Abstract
TPS 641: Policies, interventions, communication, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: Air quality in the United States has improved since the Clean Air Act of 1970, but these improvements have varied greatly both between and within metropolitan areas. Methods: We examined local variations in annual average air quality as determinants of local variation in annual age-adjusted cardiovascular hospital admission rates (CHR) among Medicare beneficiaries aged 65 years and older for 2002-2013 across 10,097 ZIP codes (postal codes) in 123 metropolitan core-based statistical areas (CBSA) with 2010 populations greater than 500,000 persons. For 11 air pollutants, we examined local variations (ZIP code-specific variation within CBSA) in CHR and air quality for centered means (2005) and for 12-year trends (2002-2013). Results: Interquartile increments in the centered means of fine particulate matter components were associated with increased CHR (admissions per 100,000 person-years at risk): total PM2.5 (35.0, 95% confidence interval (CI) 5.3, 64.8), elemental carbon (39.3, 95% CI 9.6, 69.1) and organic carbon (33.1, 95% CI 0.9, 65.3). After further adjustment for centered mean CHR to control for ZIP code-level variations in cardiovascular risk factors, interquartile increments in the 12-year trends of gaseous air pollutants were associated with 12-year trends in CHR (annual change in admissions per 100,000 person-years at risk): nitric oxide (4.4, 95% CI 1.8, 7.1), nitrogen dioxide (4.8, 95% CI 2.0, 7.5), and carbon monoxide (4.7, 95% CI 2.0, 7.4). Conclusion: Thus, after adjustment for metropolitan area characteristics and for local variations in cardiovascular risk factors, we have shown that local improvements in air quality lead to local improvements in cardiovascular health among Medicare beneficiaries. The views expressed in this presentation are those of the authors and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency.
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