Social Susceptibility to Multiple Air Pollutants 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 exposures are also often higher. While specific factors leading to this susceptibility remain unknown, chronic psychosocial stress related to social adversity has been hypothesized as a critical component. In this study, we aim to examine associations between air pollution exposures and CVD events using a case-crossover design, and assess effect modification of these associations by community SEP and/ or specific chronic stressor exposures (e.g., crime, deprivation). We quantify relationships between exposures and CVD events in NYC using four unique datasets: [1] Spatial data on citywide community SEP and stressor indicators; [2] Surfaces for fine-scale spatial variation in multiple pollutants from NYC Community Air Survey [fine particles (PM2.5), nitrogen dioxide (NO2), summertime ozone (O3), sulfur dioxide (SO2)]; [3] Daily ambient pollution concentrations from EPA AQS monitors; [4] Complete data on in- and out-patient unscheduled CVD events presented in NYC emergency departments (ED) 2005-2011 (n = 1.3 million), from NY State Department of Health Statewide Planning and Research Cooperative System. In preliminary analyses, we observed 1.0 to 3.5% increases in excess risk of CVD ED visits – for both overall CVD risk and key sub-diagnoses (e.g., acute myocardial infarction, stroke) with a 10-ppb increase in ozone exposure on lag days 0-1. Associations with CVD for ozone on lag days 2-6 days were not significant. We have found suggestive evidence of effect modification by SEP and stressors including violent crime; we found the lowest excess risk of a CVD event in communities in the lowest-crime quartile (e.g., 0.9% excess risk on lag day 0), and increasing risks with increasing crime (e.g., 3.1% excess risk on lag day 1).