Full Citation
Title: Individual Risk Factors of PM2.5 Associated with Wintertime Mortality in Urban Patients with Chronic Obstructive Pulmonary Disease (COPD)
Citation Type: Journal Article
Publication Year: 2023
ISBN:
ISSN: 0012-3692
DOI: 10.1016/J.CHEST.2023.10.016
NSFID:
PMCID:
PMID: 37858719
Abstract: <h2>Abstract</h2><h3>Background</h3><p>Air pollution contributes to premature mortality, but potential impacts differ in populations with existing disease, particularly for individuals with multiple risk factors. While chronic obstructive pulmonary disease (COPD) increases vulnerability to air pollution, individuals with COPD and other individual risk factors are at the intersection of multiple risks and may be especially susceptible to the effect of acute outdoor air pollution.</p><h3>Research Question</h3><p>What is the association between wintertime air pollution and mortality in patients with COPD and the modifying role of individual risk factors?</p><h3>Study Design and Methods</h3><p>We evaluated 19,243 deceased Veterans with prior COPD diagnosis residing in 25 U.S. metropolitan regions (2016-2019). Electronic health records include patient demographics, smoking status, and comorbidities, such as asthma, coronary artery disease (CAD), obesity, and diabetes. Using geocoded addresses, individuals were assigned wintertime fine particulate matter (PM<sub>2.5</sub>) and NO<sub>2</sub> air pollution exposures. We estimated associations between acute air pollution and mortality using a time-stratified case-crossover design with a conditional logistic model and assessed individual risk differences by stratified analysis.</p><h3>Results</h3><p>We estimated a 1.05 (95% CI: 1.02-1.09) mortality risk for each 10 <i>μ</i>g/m<sup>3</sup> increase in daily wintertime PM<sub>2.5</sub>. Older patients and African Americans showed elevated risk. Obesity was a substantial air pollution-related mortality risk factor (OR: 1.11; 95% CI: 1.01-1.23) and the estimated risk for individuals with obesity plus CAD or obesity plus diabetes was 16% higher.</p><h3>Interpretation</h3><p>Wintertime PM<sub>2.5</sub> exposure was associated with elevated mortality risk in people with COPD, but individuals with multiple comorbidities, notably obesity, had high vulnerability. Our study suggests that obesity, CAD, and diabetes are understudied modifiers of air pollution-related risks for people with existing COPD.</p>
Url: http://journal.chestnet.org/article/S0012369223056428/fulltext
Url: http://journal.chestnet.org/article/S0012369223056428/abstract
Url: https://journal.chestnet.org/article/S0012-3692(23)05642-8/abstract
User Submitted?: No
Authors: Aron, Jordan; Baldomero, Arianne K.; Rau, Austin; Fiecas, Mark B.; Wendt, Christine H.; Berman, Jesse D.
Periodical (Full): CHEST
Issue: 0
Volume: 0
Pages:
Countries: