Academic journal article Environmental Health Perspectives

Exposure to Traffic-Related Air Pollution in Relation to Progression in Physical Disability among Older Adults

Academic journal article Environmental Health Perspectives

Exposure to Traffic-Related Air Pollution in Relation to Progression in Physical Disability among Older Adults

Article excerpt

Introduction

Aging-related physical disability has become a critical health concern because of its high associated health care costs and because of the rapidly growing number of older Americans (Administration on Aging 2009; Federal Interagency Forum on AgingRelated Statistics 2010). Disability represents the combined impact of common, often comorbid chronic diseases and subclinical pathologic processes on a person's ability to perform tasks and activities that are essential for self-care and independent living. Regarded as a key indicator of overall health in older adulthood (Manton et al. 1997; Pope and Tarlov 1991), disability becomes increasingly prevalent with advancing age, from ~10% among 65- to 74-year-olds in the United States to > 50% of those > 85 years old (Manton et al. 2006; Seeman et al. 2010). Disability is the primary reason for the requirement of long-term care (Kemper 1992; McKinlay et al. 1995) and accounted for $350 billion in Medicare costs in 2009 (Manton et al. 2007). Therefore, reducing the number of disability-affected years during late life is of interest because disability threatens an individual's independence and increases both health care utilization and the burden on informal caregivers (Fries 2003).

Exposure to air pollution--particularly long-term exposure--appears to have multiple adverse health effects, including increased risks for cardiovascular and respiratory disease [Brook et al. 2010; Brunekreef et al. 2009; Committee on the Medical Effects of Air Pollutants 2006; Health Effects Institute (HEI) 2010; Pope and Dockery 2006], stroke (Brook et al. 2010; Pope and Dockery 2006; Wellenius et al. 2012b), age-related cognitive decline (Tonne et al. 2014; Weuve et al. 2012a), rheumatoid arthritis (Hart et al. 2009), and diabetes (Andersen et al. 2012; Brook et al. 2010; Chen et al. 2013; Coogan et al. 2012; Kramer et al. 2010; Pearson et al. 2010). High exposures also appear to be associated with pathophysiologic processes that contribute to these conditions (e.g., hypertension, systemic inflammation) (Brook et al. 2010; HEI 2010; Pope and Dockery 2006; Wellenius et al. 2013). Some of these health effects may be more pronounced in older adults (Fischer et al. 2003; Goldberg et al. 2000; Medina-Ramon and Schwartz 2008) in part because of the interplay between exposures and chronic disease processes (Anderson et al. 1990; Annesi-Maesano et al. 2003; Segal et al. 2002). Given that physical disability is a common functional consequence of these subclinical processes and chronic disease conditions (CDC 2009; Black and Rush 2002), it is likely that exposure to air pollution also influences physical disability at advanced ages.

We studied the relationship between long-term exposure to air pollution and the progression of physical disability in older age by combining data from participants in the Chicago Health and Aging Project (CHAP) and exposure estimates derived using a model developed for the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) Study. Our work focused on traffic-related air pollution (TRAP), a major source of exposures to toxic pollutants in urban settings that include but are not limited to nitrogen oxides, carbon moN[O.sub.X]ide, ozone, and ultrafine suspended particles (Adar and Kaufman 2007; HEI 2010). We hypothesized that physical disability would progress faster among those with greater long-term exposure to TRAP. An increasing number of people live in urban areas (United Nations, Department of Economic and Social Affairs, Population Division 2014), where TRAP is highly concentrated but is not uniformly distributed (Jerrett et al. 2005), providing impetus for determining whether TRAP exposure influences the disabling process and for studying this question in intra-urban settings.

Methods

Study Population

We conducted our investigation within CHAP, a longitudinal study of residents of a geographically defined area on the south side of Chicago, IL, who were aged 65 and older (Bienias et al. …

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