence from stock market anomalies
Nguyen, H. T., & Pham, M. H. (2020) · Journal of Behavioral and Experimental Finance · doi:10.1016/j.jbef.2020.100441 · Cited by 24
Respiratory function declines in children with asthma associated with chemical species of fine particulate matter (PM2.5) in Nagasaki, Japan
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Effects of air pollution and habitual exercise on the risk of death: a longitudinal cohort study
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Estimating a Causal Exposure Response Function with a Continuous Error-Prone Exposure: A Study of Fine Particulate Matter and All-Cause Mortality
Josey, K., deSouza, P. N., Wu, X., Braun, D., & Nethery, R. C. (2022) · Journal of Agricultural Biological and Environmental Statistics · doi:10.1007/s13253-022-00508-z · Cited by 23
“These exposure predictions have been widely used in epidemiological studies (Di et al. 2017; Rhee et al. 2019; Wu et al. 2019; Yazdi et al. 2019; Wu et al. 2020; Danesh Yazdi et al. 2021).”
BackgroundInfluential
Counterfactual time series analysis of short-term change in air pollution following the COVID-19 state of emergency in the United States
Dey, T., Tyagi, P., Sabath, M. B., Kamareddine, L., Henneman, L., Braun, D., & Dominici, F. (2021) · Scientific Reports · doi:10.1038/s41598-021-02776-0 · Cited by 23
EU Net-Zero Policy Achievement Assessment in Selected Members through Automated Forecasting Algorithms
Tudor, C. D., & Şova, R. (2022) · ISPRS International Journal of Geo-Information · doi:10.3390/ijgi11040232 · Cited by 23
“Mounting empirical evidence recognizes polluting emissions as a leading factor for socio-economic indicators, including economic growth, mortality, and health variables [33–36].”
Background
Spatial-temporal characterization of air pollutants using a hybrid deep learning/Kriging model incorporated with a weather normalization technique
Lin, G.-Y., Lee, Y.-M., Tsai, C., & Lin, C.-Y. (2022) · Atmospheric Environment · doi:10.1016/j.atmosenv.2022.119304 · Cited by 23
Evaluation of PM10 concentration by using Mars and XGBOOST algorithms in Iğdır Province of Türkiye
Tırınk, S., & Öztürk, B. (2022) · International Journal of Environmental Science and Technology · doi:10.1007/s13762-022-04511-2 · Cited by 23
Time trends in the burden of stroke and subtypes attributable to PM2.5 in China from 1990 to 2019
Chen, H., Zhou, Z., Li, Z., Liang, S., Zhou, J., Zou, G., & Zhou, S. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1026870 · Cited by 23
“5μm, has become one of the three risk factors resulting in more than 1% of DALYs globally (5, 6), causing 8.”
Background
Impact of lowering fine particulate matter from major emission sources on mortality in Canada: A nationwide causal analysis
Chen, H., Quick, M., Kaufman, J. S., Chen, C., Kwong, J. C., van Donkelaar, A., Meng, J., Martin, R. V., Kim, J., Lavigne, É., et al. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2209490119 · Cited by 27
“For example, in a large U.S. cohort study comprising 61 million Medicare recipients, living with lower SES consistently heightened the association of premature death with long-term exposure to PM2.”
Background
Associations between Changes in Exposure to Air Pollutants due to Relocation and the Incidence of 14 Major Disease Categories and All-Cause Mortality: A Natural Experiment Study
Chen, G., Qian, Z. M., Zhang, J., Wang, X., Zhang, Z., Cai, M., Arnold, L. D., Abresch, C., Wang, C., Liu, Y., et al. (2024) · Environmental Health Perspectives · doi:10.1289/ehp14367 · Cited by 25
Into the Black Box: What Can Machine Learning Offer Environmental Health Research?
Schmidt, C. W. (2020) · Environmental Health Perspectives · doi:10.1289/ehp5878 · Cited by 24
“Building on this approach, Francesca Dominici, a biostatistician and codirector of the Data Science Initiative at Harvard University, has related machine learning–derived estimates of airborne PM2:5 concentrations to changes in mortality among older Americans.13 For that effort, she and her colleagues relied on a mode…”
Background

Authors: Di, Q., Wang, Y., Zanobetti, A., Wang, Y., Koutrakis, P., Choirat, C., Dominici, F., & Schwartz, J. D.
Affiliations: Harvard University (US)
ORCID: Di, Qian
Wang, Yan
Zanobetti, Antonella
Wang, Yun
Koutrakis, Petros
Choirat, Christine
Dominici, Francesca
Schwartz, Joel D.
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
DOI: 10.1056/nejmoa1702747
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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Air Pollution and Mortality in the Medicare Population

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