Evaluation of the Sex-and-Age-Specific Effects of PM2.5 on Hospital Readmission in the Presence of the Competing Risk of Mortality in the Medicare Population of Utah 1999–2009
by
Claire L Leiser 1,2,*, Ken R Smith 1,3, James A VanDerslice 4, Jason P Glotzbach 5
, Timothy W Farrell 6,7 and Heidi A Hanson 1,5
Claire L Leiser 1,2,*, Ken R Smith 1,3, James A VanDerslice 4, Jason P Glotzbach 5, Timothy W Farrell 6,7 and Heidi A Hanson 1,5
1
Population Sciences, University of Utah, Huntsman Cancer Institute 2000 Circle of Hope Dr, Ste. 1500, Salt Lake City, UT 84112, USA
2
Department of Epidemiology, University of Washington, Seattle, WA 98105, USA
3
Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT 84112, USA
4
Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84112, USA
5
Department of Surgery, University of Utah, Salt Lake City, UT 84112, USA
6
Department of Medicine, University of Utah, Salt Lake City, UT 84112, USA
7
Veteran’s Affairs Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, UT 84112, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2114; https://doi.org/10.3390/jcm8122114
Received: 12 October 2019 / Revised: 12 November 2019 / Accepted: 19 November 2019 / Published: 2 December 2019
(This article belongs to the Section Epidemiology & Public Health)
Acute ambient air pollution exposure increases risk of cardiac events. We evaluated sex-and-age-specific effects of PM2.5 on hospital readmission and death among 19,602 Medicare beneficiaries (Nevents = 30,510) who survived cardiovascular events including myocardial infarction (MI), heart failure (HF), ischemic heart disease (IHD), and cardiac arrhythmias in Utah from 1999–2009. Fine and Gray regression jointly modeled the effect of PM2.5 on readmission hazard rates while allowing for the competing risk of death. Models were stratified by age and sex and adjusted for Charlson Comorbidity Index, dual enrollment in Medicare Parts A and B, temperature, and household income. There were 2032 cardiac readmissions and 1420 deaths after discharge. Among males age 65–74 years admitted for HF, a 10 μm/m3 increase in PM2.5 was associated with a 30% increase in risk of readmission (p = 0.01). Among females age 75–84 admitted for HF, PM2.5 was associated with a 22% increase in risk of readmission (p = 0.01). Among females age 75–84 years admitted for IHD, PM2.5 was associated with a 25% decrease in readmission (p = 0.01), however this was explained by a 36% increase in risk of death (p = 0.01). Exposure to PM2.5 was associated with increased risk of readmission and death. Associations were dependent upon age, sex, and index condition.
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Keywords:
particulate matter; air pollution; readmission; mortality
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MDPI and ACS Style
Leiser, C.L.; Smith, K.R.; VanDerslice, J.A.; Glotzbach, J.P.; Farrell, T.W.; Hanson, H.A. Evaluation of the Sex-and-Age-Specific Effects of PM2.5 on Hospital Readmission in the Presence of the Competing Risk of Mortality in the Medicare Population of Utah 1999–2009. J. Clin. Med. 2019, 8, 2114.
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