Low-level PM 2.5 exposure, Cardiovascular and Non-accidental Mortality, and Related Health Disparities in 12 U.S. States.

Background: Investigations into long-term fine particulate matter (PM 2.5 ) exposure's impact on non-accidental and cardiovascular (CVD) deaths primarily involve non-representative adult populations at concentrations above the new EPA annual PM 2.5 standard.

Methods: Using generalized linear models, we studied PM 2.5 exposure on rates of five mortality outcomes (all non-accidental, CVD, myocardial infarction (MI), stroke, and congestive heart failure (CHF)) in 12 US States from 2000-2016. We aggregated predicted annual PM 2.5 exposures from a validated ensemble exposure model, ambient temperature from Daymet predictions, and mortality rates to all Census tract-years within the States. We obtained covariates from the decennial Census and the American Community Surveys and assessed effect measure modification by race and education with stratification.

Results: For each 1-ug/m 3 increase in annual PM 2.5 , we found positive associations with all five mortality outcomes: all non-accidental (1.08%; 95% CI: 0.96%, 1.20%), all CVD (1.27%; 95% CI: 1.14%, 1.41%), MI (1.89%; 95% CI: 1.67%, 2.11%), stroke (1.08%; 95% CI: 0.87%, 1.30%) and CHF (2.20%; 95% CI: 1.97%, 2.44%). Positive associations persisted at <8 ug/m 3 PM 2.5 levels and among populations with only under 65. In our study, race, but not education, modifies associations. High-educated Black had a 2.90% larger increased risk of CVD mortality (95% CI: 2.42%, 3.39%) compared to low-educated non-Black.

Conclusion: Long-term PM 2.5 exposure is associated with non-accidental and CVD mortality in 12 states, below the new EPA standard, for both low PM 2.5 regions and the general population. Vulnerability to CVD mortality persists among Black individuals regardless of education level.