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        Associations between Long-Term Exposure to Chemical Constituents of Fine Particulate Matter (PM <sub>2.5</sub> ) and Mortality in Medicare Enrollees in the Eastern United States

        Chung, Yeonseung,Dominici, Francesca,Wang, Yun,Coull, Brent A.,Bell, Michelle L. U.S. Dept. of Health, Education, and Welfare, Publ 2015 Environmental health perspectives Vol.123 No.5

        <P><B>Background:</B></P><P>Several epidemiological studies have reported that long-term exposure to fine particulate matter (PM<SUB>2.5</SUB>) is associated with higher mortality. Evidence regarding contributions of PM<SUB>2.5</SUB> constituents is inconclusive.</P><P><B>Objectives:</B></P><P>We assembled a data set of 12.5 million Medicare enrollees (≥ 65 years of age) to determine which PM<SUB>2.5</SUB> constituents are <I>a</I>) associated with mortality controlling for previous-year PM<SUB>2.5</SUB> total mass (main effect); and <I>b</I>) elevated in locations exhibiting stronger associations between previous-year PM<SUB>2.5</SUB> and mortality (effect modification).</P><P><B>Methods:</B></P><P>For 518 PM<SUB>2.5</SUB> monitoring locations (eastern United States, 2000–2006), we calculated monthly mortality rates, monthly long-term (previous 1-year average) PM<SUB>2.5</SUB>, and 7-year averages (2000–2006) of major PM<SUB>2.5</SUB> constituents [elemental carbon (EC), organic carbon matter (OCM), sulfate (SO<SUB>4</SUB><SUP>2–</SUP>), silicon (Si), nitrate (NO<SUB>3</SUB><SUP>–</SUP>), and sodium (Na)] and community-level variables. We applied a Bayesian hierarchical model to estimate location-specific mortality rates associated with previous-year PM<SUB>2.5</SUB> (model level 1) and identify constituents that contributed to the spatial variability of mortality, and constituents that modified associations between previous-year PM<SUB>2.5</SUB> and mortality (model level 2), controlling for community-level confounders.</P><P><B>Results:</B></P><P>One–standard deviation (SD) increases in 7-year average EC, Si, and NO<SUB>3</SUB><SUP>–</SUP> concentrations were associated with 1.3% [95% posterior interval (PI): 0.3, 2.2], 1.4% (95% PI: 0.6, 2.4), and 1.2% (95% PI: 0.4, 2.1) increases in monthly mortality, controlling for previous-year PM<SUB>2.5</SUB>. Associations between previous-year PM<SUB>2.5</SUB> and mortality were stronger in combination with 1-SD increases in SO<SUB>4</SUB><SUP>2–</SUP> and Na.</P><P><B>Conclusions:</B></P><P>Long-term exposures to PM<SUB>2.5</SUB> and several constituents were associated with mortality in the elderly population of the eastern United States. Moreover, some constituents increased the association between long-term exposure to PM<SUB>2.5</SUB> and mortality. These results provide new evidence that chemical composition can partly explain the differential toxicity of PM<SUB>2.5</SUB>.</P><P><B>Citation:</B></P><P>Chung Y, Dominici F, Wang Y, Coull BA, Bell ML. 2015. Associations between long-term exposure to chemical constituents of fine particulate matter (PM<SUB>2.5</SUB>) and mortality in Medicare enrollees in the eastern United States. Environ Health Perspect 123:467–474; http://dx.doi.org/10.1289/ehp.1307549</P>

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