Background Recent studies have reported associations betweenparticulate air pollution and daily mortality rates. Population-based,cross-sectional studies of metropolitan areas in the UnitedStates have also found associations between particulate airpollution and annual mortality rates, but these studies havebeen criticized, in part because they did not directly controlfor cigarette smoking and other health risks.
Methods In this prospective cohort study, we estimated the effectsof air pollution on mortality, while controlling for individualrisk factors. Survival analysis, including Cox proportional-hazardsregression modeling, was conducted with data from a 14-to-16-yearmortality follow-up of 8111 adults in six U.S. cities.
Results Mortality rates were most strongly associated with cigarettesmoking. After adjusting for smoking and other risk factors,we observed statistically significant and robust associationsbetween air pollution and mortality. The adjusted mortality-rateratio for the most polluted of the cities as compared with theleast polluted was 1.26 (95 percent confidence interval, 1.08to 1.47). Air pollution was positively associated with deathfrom lung cancer and cardiopulmonary disease but not with deathfrom other causes considered together. Mortality was most stronglyassociated with air pollution with fine particulates, includingsulfates.
Conclusions Although the effects of other, unmeasured risk factorscannot be excluded with certainty, these results suggest thatfine-particulate air pollution, or a more complex pollutionmixture associated with fine particulate matter, contributesto 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.
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