Long-term air pollution exposure and markers of cardiometabolic health in the National Longitudinal Study of Adolescent to Adult Health (Add Health)

BACKGROUND: Air pollution exposure is associated with cardiovascular morbidity and mortality. Although exposure to air pollution early in life may represent a critical window for development of cardiovascular disease risk factors, few studies have examined associations of long-term air pollution exposure with markers of cardiovascular and metabolic health in young adults. OBJECTIVES: By combining health data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) with air pollution data from the Fused Air Quality Surface using Downscaling (FAQSD) archive, we: (1) calculated multi-year estimates of exposure to ozone (O(3)) and particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM(2.5)) for Add Health participants; and (2) estimated associations between air pollution exposures and multiple markers of cardiometabolic health. METHODS: Add Health is a nationally representative longitudinal cohort study of over 20,000 adolescents aged 12–19 in the United States (US) in 1994—95 (Wave I). Participants have been followed through adolescence and into adulthood with five in-home interviews. Estimated daily concentrations of O(3) and PM(2.5) at census tracts were obtained from the FAQSD archive and used to generate tract-level annual averages of O(3) and PM(2.5) concentrations. We estimated associations between average O(3) and PM(2.5) exposures from 2002 to 2007 and markers of cardiometabolic health measured at Wave IV (2008–09), including hypertension, hyperlipidemia, body mass index (BMI), diabetes, C-reactive protein, and metabolic syndrome. RESULTS: The final sample size was 11,259 individual participants. The average age of participants at Wave IV was 28.4 years (range: 24–34 years). In models adjusting for age, race/ethnicity, and sex, long-term O(3) exposure (2002–07) was associated with elevated odds of hypertension, with an odds ratio (OR) of 1.015 (95% confidence interval [CI]: 1.011, 1.029); obesity (1.022 [1.004, 1.040]); diabetes (1.032 [1.009,1.054]); and metabolic syndrome (1.028 [1.014, 1.041]); PM(2.5) exposure (2002–07) was associated with elevated odds of hypertension (1.022 [1.001, 1.045]). CONCLUSION: Findings suggest that long-term ambient air pollution exposure, particularly O(3) exposure, is associated with cardiometabolic health in early adulthood.