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August 21, 2002

Pollution-Related Mortality and Educational Level—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(7):830. doi:10.1001/jama.288.7.828

In Reply: We controlled for educational level, as well as for smoking and other risk factors, in our pollution mortality estimates. There was no evidence that the estimated pollution-mortality effects were due to confounding by education or other observed risk factors. Nevertheless, we found an apparent effect modification by smoking status and education levels. We agree with Dr Finkelstein that the education-related effect modification may be at least partially due to higher exposures due to closer proximity to pollution sources, poorer housing, less home and work-place air conditioning and filtering, and possibly other factors. There are, of course, various important consequences related to this effect modification. For example, because individuals with less education are somewhat underrepresented in our cohort, we may have underestimated the average pollution-mortality effect estimates for the overall population.

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