Advertisement
ADVANCED SEARCH

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Finkelstein, M. M. Articles by Sears, M. R. Search for Related Content PubMed PubMed Citation Articles by Finkelstein, M. M. Articles by Sears, M. R. Related Collections Socioeconomic determinants of health Environmental Issues Lung function

Relation between income, air pollution and mortality: a cohort study

From the Program in Occupational Health and Environmental Medicine (M.M. Finkelstein and Verma), the Institute of Environment and Health (M.M. Finkelstein, Jerrett, DeLuca, N. Finkelstein and Verma), the Centre for Spatial Analysis (DeLuca), the Department of Family Medicine (M.M. Finkelstein and Verma), the Health Studies Program, School of Geography and Geology (Jerrett, DeLuca and N. Finkelstein), and the Department of Medicine (Sears), McMaster University, Hamilton, Ont.; and the Departments of Family Medicine and Public Health Sciences (M.M. Finkelstein) and the Department of Medicine (Chapman), University of Toronto, Toronto, Ont.

Correspondence to: Dr. Murray M. Finkelstein, Family Medicine Centre, Ste. 413, Mount Sinai Hospital, Toronto ON M5G 1X5; fax 416 326-7761; murray.finkelstein{at}utoronto.ca

Background: Community levels of air pollution have been associated with variability in mortality rates, but previous studies have inferred exposure to pollutants on a citywide basis. We investigated mortality in relation to neighbourhood levels of income and air pollution in an urban area.

Methods: We identified 5228 people in the Hamilton–Burlington area of southern Ontario who had been referred for pulmonary function testing between 1985 and 1999. Nonaccidental deaths that occurred in this group between 1992 and 1999 were ascertained from the Ontario Mortality Registry. Mean household income was estimated by linking the subjects' postal codes with the 1996 census. Mean neighbourhood levels of total suspended particulates and sulfur dioxide were estimated by interpolation from data from a network of sampling stations. We used proportional hazards regression models to compute mortality risk in relation to income and pollutant levels, while adjusting for pulmonary function, body mass index and diagnoses of chronic disease. Household incomes and pollutant levels were each divided into 2 risk categories (low and high) at the median.

Results: Mean pollutant levels tended to be higher in lower-income neighbourhoods. Both income and pollutant levels were associated with mortality differences. Compared with people in the most favourable category (higher incomes and lower particulate levels), those with all other income–particulate combinations had a higher risk of death from nonaccidental causes (lower incomes and higher particulate levels: relative risk [RR] 2.62, 95% confidence interval [CI] 1.67–4.13; lower incomes and lower particulate levels: RR 1.82, 95% CI 1.30–2.55; higher incomes and higher particulate levels: RR 1.33, 95% CI 1.12–1.57). Similar results were observed for sulfur dioxide. The relative risk was lower at older ages.

Interpretation: Mortality rates varied by neighbourhood of residence in this cohort of people whose lung function was tested. Two of the broader determinants of health — income and air pollution levels — were important correlates of mortality in this population.

This article has been cited by other articles:

				P. Subbarao and M. R Sears The chicken or the egg? Perhaps the egg Arch. Dis. Child., July 1, 2008; 93(7): 552 - 553. [Full Text] [PDF]

				S. H. Downs, C. Schindler, L.-J. S. Liu, D. Keidel, L. Bayer-Oglesby, M. H. Brutsche, M. W. Gerbase, R. Keller, N. Kunzli, P. Leuenberger, et al. Reduced Exposure to PM10 and Attenuated Age-Related Decline in Lung Function N. Engl. J. Med., December 6, 2007; 357(23): 2338 - 2347. [Abstract] [Full Text] [PDF]

				P. Elliott, G. Shaddick, J. C Wakefield, C. d. Hoogh, and D. J Briggs Long-term associations of outdoor air pollution with mortality in Great Britain Thorax, December 1, 2007; 62(12): 1088 - 1094. [Abstract] [Full Text] [PDF]

				O. Laurent, D. Bard, L. Filleul, and C. Segala Effect of socioeconomic status on the relationship between atmospheric pollution and mortality J Epidemiol Community Health, August 1, 2007; 61(8): 665 - 675. [Abstract] [Full Text] [PDF]

				B. Chaix, M. Rosvall, and J. Merlo Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort J Epidemiol Community Health, April 1, 2007; 61(4): 349 - 355. [Abstract] [Full Text] [PDF]

				A. Zeka, A. Zanobetti, and J. Schwartz Individual-Level Modifiers of the Effects of Particulate Matter on Daily Mortality Am. J. Epidemiol., May 1, 2006; 163(9): 849 - 859. [Abstract] [Full Text] [PDF]

				B. Chaix, S. Gustafsson, M. Jerrett, H. Kristersson, T. Lithman, A. Boalt, and J. Merlo Children's exposure to nitrogen dioxide in Sweden: investigating environmental injustice in an egalitarian country. J Epidemiol Community Health, March 1, 2006; 60(3): 234 - 241. [Abstract] [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2003, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.