Individual Risk Factors of PM2.5 Associated With Wintertime Mortality in Urban Patients With COPD

Jordan Aron; Arianne K Baldomero; Austin Rau; Mark B Fiecas; Christine H Wendt; Jesse D Berman

doi:10.1016/j.chest.2023.10.016

Individual Risk Factors of PM_2.5 Associated With Wintertime Mortality in Urban Patients With COPD

Chest. 2024 Apr;165(4):825-835. doi: 10.1016/j.chest.2023.10.016. Epub 2023 Oct 18.

Authors

Jordan Aron¹, Arianne K Baldomero², Austin Rau³, Mark B Fiecas⁴, Christine H Wendt⁵, Jesse D Berman³

Affiliations

¹ Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: aron0064@umn.edu.
² Pulmonary, Allergy, Critical Care and Sleep Medicine, Medical School, University of Minnesota, Minneapolis, MN; Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.
³ Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN.
⁴ Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
⁵ Pulmonary, Allergy, Critical Care and Sleep Medicine, Medical School, University of Minnesota, Minneapolis, MN; Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN.

PMID: 37858719
PMCID: PMC11026168 (available on 2025-04-01)
DOI: 10.1016/j.chest.2023.10.016

Abstract

Background: Air pollution contributes to premature mortality, but potential impacts differ in populations with existing disease, particularly for individuals with multiple risk factors. Although COPD increases vulnerability to air pollution, individuals with COPD and other individual risk factors are at the intersection of multiple risks and may be especially susceptible to the effect of acute outdoor air pollution.

Research question: What is the association between wintertime air pollution and mortality in patients with COPD and the modifying role of individual risk factors?

Study design and methods: This study evaluated 19,243 deceased veterans with prior COPD diagnosis who had resided in 25 US metropolitan regions (2016-2019). Electronic health records included patient demographic characteristics; smoking status; and comorbidities such as asthma, coronary artery disease (CAD), obesity, and diabetes. Using geocoded addresses, individuals were assigned wintertime fine particulate matter (particulate matter smaller than 2.5 μg in diameter [PM_2.5]) and nitrogen dioxide air pollution exposures. Associations between acute air pollution and mortality were estimated by using a time-stratified case-crossover design with a conditional logistic model, and individual risk differences were assessed according to stratified analysis.

Results: A 1.05 (95% CI, 1.02-1.09) mortality risk was estimated for each 10 μg/m³ increase in daily wintertime PM_2.5). Older patients and Black individuals displayed elevated risk. Obesity was a substantial air pollution-related mortality risk factor (OR, 1.11; 95% CI, 1.01-1.23), and the estimated risk for individuals with obesity plus CAD or obesity plus diabetes was 16% higher.

Interpretation: Wintertime PM_2.5 exposure was associated with elevated mortality risk in people with COPD, but individuals with multiple comorbidities, notably obesity, had high vulnerability. Our study suggests that obesity, CAD, and diabetes are understudied modifiers of air pollution-related risks for people with existing COPD.

Keywords: COPD; air pollution; coronary artery disease; diabetes; obesity.

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Coronary Artery Disease*
Diabetes Mellitus* / epidemiology
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Humans
Obesity / epidemiology
Particulate Matter / adverse effects
Particulate Matter / analysis
Pulmonary Disease, Chronic Obstructive* / chemically induced
Pulmonary Disease, Chronic Obstructive* / epidemiology
Risk Factors

Substances

Air Pollutants
Particulate Matter