Environment/Climate Change
Beyond race and income: the role of contextual deprivation in air pollution and cardiovascular disease Jiajun Luo* Jiajun Luo Zhihao Jin Briseis Aschebrook-Kilfoy
Background: Socioeconomically disadvantaged groups are more influenced by fine particulate matter (PM2.5). Previous research primarily examined individual-level socioeconomic factors, but contextual deprivation is usually ignored.
Objective: To assess disparities in PM2.5 exposure effects among subpopulations defined by different socioeconomic characteristics
Method: Data from over 210,000 participants in the All of Us Research Program (up to February 2023) were used to estimate hazard ratios (HRs) and exposure-response curves for PM2.5 exposure and heart attack or stroke incidents. Subpopulations were categorized by contextual deprivation (less/more deprived), household income (above/below $50K), and race/ethnicity (non-Hispanic White/Black). Ratio of hazard ratios (RHRs) measured disparities among these groups.
Results: Lower PM2.5 levels correlated with reduced heart attack and stroke risks across all participants. However, disadvantaged groups (more deprived, income under $50K, non-Hispanic Black) showed greater benefits from reduced PM2.5 levels. The disparities were most pronounced in groups defined by contextual deprivation. For instance, reducing PM2.5 from 12 to 6 μg/m3, the HR (95% confidence interval) for stroke was 0.86 (0.64-1.16) in the less deprived vs. 0.26 (0.18-0.36) in the more deprived; 0.62 (0.39-1.00) in the over $50K vs. 0.41 (0.27-0.63) in the under $50K; 0.59 (0.41-0.85) in non-Hispanic Whites vs. 0.22 (0.13-0.37) in non-Hispanic Blacks. The RHR was highest for contextual deprivation (3.35 [2.13-5.27]), compared to income (1.52 [0.79-2.92]) and race (2.70 [1.40-5.22]).
Conclusion: While individual race and income remain undeniably crucial for the unequal impacts of PM2.5, our findings suggest that contextual deprivation is a more robust socioeconomic characteristic modifying the effect of PM2.5 exposure.
