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Original Contribution
May 14, 2008

Coarse Particulate Matter Air Pollution and Hospital Admissions for Cardiovascular and Respiratory Diseases Among Medicare Patients

Author Affiliations

Author Affiliations: Departments of Biostatistics (Drs Peng, McDermott, Zeger, and Dominici, and Mr Chang) and Epidemiology (Dr Samet), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut (Dr Bell).

JAMA. 2008;299(18):2172-2179. doi:10.1001/jama.299.18.2172

Context Health risks of fine particulate matter of 2.5 μm or less in aerodynamic diameter (PM2.5) have been studied extensively over the last decade. Evidence concerning the health risks of the coarse fraction of greater than 2.5 μm and 10 μm or less in aerodynamic diameter (PM10-2.5) is limited.

Objective To estimate risk of hospital admissions for cardiovascular and respiratory diseases associated with PM10-2.5 exposure, controlling for PM2.5.

Design, Setting, and Participants Using a database assembled for 108 US counties with daily cardiovascular and respiratory disease admission rates, temperature and dew-point temperature, and PM10-2.5 and PM2.5 concentrations were calculated with monitoring data as an exposure surrogate from January 1, 1999, through December 31, 2005. Admission rates were constructed from the Medicare National Claims History Files, for a study population of approximately 12 million Medicare enrollees living on average 9 miles (14.4 km) from collocated pairs of PM10 and PM2.5 monitors.

Main Outcome Measures Daily counts of county-wide emergency hospital admissions for primary diagnoses of cardiovascular or respiratory disease.

Results There were 3.7 million cardiovascular disease and 1.4 million respiratory disease admissions. A 10-μg/m3 increase in PM10-2.5 was associated with a 0.36% (95% posterior interval [PI], 0.05% to 0.68%) increase in cardiovascular disease admissions on the same day. However, when adjusted for PM2.5, the association was no longer statistically significant (0.25%; 95% PI, −0.11% to 0.60%). A 10-μg/m3 increase in PM10-2.5 was associated with a nonstatistically significant unadjusted 0.33% (95% PI, −0.21% to 0.86%) increase in respiratory disease admissions and with a 0.26% (95% PI, −0.32% to 0.84%) increase in respiratory disease admissions when adjusted for PM2.5. The unadjusted associations of PM2.5 with cardiovascular and respiratory disease admissions were 0.71% (95% PI, 0.45%-0.96%) for same-day exposure and 0.44% (95% PI, 0.06% to 0.82%) for exposure 2 days before hospital admission.

Conclusion After adjustment for PM2.5, there were no statistically significant associations between coarse particulates and hospital admissions for cardiovascular and respiratory diseases.