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Racial/ethnic disparities in PM2.5-attributable cardiovascular mortality burden in the United States

Nature Human Behaviour volume 7, pages 2074–2083 (2023)Cite this article

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Abstract

Average ambient fine particulate matter (PM2.5) concentrations have decreased in the US in recent years, but the health benefits of this improvement among different racial/ethnic groups are unknown. We estimate the associations between long-term exposure to ambient PM2.5 and cause-specific cardiovascular disease (CVD) mortality rate and assess the PM2.5-attributable CVD deaths by race/ethnicity across 3,103 US counties during 2001–2016 (n = 595,776 county-months). A 1 µg m−3 increase in PM2.5 concentration was associated with increases of 7.16 (95% confidence interval (CI): 3.81, 10.51) CVD deaths per 1,000,000 Black people per month, significantly higher than the estimates for non-Hispanic white people (1.76 (95% CI: 1.37, 2.15); difference in coefficients: 5.40 (95% CI: 2.03, 8.77), P = 0.001). No significant difference in this association was observed between Hispanic (2.66 (95% CI: −0.03, 5.35)) and non-Hispanic white people (difference in coefficients: 0.90 (95% CI: −1.81, 3.61), P = 0.523). From 2001 to 2016, the absolute disparity in PM2.5-attributable CVD mortality burden was reduced by 44.04% between non-Hispanic Black and white people and by 2.61% between Hispanic and non-Hispanic white people. However, in 2016, the burden remained 3.47 times higher for non-Hispanic Black people and 0.45 times higher for Hispanic people than for non-Hispanic white people. We call for policies that aim to reduce both exposure and vulnerability to PM2.5 for racial/ethnic minorities.

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Fig. 1: Distribution of PM2.5 concentration in all counties in the contiguous US.
Fig. 2: Average annual cardiovascular deaths attributable to PM2.5 (2001–2016).
Fig. 3: Changes in annual cardiovascular deaths attributable to PM2.5 by county and by specific cause from 2001 to 2016.
Fig. 4: Racial/ethnic disparity in annual cardiovascular mortality rates attributable to PM2.5 from 2001 to 2016.

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Data availability

The monthly county-level cause-specific mortality data can be requested from the National Center for Health Statistics (https://www.cdc.gov/nchs/index.htm). Other data that support the findings of this study are available at https://zenodo.org/record/8121894 (https://doi.org/10.5281/zenodo.8121894)57.

Code availability

R code for this analysis is available at https://github.com/CHENlab-Yale/PM2.5_CVD_mortality_US.

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Acknowledgements

E.Z. received support from the National Institute on Aging (R21AG074238-01, E.Z.), the National Institute on Minority Health and Health Disparities (1R01MD017298-01, E.Z.), the Research Education Core of the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342, E.Z.) and the Institution for Social and Policy Studies at Yale University. I.O. received support from the National Institutes on Health Director’s Early Independence Award (DP5OD029636, I.O.). Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R01MD016054 (K.C.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA

    Yiqun Ma & Kai Chen

  2. Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA

    Yiqun Ma & Kai Chen

  3. Department of Sociology, Yale University, New Haven, CT, USA

    Emma Zang

  4. Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA

    Ijeoma Opara

  5. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA

    Yuan Lu & Harlan M. Krumholz

  6. Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA

    Yuan Lu & Harlan M. Krumholz

  7. Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA

    Harlan M. Krumholz

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Contributions

Y.M. conducted formal analyses and drafted the manuscript. K.C. conceived of and supervised the conduct of this study and edited the manuscript. E.Z. applied and managed the mortality dataset, supervised the statistical analysis and revised the manuscript. I.O. contributed to the writing and manuscript revision. Y.L. and H.K. contributed to the interpretation of results and manuscript revision. All authors reviewed and approved the final version of this manuscript.

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Correspondence to Kai Chen.

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Nature Human Behaviour thanks Sebhat Erqou, Srinivasa Katikireddi and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Ma, Y., Zang, E., Opara, I. et al. Racial/ethnic disparities in PM2.5-attributable cardiovascular mortality burden in the United States. Nat Hum Behav 7, 2074–2083 (2023). https://doi.org/10.1038/s41562-023-01694-7

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