title: Spatial analysis of air pollution and mortality in Los Angeles.
abstract: BACKGROUND
  The assessment of air pollution exposure using only community average concentrations may lead to measurement error that lowers estimates of the health burden attributable to poor air quality. To test this hypothesis, we modeled the association between air pollution and mortality using small-area exposure measures in Los Angeles, California.
  
  
  METHODS
  Data on 22,905 subjects were extracted from the American Cancer Society cohort for the period 1982-2000 (5,856 deaths). Pollution exposures were interpolated from 23 fine particle (PM2.5) and 42 ozone (O3) fixed-site monitors. Proximity to expressways was tested as a measure of traffic pollution. We assessed associations in standard and spatial multilevel Cox regression models.
  
  
  RESULTS
  After controlling for 44 individual covariates, all-cause mortality had a relative risk (RR) of 1.17 (95% confidence interval=1.05-1.30) for an increase of 10 mug/m PM2.5 and a RR of 1.11 (0.99-1.25) with maximal control for both individual and contextual confounders. The RRs for mortality resulting from ischemic heart disease and lung cancer deaths were elevated, in the range of 1.24-1.6, depending on the model used. These PM results were robust to adjustments for O3 and expressway exposure.
  
  
  CONCLUSIONS
  Our results suggest the chronic health effects associated with within-city gradients in exposure to PM2.5 may be even larger than previously reported across metropolitan areas. We observed effects nearly 3 times greater than in models relying on comparisons between communities. We also found specificity in cause of death, with PM2.5 associated more strongly with ischemic heart disease than with cardiopulmonary or all-cause mortality.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90089-9011, USA. jerrett@usc.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Jerrett
authors.forename: Richard T
authors.initials: RT
authors.lastname: Burnett
authors.forename: Renjun
authors.initials: R
authors.lastname: Ma
authors.forename: C Arden
authors.initials: CA
authors.lastname: Pope
authors.forename: Daniel
authors.initials: D
authors.lastname: Krewski
authors.forename: K Bruce
authors.initials: KB
authors.lastname: Newbold
authors.forename: George
authors.initials: G
authors.lastname: Thurston
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Shi
authors.forename: Norm
authors.initials: N
authors.lastname: Finkelstein
authors.forename: Eugenia E
authors.initials: EE
authors.lastname: Calle
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thun
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D009026:Mortality / Q000639:trends*; D010316:Particle Size; D016016:Proportional Hazards Models; D018570:Risk Assessment; D017062:Small-Area Analysis