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Original Article
Volume 329:1753-1759 December 9, 1993 Number 24
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An Association between Air Pollution and Mortality in Six U.S. Cities
Douglas W. Dockery, C. Arden Pope, Xiping Xu, John D. Spengler, James H. Ware, Martha E. Fay, Benjamin G. Ferris, and Frank E. Speizer

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ABSTRACT

Background Recent studies have reported associations between particulate air pollution and daily mortality rates. Population-based, cross-sectional studies of metropolitan areas in the United States have also found associations between particulate air pollution and annual mortality rates, but these studies have been criticized, in part because they did not directly control for cigarette smoking and other health risks.

Methods In this prospective cohort study, we estimated the effects of air pollution on mortality, while controlling for individual risk factors. Survival analysis, including Cox proportional-hazards regression modeling, was conducted with data from a 14-to-16-year mortality follow-up of 8111 adults in six U.S. cities.

Results Mortality rates were most strongly associated with cigarette smoking. After adjusting for smoking and other risk factors, we observed statistically significant and robust associations between air pollution and mortality. The adjusted mortality-rate ratio for the most polluted of the cities as compared with the least polluted was 1.26 (95 percent confidence interval, 1.08 to 1.47). Air pollution was positively associated with death from lung cancer and cardiopulmonary disease but not with death from other causes considered together. Mortality was most strongly associated with air pollution with fine particulates, including sulfates.

Conclusions Although the effects of other, unmeasured risk factors cannot be excluded with certainty, these results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.


Source Information

From the Environmental Epidemiology Program (D.W.D., C.A.P., X.X., M.E.F., B.G.F., F.E.S.), the Exposure Assessment and Engineering Program (J.D.S.), and the Interdisciplinary Program in Health (C.A.P.), Department of Environmental Health, and the Department of Biostatistics (J.H.W.), Harvard School of Public Health, Boston; the Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston (D.W.D., F.E.S.); and the Economics Department, Brigham Young University, Provo, Utah (C.A.P.). Presented in part at the annual meeting of the American Thoracic Society, San Francisco, May 19, 1992, and at the Aerosols in Medicine Congress of the International Society for Aerosols in Medicine, Garmisch-Partenkirchen, Germany, April 1, 1993.

Address reprint requests to Dr. Dockery at the Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115.

Full Text of this Article


Related Letters:

Air Pollution and Mortality
Moolgavkar S. H., Dockery D. W., Pope C. A.
Extract | Full Text  
N Engl J Med 1994; 330:1237-1238, Apr 28, 1994. Correspondence

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