空气污染与种族和社会阶层交叉处的死亡率。
Air Pollution and Mortality at the Intersection of Race and Social Class.
机构信息
From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.).
出版信息
N Engl J Med. 2023 Apr 13;388(15):1396-1404. doi: 10.1056/NEJMsa2300523. Epub 2023 Mar 24.
BACKGROUND
Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM pollution than high-income Americans. Because information is lacking on exposure-response curves for PM exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM standards.
METHODS
We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible).
RESULTS
Lower PM exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM levels decreased. For example, the hazard ratio associated with decreasing PM from 12 μg per cubic meter to 8 μg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation.
CONCLUSIONS
Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).
背景
与美国白人相比，美国黑人每年接触的细颗粒物（空气动力学直径≤2.5μm 的颗粒[PM]）空气污染水平更高，而且可能更容易受到其健康影响。美国低收入人群可能比高收入人群更容易受到 PM 污染的影响。由于缺乏按种族和社会经济地位分类的边缘化亚人群的 PM 暴露与死亡率之间的暴露-反应曲线的信息，环境保护局缺乏重要证据来为其 PM 标准的监管规则制定提供信息。
方法
我们分析了 2000 年至 2016 年期间来自 7300 万 65 岁或以上人群的 Medicare 数据中的 6.23 亿人年，以估计种族身份（黑人与白人）和收入水平（符合医疗补助条件与不符合条件）同时定义的亚人群中，每年 PM 暴露与死亡率之间的关联。
结果
在全人群中，较低的 PM 暴露与较低的死亡率相关，但随着 PM 水平的降低，边缘化亚人群似乎获益更多。例如，对于白人高收入亚人群，从每立方米 12μg 降至每立方米 8μg 的 PM 时，相关风险比为 0.963（95%置信区间[CI]，0.955 至 0.970），而边缘化亚人群的等效风险比则较低：黑人高收入亚人群为 0.931（95%CI，0.909 至 0.953），白人低收入亚人群为 0.940（95%CI，0.931 至 0.948），黑人低收入亚人群为 0.939（95%CI，0.921 至 0.957）。
结论
高收入黑人、低收入白人以及低收入黑人可能比高收入白人从较低的 PM 水平中获益更多。这些发现强调了在评估健康不平等时，将种族身份和收入结合起来考虑的重要性。（由美国国立卫生研究院和阿尔弗雷德·P·斯隆基金会资助）。
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