title: Ozone, Fine Particulate Matter, and Chronic Lower Respiratory Disease Mortality in the United States.
abstract: BACKGROUND
  Short-term effects of air pollution exposure on respiratory disease mortality are well established. However, few studies have examined the effects of long-term exposure, and among those that have, results are inconsistent.
  
  
  OBJECTIVE
  To evaluate long-term association between ambient ozone, fine particulate matter (PM2.5, particles with an aerodynamic diameter of 2.5 μm or less), and chronic lower respiratory disease (CLRD) mortality in the contiguous United States.
  
  
  METHODS
  We fit Bayesian hierarchical spatial Poisson models, adjusting for five county-level covariates (percentage of adults aged ≥65 years, poverty, lifetime smoking, obesity, and temperature), with random effects at state and county levels to account for spatial heterogeneity and spatial dependence.
  
  
  RESULTS
  We derived county-level average daily concentration levels for ambient ozone and PM2.5 for 2001-2008 from the U.S. Environmental Protection Agency's down-scaled estimates and obtained 2007-2008 CLRD deaths from the National Center for Health Statistics. Exposure to ambient ozone was associated with an increased rate of CLRD deaths, with a rate ratio of 1.05 (95% credible interval, 1.01-1.09) per 5-ppb increase in ozone; the association between ambient PM2.5 and CLRD mortality was positive but statistically insignificant (rate ratio, 1.07; 95% credible interval, 0.99-1.14).
  
  
  CONCLUSIONS
  This study links air pollution exposure data with CLRD mortality for all 3,109 contiguous U.S. counties. Ambient ozone may be associated with an increased rate of death from CLRD in the contiguous United States. Although we adjusted for selected county-level covariates and unobserved influences through Bayesian hierarchical spatial modeling, the possibility of ecologic bias remains.
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Hao
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lina
authors.initials: L
authors.lastname: Balluz
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Heather
authors.initials: H
authors.lastname: Strosnider
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Xiao Jun
authors.initials: XJ
authors.lastname: Wen
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Li
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Judith R
authors.initials: JR
authors.lastname: Qualters
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000032:analysis; D001499:Bayes Theorem; D015897:Comorbidity; D004781:Environmental Exposure; D004784:Environmental Monitoring / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010126:Ozone / Q000032:analysis*; D052638:Particulate Matter / Q000032:analysis*; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone
keywords: Bayesian hierarchical spatial models; air pollution; chronic lower respiratory disease mortality