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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The association between ambient particulate matter exposure and the telomere–mitochondrial axis of aging in newborns
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A method for using stationary networks to observe long-term trends of on-road emission factors of primary aerosol from heavy-duty vehicles
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Association between Air Pollution and Physical Activity and Sedentary Behavior among Adults Aged 60 Years or Older in China: A Cross-Sectional Study
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“…cohort studies in the USA and Canada showed that long-term exposure to ambient O3 increased risk of excess chronic deaths from respiratory diseases (RD) and cardiovascular diseases (CVD, Jerrett et al., 2009; Turner et al., 2016; Lim et al., 2019) and non-accidental diseases (NAD, Di et al., 2017).”
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Asthma mortality is triggered by short-term exposures to ambient air pollutants: Evidence from a Chinese urban population
Zhang, Y., Xiang, Q., Yu, C., & Yang, Z. (2020) · Atmospheric Environment · doi:10.1016/j.atmosenv.2020.117271 · Cited by 10
A Representation of the World Population Dynamics for Integrated Assessment Models
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Cyclic Ion Mobility Spectrometry Coupled to High-Resolution Time-of-Flight Mass Spectrometry Equipped with Atmospheric Solid Analysis Probe for the Molecular Characterization of Combustion Particulate Matter
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“One of these challenges is the increase of the road traffic in cities and, thus, of the levels of air pollution, which is actually causing serious health disorders for city dwellers, regardless of their age, gender, or any other factor [1].”
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“The policy effect was insignificant in children [24], the elderly [30-32], disabled individuals [25], and Medicaid recipients [24,33], who constitute populations that would be argu-Table ably particularly vulnerable to air pollution.”
Background
Evaluating the sensitivity of mortality attributable to pollution to modeling Choices: A case study for Colorado
deSouza, P., Anenberg, S. C., Fann, N. L., McKenzie, L. M., Chan, E., Roy, A., Jimenez, J. L., Raich, W., Roman, H. A., & Kinney, P. L. (2024) · Environment International · doi:10.1016/j.envint.2024.108416 · Cited by 10
“The only other study that considers racial/ethnic specific CRFs for evaluating the mortality attributable to PM 2.5 also used the CRFs reported in Di et al., (2017) (Spiller et al., 2021).”
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Association Between Long‑Term Exposure to Air Pollution and the Rate of Mortality After Hip Fracture Surgery in Patients Older Than 60 Years: Nationwide Cohort Study in Taiwan
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Comparing traditional and causal inference methodologies for evaluating impacts of long-term air pollution exposure on hospitalization with Alzheimer disease and related dementias
Qin, M., Khoshnevis, N., Dominici, F., Braun, D., Zanobetti, A., & Mork, D. (2024) · American Journal of Epidemiology · doi:10.1093/aje/kwae133 · Cited by 10
Spatial Analysis of Intra-Urban Air Pollution Disparities through an Environmental Justice Lens: A Case Study of Philadelphia, PA
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“Some groups, such as children, the elderly, and low-socioeconomic status populations, have a greater risk for negative health outcomes from air pollution exposure [14–16] due to their limited capacity to cope with the effects of exposure.”
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Spatial data fusion adjusting for preferential sampling using integrated nested Laplace approximation and stochastic partial differential equation
Zhong, R., Amaral, A. V. R., & Moraga, P. (2024) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.1093/jrsssa/qnae058 · Cited by 12
Childhood Air Pollution Exposure Associated with Self-reported Bronchitic Symptoms in Adulthood
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Jiřík, V., Machaczka, O., Riedlová, P., Kramná, D., Siemiatkowski, G., Ośródka, L., Krajny, E., Ambrož, A., Topinka, J., & Rössner, P. (2024) · Environmental Sciences Europe · doi:10.1186/s12302-024-00948-z · Cited by 10
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Patton, A. P., Boogaard, H., Vienneau, D., Brook, J. R., Smargiassi, A., Joss, M. K., Szpiro, A. A., Sagiv, S. K., Samoli, E., Hoffmann, B. H., et al. (2024) · Journal of Exposure Science & Environmental Epidemiology · doi:10.1038/s41370-024-00731-5 · Cited by 9
Health impact assessment on life expectancy gains ascribed to particulate matter reduction
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Insights Into Summertime Surface Ozone Formation From Diurnal Variations in Formaldehyde and Nitrogen Dioxide Along a Transect Through New York City
Tao, M., Fiore, A. M., Karambelas, A., Miller, P. J., Valin, L. C., Judd, L., Tzortziou, M. A., Whitehill, A., Teora, A., Tian, Y., et al. (2025) · Journal of Geophysical Research Atmospheres · doi:10.1029/2024jd040922 · Cited by 11
“The primary constituent of smog, ground‐level ozone (O 3 ), is regulated under the U.S. Clean Air Act (CAA) as a criteria pollutant because it can trigger respiratory disease, damage lung function, and increase the risk of premature death (Di, Dai et al., 2017, Di, Wang et al., 2017; Filippidou & Koukouliata, 2011; Ho…”
Quantitative Assessment of Relationship between Population Exposure to PM2.5 and Socio-Economic Factors at Multiple Spatial Scales over Mainland China
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Prospects of green roof technology as a sustainable solution to urban pollution index
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High-resolution air quality simulations of ozone exceedance events during the Lake Michigan Ozone Study
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Long-term exposures to ambient particulate matter and ozone pollution with lower extremity deep vein thrombosis after surgical operations: a retrospective case-control study in Beijing, China
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Short‐Term Ambient Air Pollution Exposure and Risk of Out‐of‐Hospital Cardiac Arrest in Sweden: A Nationwide Case‐Crossover Study
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Estimating Health Impacts Due to the Reduction of Particulate Air Pollution from the Household Sector Expected under Various Scenarios
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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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