Mortality in the Medicare Population and Chronic Exposure to Fine Particulate Air Pollution in Urban Centers (2000–2005)

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Abstract
BACKGROUND: Prospective cohort studies constitute the major source of evidence about the mortality effects of chronic exposure to particulate air pollution. Additional studies are needed to provide evidence on the health effects of chronic exposure to particulate matter <= 2.5 mu m in aerodynamic diameter (PM2.5) because few studies have been carried out and the cohorts have not been representative. OBJECTIVES: This study was designed to estimate the relative risk of death associated with long-term exposure to PM2.5 by region and age groups in a U.S. population of elderly, for the period 2000-2005. METHODS: By linking PM2.5 monitoring data to the Medicare billing claims by ZIP code of residence of the enrollees, we have developed a new retrospective cohort study, the Medicare Cohort Air Pollution Study. The study population comprises 13.2 million participants living in 4,568 ZIP codes having centroids within 6 miles of a PM2.5 monitor. We estimated relative risks adjusted by socioeconomic status and smoking by fitting log-linear regression models. RESULTS: In the eastern and central regions, a 10-mu g/m(3) increase in 6-year average of PM2.5 is associated with 6.8% [95% confidence interval (CI), 4.9-8.7%] and 13.2% (95% CI, 9.5-16.9) increases in mortality, respectively. We found no evidence of an association in the western region or for persons : 85 years of age. CONCLUSIONS: We established a cohort of Medicare participants for investigating air pollution and mortality on longer-term time frames. Chronic exposure to PM2.5 was associated with mortality in the eastern and central regions, but not in the western United States.