Multilevel Modeling of PM2.5 and Risk of Cardiovascular Disease and Diabetes Mellitus in Adults Aged 65 and Older

Abstract

We aimed to test a hypothesis that elevated ambient particulate matter (PM) 2.5 concentrations are significantly associated with risk of coronary heart disease (CHD), stroke, and diabetes mellitus (DM) in adults aged 65 and older. We analyzed data (2010-2013) from U.S. 1118 counties to examine the association between PM2.5 concentrations and risk of prevalent CHD, stroke, and DM, and mortality from cardiovascular disease (CVD), CHD, stroke, and DM in adults aged ≥ 65. Multilevel regression analysis technique was applied to test these associations. The results show that the annual mean of PM2.5 concentration was 8.7 μg/m3 in the total study sample. Significant differences in mean PM2.5 concentrations were observed across counties and states in the U.S. Multilevel regression analysis indicates that an average annual concentration of 1 μg/m3 increase in PM2.5 concentration was significantly associated with an increased prevalence of CHD, stroke, and DM by 4.9‰ (95% CI: 3.1‰ - 6.7‰), 0.8‰ (0.5‰ - 1.1‰), and 3.3‰ (2.9‰ - 4.4‰), respectively. State-level correlation analyses indicate that increased PM2.5 concentrations were significantly associated with increased age-adjusted mortality from CVD (r = 0.76, p p = 0.004), stroke (r = 0.60, p p = 0.02). In conclusion, Elevated PM2.5 concentrations were significantly associated with an increased risk of the prevalence and mortality from CVD, CHD, stroke, and DM. Continued effort to control ambient PM2.5 concentrations could play an important role in risk reduction of cardiovascular disease and diabetes in the elderly.