Community Social Stressors and Susceptibility to Urban Air Pollution in Cardiovascular Disease

Abstract

Cardiovascular disease (CVD), the leading cause of death in the U.S., has been linked to chronic and acute air pollution exposures. Research has identified stronger effects of air pollution in lower-socioeconomic position (SEP) communities, where pollution exposures are also often higher. While specific factors underlying this susceptibility are unknown, chronic psychosocial stress related to social adversity is hypothesized as a key component. In this study, we use data on 1.3 million New York City (NYC) CVD emergency department (ED) visits, multiple air pollutants [fine particles (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2)], and community-level SEP, violence, and race-based residential segregation to: (1) examine associations between spatiotemporal pollution exposures and CVD events in NYC for 2005-2011, and (2) assess effect modification in pollution-CVD associations by community social stressors. In case-crossover models examining associations between spatio-temporal air pollution and CVD, we found significant same-day associations between NO2 and risk of any CVD event, ischemic heart disease, and heart failure; this association remained significant with any form of co-pollutant adjustment. Significant associations for PM2.5 and SO2 on all CVD, heart failure (for PM2.5), and ischemic heart disease (for SO2) were somewhat less robust to co-pollutant adjustment. Finally, to test effect modification in the relationship between spatio-temporal pollution measures and CVD, we tested whether associations with individual-level CVD risk differed by community SEP and/ or chronic stressors. We found, as hypothesized, stronger associations between pollutants and CVD risk among individuals in communities with higher social stressor exposures. Further analyses are needed to compare relative modification by multiple community stressors.