Residential Exposure to Traffic-Related Air Pollution and Survival after Heart Failure

• Published in: Environmental health perspectives Vol. 116; no. 4; pp. 481 - 485
• Main Authors: Medina-Ramón, Mercedes, Goldberg, Robert, Melly, Steven, Mittleman, Murray A., Schwartz, Joel
• Format: Journal Article
• Language: English
• Published: United States National Institute of Environmental Health Sciences. National Institutes of Health. Department of Health, Education and Welfare 01.04.2008; National Institute of Environmental Health Sciences
• Subjects: Aged; Air Pollutants - toxicity; Air pollution; Air Pollution - adverse effects; Air pollution effects; Bus routes; Buses; Environmental aspects; Environmental Exposure - adverse effects; Epidemiology; Exposure; Female; Health aspects; Health risks; Heart; Heart failure; Heart Failure - mortality; Hospitalization; Humans; Insurance Claim Review; International Statistical Classification of Diseases; Male; Mortality; Mortality risk; Motor vehicle traffic; Motor Vehicles; Particles; Particulate matter; Prognosis; Proportional Hazards Models; Residence Characteristics - statistics & numerical data; Risk factors; Roads; Traffic; Vehicle emissions; United States; USA, Massachusetts; epidemiology; heart failure; follow-up studies; air pollution; survival
• ISSN: 0091-6765; 1552-9924
• DOI: 10.1289/ehp.10918

Background: Although patients with heart failure (HF) have been identified as particularly susceptible to the acute effects of air pollution, the effects of long-term exposure to air pollution on patients with this increasingly prevalent disease are largely unknown. Objective: This study was designed to examine the mortality risk associated with residential exposure to traffic-related air pollution among HF patients. Methods: A total of 1,389 patients hospitalized with acute HF in greater Worcester, Massachusetts, during 2000 were followed for survival through December 2005. We used daily traffic within 100 and 300 m of residence as well as the distance from residence to major roadways and to bus routes as proxies for residential exposure to traffic-related air pollution. We assessed mortality risks for each exposure variable using Cox proportional hazards models adjusted for prognostic factors. Results: After the 5-year follow-up, only 334 (24%) subjects were still alive. An interquartile range increase in daily traffic within 100 m of home was associated with a mortality hazard ratio (HR) of 1.15 [95% confidence interval (CI), 1.05-1.25], whereas for traffic within 300 m this association was 1.09 (95% CI, 1.01-1.19). The mortality risk decreased with increasing distance to bus routes (HR = 0.88; 95% CI, 0.81-0.96) and was larger for those living within 100 m of a major roadway or 50 m of a bus route (HR = 1.30; 95% CI, 1.13-1.49). Adjustment for area-based income and educational level slightly attenuated these associations. Conclusions: Residential exposure to traffic-related air pollution increases the mortality risk after hospitalization with acute HF. Reducing exposure to traffic-related emissions may improve the long-term prognosis of HF patients.