Chronic Fine and Coarse Particulate Exposure, Mortality, and Coronary Heart Disease in the Nurses’ Health Study

BACKGROUND The relationship of fine particulate matter < 2.5 microm in diameter (PM(2.5)) air pollution with mortality and cardiovascular disease is well established, with more recent long-term studies reporting larger effect sizes than earlier long-term studies. Some studies have suggested the coarse fraction, particles between 2.5 and 10 microm (PM(10-2.5)), may also be important. With respect to mortality and cardiovascular events, questions remain regarding the relative strength of effect sizes for chronic exposure to fine and coarse particles. OBJECTIVES We examined the relationship of chronic PM(2.5) and PM(10-2.5) exposures with all-cause mortality and fatal and nonfatal incident coronary heart disease (CHD), adjusting for time-varying covariates. METHODS The current study included women from the Nurses' Health Study living in metropolitan areas of the northeastern and midwestern United States. Follow-up was from 1992 to 2002. We used geographic information systems-based spatial smoothing models to estimate monthly exposures at each participant's residence. RESULTS We found increased risk of all-cause mortality [hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.02-1.54] and fatal CHD (HR = 2.02; 95% CI, 1.07-3.78) associated with each 10-microg/m(3) increase in annual PM(2.5) exposure. The association between fatal CHD and PM(10-2.5) was weaker. CONCLUSIONS Our findings contribute to growing evidence that chronic PM(2.5) exposure is associated with risk of all-cause and cardiovascular mortality.