Faculty, Staff and Student Publications
Language
English
Publication Date
8-27-2025
Journal
International Journal of Environmental Research and Public Health
DOI
10.3390/ijerph22091340
PMID
41007483
PMCID
PMC12469847
PubMedCentral® Posted Date
8-27-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Fine particulate matter (PM2.5) has been associated with mortality at low concentrations, with higher per-unit risk at lower exposure levels, and no threshold of effect. We examined characteristics of Medicare decedents living in zip codes at the lowest end of the U.S. PM2.5 exposure distribution to determine whether there is a demographic, health or exposure profile of beneficiaries for whom even low PM2.5 exposure is associated with increased mortality. The study included 2,773,647 decedent cases and 27,736,470 non-decedent controls, matched on decile of long-term PM2.5 exposure from among 36 million Medicare fee-for-service beneficiaries enrolled 2015–2016. Outcomes of the study included all-cause and cause-specific mortality, stratified by decile and beneficiary characteristics. Increased PM2.5-related mortality within the lowest exposure decile was found only among Native American beneficiaries, with odds ratios of 1.11 (95% CI, 1.01–1.21) and 1.21 (95% CI, 1.11–1.32) per 1 µg/m3 increase in PM2.5, for those eligible and ineligible for Medicaid, respectively, and was driven by significant increases in selected kidney and cardiovascular outcomes, diabetes, and chronic obstructive pulmonary disease. These results may reflect particular sensitivity to PM2.5; factors varying with PM2.5 at the zip code level, including constituent exposures or social determinants of health; or inaccuracies in exposure estimates.
Keywords
Humans, Particulate Matter, United States, Medicare, Female, Male, Aged, Environmental Exposure, Air Pollutants, Aged, 80 and over, Mortality, Cohort Studies, fine particulate matter, mortality, Medicare, American Indian or Alaska Native
Published Open-Access
yes
Recommended Citation
, "Low-Level PM2.5 Exposure and Mortality in the Medicare Cohort: The Role of Native American Beneficiaries" (2025). Faculty, Staff and Student Publications. 1394.
https://digitalcommons.library.tmc.edu/uthsph_docs/1394