Fine particulate matters: The impact of air quality standards on cardiovascular mortality

Background: In 1997 the U.S. Environmental Protection Agency set the first annual National Ambient Air Quality Standard (NAAQS) for fine particulate matter (PM2.5). Although the weight of scientific evidence has determined that a causal relationship exists between PM2.5 exposures and cardiovascular effects, few studies have concluded whether NAAQS-related reductions in PM2.5 led to improvements in public health. Methods: We examined the change in cardiovascular (CV) mortality rate and the association between change in PM2.5 and change in CV-mortality rate before (2000-2004) and after implementation of the 1997 annual PM2.5 NAAQS (2005-2010) among U.S. counties. We further examined how the association varied with respect to two factors related to NAAQS compliance: attainment status and design values (DV). We used difference-in-differences and linear regression models, adjusted for sociodemographic confounders. Findings: Across 619 counties, there were 1.10 (95% CI: 0.37, 1.82) fewer CV-deaths per year per 100,000 people for each 1 g/m(3) decrease in PM2.5. Nonattainment counties had a twofold larger reduction in mean annual PM2.5, 2.1 mu g/m(3), compared to attainment counties, 0.97 mu g/m(3). CV-mortality rate decreased by 0.59 (95% CI: -0.54, 1.71) in nonattainment and 1.96 (95% CI: 0.77, 3.15) deaths per 100,000 people for each 1 mu g/m(3) decrease in PM2.5 in attainment counties. When stratifying counties by DV, results were similar: counties with DV greater than 15 g/m(3) experienced the greatest decrease in mean annual PM2.5 (2.29 g/m(3)) but the smallest decrease in CV-mortality rate per unit decrease in PM2.5, 0.73 (95% CI: 0.57, 2.02). Interpretation: We report a significant association between the change in PM2.5 and the change in CV-mortality rate before and after the implementation of NAAQS and note that the health benefits per 1 mu g/m(3) decrease in PM2.5 persist at levels below the current national standard.