Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries
Background: Air pollution has been linked to cardiovascular diseases (CVDs). In this study, we assess whether exposure to air pollutants and ambient temperature is associated with repeated admissions with adverse cardiovascular outcomes. Methods: We used data from Medicare beneficiaries between 2000...
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Elsevier
2025-08-01
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| Series: | Environment International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S016041202500368X |
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| author | Mahdieh Danesh Yazdi Yaguang Wei Qian Di Weeberb J. Requia Adjani A. Peralta Francesca Dominici Joel D. Schwartz |
| author_facet | Mahdieh Danesh Yazdi Yaguang Wei Qian Di Weeberb J. Requia Adjani A. Peralta Francesca Dominici Joel D. Schwartz |
| author_sort | Mahdieh Danesh Yazdi |
| collection | DOAJ |
| description | Background: Air pollution has been linked to cardiovascular diseases (CVDs). In this study, we assess whether exposure to air pollutants and ambient temperature is associated with repeated admissions with adverse cardiovascular outcomes. Methods: We used data from Medicare beneficiaries between 2000 and 2016 to look at the effects of intermediate and long-term exposure to ambient PM2.5, NO2, O3, and temperature on second admissions with myocardial infarction (MI) and ischemic stroke. We derived exposure levels from high-resolution spatiotemporal models. We adjusted for demographic, socioeconomic, and access-to-care characteristics. Cox proportional hazards models were used to assess these relationships. We further looked at the effects of exposure at lower air pollution concentrations defined as PM2.5 < 9 µg/m3, NO2 < 25 ppb, and O3 < 50 ppb. Results: PM2.5 and NO2 increased the hazard of second admissions with both MI and stroke. For PM2.5, the effects were more pronounced for longer exposure time windows. Each µg/m3 increase in one-year PM2.5 levels before the first admission increased the hazard of a second admission with MI by 1.1% (95% CI: 1.0%-1.2%) and stroke by 0.9% (95% CI: 0.8%-1.1%). O3 exhibited a slight protective effect for both outcomes. Higher temperatures were associated with a higher hazard of second admissions with stroke. These results persisted at lower concentrations. Conclusion: Our study demonstrates that exposures to PM2.5 and NO2 are associated with increased rates of second admissions with MIs and strokes. Higher temperatures were also further associated with an increase in the rate of second admissions with stroke. |
| format | Article |
| id | doaj-art-af1b83afe8aa47e7a61aa218a5b00077 |
| institution | Kabale University |
| issn | 0160-4120 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Environment International |
| spelling | doaj-art-af1b83afe8aa47e7a61aa218a5b000772025-08-20T03:26:56ZengElsevierEnvironment International0160-41202025-08-0120210961710.1016/j.envint.2025.109617Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiariesMahdieh Danesh Yazdi0Yaguang Wei1Qian Di2Weeberb J. Requia3Adjani A. Peralta4Francesca Dominici5Joel D. Schwartz6Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA; Corresponding author at: Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, Health Sciences Center, Level 3, Stony Brook, NY 11794, USA.Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USAVanke School of Public Health, Tsinghua University, Beijing, ChinaCenter for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getulio Vargas, Brasília, Distrito Federal, BrazilDepartment of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USADepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USADepartment of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USABackground: Air pollution has been linked to cardiovascular diseases (CVDs). In this study, we assess whether exposure to air pollutants and ambient temperature is associated with repeated admissions with adverse cardiovascular outcomes. Methods: We used data from Medicare beneficiaries between 2000 and 2016 to look at the effects of intermediate and long-term exposure to ambient PM2.5, NO2, O3, and temperature on second admissions with myocardial infarction (MI) and ischemic stroke. We derived exposure levels from high-resolution spatiotemporal models. We adjusted for demographic, socioeconomic, and access-to-care characteristics. Cox proportional hazards models were used to assess these relationships. We further looked at the effects of exposure at lower air pollution concentrations defined as PM2.5 < 9 µg/m3, NO2 < 25 ppb, and O3 < 50 ppb. Results: PM2.5 and NO2 increased the hazard of second admissions with both MI and stroke. For PM2.5, the effects were more pronounced for longer exposure time windows. Each µg/m3 increase in one-year PM2.5 levels before the first admission increased the hazard of a second admission with MI by 1.1% (95% CI: 1.0%-1.2%) and stroke by 0.9% (95% CI: 0.8%-1.1%). O3 exhibited a slight protective effect for both outcomes. Higher temperatures were associated with a higher hazard of second admissions with stroke. These results persisted at lower concentrations. Conclusion: Our study demonstrates that exposures to PM2.5 and NO2 are associated with increased rates of second admissions with MIs and strokes. Higher temperatures were also further associated with an increase in the rate of second admissions with stroke.http://www.sciencedirect.com/science/article/pii/S016041202500368XAir pollutionTemperatureMyocardial infarctionIschemic strokeSecond events |
| spellingShingle | Mahdieh Danesh Yazdi Yaguang Wei Qian Di Weeberb J. Requia Adjani A. Peralta Francesca Dominici Joel D. Schwartz Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries Environment International Air pollution Temperature Myocardial infarction Ischemic stroke Second events |
| title | Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries |
| title_full | Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries |
| title_fullStr | Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries |
| title_full_unstemmed | Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries |
| title_short | Effects of intermediate and long-term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries |
| title_sort | effects of intermediate and long term exposure to ambient air pollution and temperature on hospital admissions with second cardiovascular events among medicare beneficiaries |
| topic | Air pollution Temperature Myocardial infarction Ischemic stroke Second events |
| url | http://www.sciencedirect.com/science/article/pii/S016041202500368X |
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