Abstract
We examined the association between average annual fine particulate matter (PM(2.5)) and ozone and first hospital admissions of Medicare participants for stroke, chronic obstructive pulmonary disease (COPD), pneumonia, myocardial infarction (MI), lung cancer, and heart failure (HF). Annual average PM(2.5) and ozone levels were estimated using high-resolution spatio-temporal models. We fit a marginal structural Cox proportional hazards model, using stabilized inverse probability weights (IPWs) to account for the competing risk of death and confounding. Analyses were then repeated after restricting to exposure levels below the current U.S. standards. The results showed that PM(2.5) was significantly associated with an increased hazard of admissions for all studied outcomes; the highest observed being a 6.1% (95% CI: 5.9%-6.2%) increase in the hazard of admissions with pneumonia for each μg/m(3) increase in particulate levels. Ozone was also significantly associated with an increase in the risk of first hospital admissions of all outcomes. The hazard of pneumonia increased by 3.0% (95% CI: 2.9%-3.1%) for each ppb increase in the ozone level. Our results reveal a need to regulate long-term ozone exposure, and that associations persist below current PM(2.5) standards.