Department of Medicine, Division of Cardiovascular Medicine
Aged; Air Pollutants; Air Pollution; Environmental Exposure; Female; Heart Failure; Humans; Insurance Claim Review; Male; *Motor Vehicles; Prognosis; Proportional Hazards Models; Residence Characteristics
Biostatistics | Epidemiology | Health Services Research
BACKGROUND: Although patients with heart failure (HF) have been identified as particularly susceptible to the acute effects of air pollution, the effects of long-term exposure to air pollution on patients with this increasingly prevalent disease are largely unknown.
OBJECTIVE: This study was designed to examine the mortality risk associated with residential exposure to traffic-related air pollution among HF patients.
METHODS: A total of 1,389 patients hospitalized with acute HF in greater Worcester, Massachusetts, during 2000 were followed for survival through December 2005. We used daily traffic within 100 and 300 m of residence as well as the distance from residence to major roadways and to bus routes as proxies for residential exposure to traffic-related air pollution. We assessed mortality risks for each exposure variable using Cox proportional hazards models adjusted for prognostic factors.
RESULTS: After the 5-year follow-up, only 334 (24%) subjects were still alive. An interquartile range increase in daily traffic within 100 m of home was associated with a mortality hazard ratio (HR) of 1.15 [95% confidence interval (CI), 1.05-1.25], whereas for traffic within 300 m this association was 1.09 (95% CI, 1.01-1.19). The mortality risk decreased with increasing distance to bus routes (HR = 0.88; 95% CI, 0.81-0.96) and was larger for those living within 100 m of a major roadway or 50 m of a bus route (HR = 1.30; 95% CI, 1.13-1.49). Adjustment for area-based income and educational level slightly attenuated these associations.
CONCLUSIONS: Residential exposure to traffic-related air pollution increases the mortality risk after hospitalization with acute HF. Reducing exposure to traffic-related emissions may improve the long-term prognosis of HF patients.
DOI of Published Version
Environ Health Perspect. 2008 Apr;116(4):481-5. Link to article on publisher's site
Environmental health perspectives
Medina-Ramón, Mercedes; Goldberg, Robert J.; Melly, Steven J.; Mittleman, Murray A.; and Schwartz, Joel, "Residential exposure to traffic-related air pollution and survival after heart failure" (2008). Quantitative Health Sciences Publications and Presentations. 343.