Faculty, Staff and Student Publications
Language
English
Publication Date
4-4-2026
Journal
International Journal of Environmental Research and Public Health
DOI
10.3390/ijerph23040464
PMID
42074403
PMCID
PMC13116330
PubMedCentral® Posted Date
4-4-2026
PubMedCentral® Full Text Version
Post-print
Abstract
Ambient fine particulate matter (PM2.5) is associated with increased mortality at concentrations below current regulatory standards. Studies of low-level exposure often rely on large administrative cohorts whose geographic and demographic composition may influence observed associations. In a prior analysis, we observed an association between long-term PM2.5 and all-cause mortality among Native American Medicare beneficiaries living in zip codes within the lowest decile of PM2.5 exposure. The present study, a case-control analysis of 1,713,399 low-PM2.5-exposed beneficiaries enrolled in traditional Medicare during 2015-2016, evaluated whether this association could be explained by geographic context, socioeconomic position (SEP), or baseline health status. We used principal components analysis to summarize area-level SEP indicators and beneficiary-level chronic disease diagnoses. In fully adjusted pooled models, PM2.5 was more strongly associated with mortality among Native American beneficiaries (odds ratio, OR = 1.12 per ug/m3; 95% CI 1.06-1.18) than among non-Native American beneficiaries (OR = 1.01 per ug/m3; 95% CI 1.001-1.02). Sequential adjustment among Native Americans showed that state-level geographic clustering accounted for most attenuation of the PM2.5 coefficient, with additional modest attenuation after adjustment for SEP and chronic disease patterns. These findings suggest that PM2.5-mortality associations observed in low-exposure populations may partly reflect geographic composition and underlying health differences within these large cohorts.
Keywords
United States, Humans, Particulate Matter, Chronic Disease, Medicare, Female, Environmental Exposure, Indians, North American, Male, Case-Control Studies, Aged, Air Pollutants, Aged, 80 and over, Socioeconomic Disparities in Health, Mortality, Socioeconomic Factors, American Indian or Alaska Native, mortality, fine particulate matter, socioeconomic position, chronic disease, principal components analysis, Medicare, tribal lands
Published Open-Access
yes
Recommended Citation
Judy Wendt Hess and Wenyaw Chan, "Untangling Impacts of Socioeconomic Position, Chronic Disease, and Low-Level PM2.5 Exposure on Mortality Among Native American Medicare Beneficiaries" (2026). Faculty, Staff and Student Publications. 1398.
https://digitalcommons.library.tmc.edu/uthsph_docs/1398