Health effects of short-term exposure to particulate matter in people with disabilities: at the intersection of disability, socioeconomic status, and co-morbid conditions

Abstract

Background / AimPeople with disabilities are at greater risk of being deprived, engaging in health-risk behaviors, and having comorbidities than the non-disabled population, which may impose an additional burden of disease from air pollution. However, no studies have specifically explored the effects of ambient particulate matter in people with disabilities. This study aims to investigate the association between short-term exposure to PM and hospital admissions by the existence of a disability, disability types, socioeconomic status, and comorbidities. MethodsThe study subject is from the Korean National Health Insurance Services –National Sample Cohort. We identified 17,839 hospital admissions for cardiovascular disease from the disabled population and 43,020 from the non-disabled population who resided in seven metropolitan cities from 2006 to 2013. A time-stratified case-crossover analysis using conditional logistic regression was used to investigate the association between PM10 and hospital admissions for CVD. The models were adjusted for daily temperature, relative humidity, and national holidays. We further explored effect modifications by the existence of a disability, disability types (physical, visual, hearing, intellectual disability/disability of brain lesion/mental disorder/kidney dysfunction), SES, and comorbidities. ResultsThe association between 10ug/m3 increase in PM10 and CVD admissions was similar between people with any disability (1.1%, 95% Confidence Interval: 0.1%, 2.2%) and people without disability (0.9%, 95% CI: 0.2%, 1.6%). When stratifying by disability types, however, the effects of PM10 substantially differ among the disabled, from -3.1% (95% CI: -9.4%, 3.7%) in people with visual disability to 2.3% (95% CI: 0.5%, 4.3%) in people with physical disability. In addition, in the disabled population, the associations were stronger in people aged 19-64 years, with low SES, and with diabetes as comorbidity compared to their non-disabled counterparts. ConclusionsSubgroups of people with disabilities may experience additional health disparities at the intersection of their specific disability, SES, and comorbidities.