Skip Navigation
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.


The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Your Environment. Your Health.

Publication Detail

Title: Estimating the Causal Effect of Low Levels of Fine Particulate Matter on Hospitalization.

Authors: Makar, Maggie; Antonelli, Joseph; Di, Qian; Cutler, David; Schwartz, Joel; Dominici, Francesca

Published In Epidemiology, (2017 09)

Abstract: In 2012, the EPA enacted more stringent National Ambient Air Quality Standards (NAAQS) for fine particulate matter (PM2.5). Few studies have characterized the health effects of air pollution levels lower than the most recent NAAQS for long-term exposure to PM2.5 (now 12 μg/m).We constructed a cohort of 32,119 Medicare beneficiaries residing in 5138 US ZIP codes who were interviewed as part of the Medicare Current Beneficiary Survey (MCBS) between 2002 and 2010 and had 1 year of follow-up. We considered four outcomes: all-cause hospitalizations, hospitalizations for circulatory diseases and respiratory diseases, and death.We found that increasing exposure to PM2.5 from levels lower than 12 μg/m to levels higher than 12 μg/m is associated with increases in all-cause admission rates of 7% (95% CI = 3%, 10%) and in circulatory admission hazard rates of 6% (95% CI = 2%, 9%). When we restricted analysis to enrollees with exposure always lower than 12 μg/m, we found that increasing exposure from levels lower than 8 μg/m to levels higher than 8 μg/m increased all-cause admission hazard rates by 15% (95% CI = 8%, 23%), circulatory by 18% (95% CI = 10%, 27%), and respiratory by 21% (95% CI = 9%, 34%).In a nationally representative sample of Medicare enrollees, changes in exposure to PM2.5, even at levels consistently below standards, are associated with increases in hospital admissions for all causes and cardiovascular and respiratory diseases. The robustness of our results to inclusion of many additional individual level potential confounders adds validity to studies of air pollution that rely entirely on administrative data.

PubMed ID: 28768298 Exiting the NIEHS site

MeSH Terms: Aged; Causality; Cohort Studies; Female; Hospitalization/statistics & numerical data*; Humans; Inhalation Exposure/adverse effects*; Inhalation Exposure/analysis; Male; Medicare/statistics & numerical data; Middle Aged; Models, Statistical; Particulate Matter/adverse effects*; Particulate Matter/analysis; Proportional Hazards Models; Risk Factors; United States/epidemiology

to Top