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Long-term ozone exposures and cause-specific mortality in a US Medicare cohort
We examined the association of long-term, daily 1-h maximum O(3) (ozone) exposures on cause-specific mortality for 22.2 million US Medicare beneficiaries between 2000–2008. We modeled the association between O(3) and mortality using age-gender-race stratified log-linear regression models, adjusted f...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Nature Publishing Group US
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197379/ https://www.ncbi.nlm.nih.gov/pubmed/30992518 http://dx.doi.org/10.1038/s41370-019-0135-4 |
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author | Kazemiparkouhi, Fatemeh Eum, Ki-Do Wang, Bingyu Manjourides, Justin Suh, Helen H. |
author_facet | Kazemiparkouhi, Fatemeh Eum, Ki-Do Wang, Bingyu Manjourides, Justin Suh, Helen H. |
author_sort | Kazemiparkouhi, Fatemeh |
collection | PubMed |
description | We examined the association of long-term, daily 1-h maximum O(3) (ozone) exposures on cause-specific mortality for 22.2 million US Medicare beneficiaries between 2000–2008. We modeled the association between O(3) and mortality using age-gender-race stratified log-linear regression models, adjusted for state of residence. We examined confounding by (1) adjusting for PM(2.5) (particles with aerodynamic diameters <2.5 μm) and NO(2) (nitrogen dioxide) exposures, temperature, and neighborhood-level characteristics and behaviors, and (2) decomposing O(3) into its temporal and spatio-temporal components and comparing estimated risk ratios. We also examined sensitivity of our results to alternate exposure measures based on warm-season 8-h daily maximum and 24-h average exposures. We found increased risks from long-term O(3) exposures to be strongest and most consistent for mortality from respiratory disease (1.030, 95% CI: 1.027, 1.034) (including COPD (chronic obstructive pulmonary disease)), CHF (congestive heart failure), and lung cancer (1.015, 95% CI: 1.010, 1.020), with no evidence of confounding by PM(2.5), NO(2), and temperature and with results similar across O(3) exposure measures. While significant, associations between long-term O(3) exposures and CVD (cardiovascular)-related mortality (1.005, 95% CI: 1.003, 1.007) were confounded by PM(2.5) and varied with the exposure measure, with associations no longer significantly positive when warm-season 8-h maximum or 24-h average O(3) was used to assess exposures. In this large study, we provide strong evidence that O(3) exposure is associated with mortality from respiratory-related causes and for the first-time, lung cancer, but raise questions regarding O(3)-related impacts on CVD mortality. Our findings demonstrate the need to further identify potential confounders. |
format | Online Article Text |
id | pubmed-7197379 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Nature Publishing Group US |
record_format | MEDLINE/PubMed |
spelling | pubmed-71973792020-06-26 Long-term ozone exposures and cause-specific mortality in a US Medicare cohort Kazemiparkouhi, Fatemeh Eum, Ki-Do Wang, Bingyu Manjourides, Justin Suh, Helen H. J Expo Sci Environ Epidemiol Article We examined the association of long-term, daily 1-h maximum O(3) (ozone) exposures on cause-specific mortality for 22.2 million US Medicare beneficiaries between 2000–2008. We modeled the association between O(3) and mortality using age-gender-race stratified log-linear regression models, adjusted for state of residence. We examined confounding by (1) adjusting for PM(2.5) (particles with aerodynamic diameters <2.5 μm) and NO(2) (nitrogen dioxide) exposures, temperature, and neighborhood-level characteristics and behaviors, and (2) decomposing O(3) into its temporal and spatio-temporal components and comparing estimated risk ratios. We also examined sensitivity of our results to alternate exposure measures based on warm-season 8-h daily maximum and 24-h average exposures. We found increased risks from long-term O(3) exposures to be strongest and most consistent for mortality from respiratory disease (1.030, 95% CI: 1.027, 1.034) (including COPD (chronic obstructive pulmonary disease)), CHF (congestive heart failure), and lung cancer (1.015, 95% CI: 1.010, 1.020), with no evidence of confounding by PM(2.5), NO(2), and temperature and with results similar across O(3) exposure measures. While significant, associations between long-term O(3) exposures and CVD (cardiovascular)-related mortality (1.005, 95% CI: 1.003, 1.007) were confounded by PM(2.5) and varied with the exposure measure, with associations no longer significantly positive when warm-season 8-h maximum or 24-h average O(3) was used to assess exposures. In this large study, we provide strong evidence that O(3) exposure is associated with mortality from respiratory-related causes and for the first-time, lung cancer, but raise questions regarding O(3)-related impacts on CVD mortality. Our findings demonstrate the need to further identify potential confounders. Nature Publishing Group US 2019-04-16 2020 /pmc/articles/PMC7197379/ /pubmed/30992518 http://dx.doi.org/10.1038/s41370-019-0135-4 Text en © The Author(s) 2019 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Kazemiparkouhi, Fatemeh Eum, Ki-Do Wang, Bingyu Manjourides, Justin Suh, Helen H. Long-term ozone exposures and cause-specific mortality in a US Medicare cohort |
title | Long-term ozone exposures and cause-specific mortality in a US Medicare cohort |
title_full | Long-term ozone exposures and cause-specific mortality in a US Medicare cohort |
title_fullStr | Long-term ozone exposures and cause-specific mortality in a US Medicare cohort |
title_full_unstemmed | Long-term ozone exposures and cause-specific mortality in a US Medicare cohort |
title_short | Long-term ozone exposures and cause-specific mortality in a US Medicare cohort |
title_sort | long-term ozone exposures and cause-specific mortality in a us medicare cohort |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197379/ https://www.ncbi.nlm.nih.gov/pubmed/30992518 http://dx.doi.org/10.1038/s41370-019-0135-4 |
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