Disentangling relationships between air pollution and the social environment on cardiovascular health in the Boston Puerto Rican Health Study

Abstract

Introduction: Disparities in cardiovascular disease (CVD) are substantial and persistent and the social environment may explain a proportion of these disparities. A critical barrier to understanding CVD disparities is the interrelated conceptual and physical nature of predictors including air pollution, socioeconomic status and psychosocial stress. We examine these relationships among a mainland Puerto Rican cohort, a population characterized by high CV risk compared to other Hispanic/Latino groups. Methods: The Boston Puerto Rican Health Study (BPRHS) is an established longitudinal cohort of Puerto Rican adults, aged 45-75 years with follow-up at 2 and 5 years. A model predicting hourly particle number concentrations (PNC) at high resolution (20 m) was developed using pollutant data from outdoor monitors, mobile monitoring, traffic, meteorology and secondary formation. Exposure estimates were linked to residential addresses. Health and demographic data was collected from the cohort via questionnaires and physical examinations. Results: 750 participants resided in Boston at baseline. Mean PNC for participants in 2003 was 25,308 particles/cm3 (standard deviation (SD): 3,828). The mean age for the cohort was 57 years, the majority (70%) were female and median household income was $11,166. Perceived stress ranged from 0-56 with a mean of 23.6 (SD: 9.4), where higher values indicate greater stress. A small, but significant inverse correlation (Pearson’s r = -0.13; p<0.0001) was observed between perceived stress and household income. PNC was also inversely correlated with income (r = -0.14; p=0.0002). Conclusions: Addressing disparities in CVD would be greatly assisted by better understanding the interrelationships between environmental and social factors that affect health. Since lower income was correlated with both higher perceived stress and higher air pollution, additional analyses that will more deeply probe these relationships and their impact on CVD are needed.