Primary Submission Category: Environmental factors
Rural-Urban Differences in Associations between Air Pollution and Cardiovascular Disease Mortality
Authors:Â Yue Sun
Presenting Author: Yue Sun*
Geographic disparities in cardiovascular disease mortality are large in the United States. Recent explanations focus mainly on differences in the population composition of health behaviors and social determinants of health, such as socioeconomic composition. While air pollution is also a known factor in individual-level heart disease burden, it is unclear what role physical environmental conditions, such as air pollution, play in explaining geographic disparities in heart disease mortality. Moreover, the effects of air pollution may be stronger in rural areas because rural residents are more likely to work outdoors and be exposed to outdoor air pollution. In this study, I examine associations between air pollution and county-level cardiovascular disease mortality and how these associations vary across rural and urban areas. To answer these questions, I merged county-level data from multiple sources. Fine particulate matter (PM 2.5) concentration as of 2013-2015 was from the Center for Air, Climate, and Energy Solutions. I calculated age-adjusted cardiovascular disease mortality as of 2016-2018 using the restricted death certificate files of National Vital Statistics System. Using spatial regression models, I find that higher concentrations of PM 2.5 are associated with higher cardiovascular disease mortality rates, controlling for counties’ rural-urban status, gross domestic product, median household income, racial/ethnic composition, health care resources, and prevalence of smoking and excessive drinking. However, the association between PM 2.5 and cardiovascular disease mortality varies across rural and urban counties. PM 2.5 predicts higher cardiovascular disease mortality in rural than in urban areas. These findings reveal the importance of air quality on the cardiovascular disease burden in both urban and rural areas, but raises concerns about the disproportionate burden in rural areas and how PM 2.5 may be contributing to the rural mortality penalty.