Air Pollution and Individual and Neighborhood Socioeconomic Status: Evidence from the Multi-Ethnic Study of Atherosclerosis (MESA)

By Hajat, Anjum; Diez-Roux, Ana V. et al. | Environmental Health Perspectives, November-December 2013 | Go to article overview

Air Pollution and Individual and Neighborhood Socioeconomic Status: Evidence from the Multi-Ethnic Study of Atherosclerosis (MESA)


Hajat, Anjum, Diez-Roux, Ana V., Adar, Sara D., Auchincloss, Amy H., Lovasi, Gina S., O'Neill, Marie S., Sheppard, Lianne, Kaufman, Joel D., Environmental Health Perspectives


Introduction

A large body of observational studies has documented associations of air pollution with health outcomes including cardiovascular disease, pregnancy outcomes, and asthma and other respiratory problems in children (Brook et al. 2010; Health Effects Institute 2010; Stieb et al. 2012). Because of the observational nature of much of the evidence, concerns are sometimes raised regarding the possibility of residual confounding by other factors. Socioeconomic status (SES) is a major concern as a cause of residual confounding because of its known links to many health outcomes (Adler and Stewart 2010) and because it is associated with air pollution exposures through class-based residential segregation and spatial clustering of air pollution sources (including traffic and point source emissions) (Gee and Payne-Sturges 2004; Mohai et al. 2009). Thus, understanding how SES and air pollution exposure are related is important when trying to infer causality based on statistical associations between air pollution and health and also has implications for a rapidly growing area of research concerning the joint effects of air pollution and SES (among other social factors) on health outcomes (Clougherty and Kubzansky 2009; Morello-Frosch and Shenassa 2006). Furthermore, characterizing the association between SES and air pollution exposures is important in order to understand the causes of disparities in many of the health conditions associated with air pollution.

Several investigations have reported associations between air pollution and SES (see Brulle and Pellow 2006). Few studies have evaluated associations between individual-level SES and air pollution (Marshall 2008). Others have examined community-level factors such as area-level poverty and educational attainment (Bell and Ebisu 2012; Brochu et al. 2011; Buzzelli and Jerrett 2007; Miranda et al. 2011; Yanosky et al. 2008). However, we are aware of only two studies that have simultaneously examined how both individual and neighborhood SES (NSES) are related to air pollution: Cesaroni et al. (2010) and Chaix et al. (2006). Both individual-and neighborhood-level SES constructs have been independently associated with health outcomes, including cardiovascular disease (Diez Roux and Mair 2010). Evidence that both constructs are independently related to air pollution would support the need to adjust for both types of measures when estimating associations between air pollution and health and would suggest that individual- and neighborhood-level socioeconomic disparities in health could be at least partly attributable to air pollution exposures.

Methodological challenges to characterizing the relation between SES and air pollution include the need to use modeling techniques that appropriately account for spatial autocorrelation (Brochu et al. 2011; Buzzelli and Jerrett 2007; Chaix et al. 2006; Jerrett et al. 2001; Yanosky et al. 2008), the need for geographic diversity (Bell and Ebisu 2012; Miranda et al. 2011), and the need for individual-level (as opposed to area-level) estimates of air pollution concentrations (Marshall 2008). Few studies of SES and air pollution have addressed these methodological issues.

A range of broader contextual factors, including the degrees of residential segregation and the spatial location of various SES groups with respect to major sources of air pollution, may modify the associations between SES and air pollution (Gee and Payne-Sturges 2004; Mohai et al. 2009). Although it is important to investigate these patterns across a range of geographic areas to properly assess heterogeneity in associations between SES and air pollution, many previous studies have been limited to a single site (Buzzelli and Jerrett 2007; Cesaroni et al. 2010; Chaix et al. 2006; Grineski et al. 2007; Jerrett et al. 2001; Marshall 2008; Molitor et al. 2011; Yanosky et al. 2008). Evidence of a lack of heterogeneity in associations between SES and air pollution would have important implications with regard to potential confounding by SES and for understanding the extent to which health disparities are attributable to air pollution. …

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