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August 21, 2002

Pollution-Related Mortality and Educational Level

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

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

To the Editor: Dr Pope and colleagues1 found that long-term exposure to air pollution is a risk factor for death from cardiopulmonary disease and lung cancer. It is puzzling that increased mortality risk was observed only in the 41.1% of the population with 12 or fewer years of education. Although this might be a chance finding related to subgroup analysis, a similar result was observed in the reanalysis of the Harvard Six-Cities Air Pollution Study.2 That study also found no pollution-related risk in the 34% of the population with more than 12 years of education. Why are individuals with more education apparently immune to the adverse effects of air pollutants? It is possible that education is a surrogate for some more proximal factors that modify risk, such as lifestyle factors, subsequent occupational exposures, and income.