Title: Inverse probability weighted distributed lag effects of short-term exposure to PM2.5 and ozone on CVD hospitalizations in New England Medicare participants - Exploring the causal effects.

Authors: Qiu, Xinye; Wei, Yaguang; Wang, Yan; Di, Qian; Sofer, Tamar; Awad, Yara Abu; Schwartz, Joel

Published In Environ Res, (2020 Mar)

Abstract: BACKGROUND: Although many studies have established significant associations between short-term air pollution and the risk of getting cardiovascular diseases, there is a lack of evidence based on causal distributed lag modeling. METHODS: Inverse probability weighting (ipw) propensity score models along with conditional logistic outcome regression models based on a case-crossover study design were applied to get the causal unconstrained distributed (lag0-lag5) as well as cumulative lag effect of short-term exposure to PM2.5/Ozone on hospital admissions of acute myocardial infarction (AMI), congestive heart failure (CHF) and ischemic stroke (IS) among New England Medicare participants during 2000-2012. Effect modification by gender, race, secondary diagnosis of Chronic Obstructive Pulmonary Diseases (COPD) and Diabetes (DM) was explored. RESULTS: Each 10 μg/m3 increase in lag0-lag5 cumulative PM2.5 exposure was associated with an increase of 4.3% (95% confidence interval: 2.2%, 6.4%, percentage change) in AMI hospital admission rate, an increase of 3.9% (2.4%, 5.5%) in CHF rate and an increase of 2.6% (0.4%, 4.7%) in IS rate. A weakened lagging effect of PM2.5 from lag0 to lag5 could be observed. No cumulative short-term effect of ozone on CVD was found. People with secondary diagnosis of COPD, diabetes, female gender and black race are sensitive population. CONCLUSIONS: Based on our causal distributed lag modeling, we found that short-term exposure to an increased ambient PM2.5 level had the potential to induce higher risk of CVD hospitalization in a causal way. More attention should be paid to population of COPD, diabetes, female gender and black race.

PubMed ID: 31927244

MeSH Terms: Aged; Aged, 80 and over; Air Pollutants*; Air Pollution*; Cardiovascular Diseases*/epidemiology; Cross-Over Studies; Environmental Exposure*; Female; Hospitalization*/statistics & numerical data; Humans; Male; Medicare; New England; Ozone*/toxicity; Particulate Matter*/toxicity; Racial Groups; United States