Residential exposure to traffic-related air pollution and survival after heart failure

Environ Health Perspect. 2008 Apr;116(4):481-5. doi: 10.1289/ehp.10918.


Background: Although patients with heart failure (HF) have been identified as particularly susceptible to the acute effects of air pollution, the effects of long-term exposure to air pollution on patients with this increasingly prevalent disease are largely unknown.

Objective: This study was designed to examine the mortality risk associated with residential exposure to traffic-related air pollution among HF patients.

Methods: A total of 1,389 patients hospitalized with acute HF in greater Worcester, Massachusetts, during 2000 were followed for survival through December 2005. We used daily traffic within 100 and 300 m of residence as well as the distance from residence to major roadways and to bus routes as proxies for residential exposure to traffic-related air pollution. We assessed mortality risks for each exposure variable using Cox proportional hazards models adjusted for prognostic factors.

Results: After the 5-year follow-up, only 334 (24%) subjects were still alive. An interquartile range increase in daily traffic within 100 m of home was associated with a mortality hazard ratio (HR) of 1.15 [95% confidence interval (CI), 1.05-1.25], whereas for traffic within 300 m this association was 1.09 (95% CI, 1.01-1.19). The mortality risk decreased with increasing distance to bus routes (HR = 0.88; 95% CI, 0.81-0.96) and was larger for those living within 100 m of a major roadway or 50 m of a bus route (HR = 1.30; 95% CI, 1.13-1.49). Adjustment for area-based income and educational level slightly attenuated these associations.

Conclusions: Residential exposure to traffic-related air pollution increases the mortality risk after hospitalization with acute HF. Reducing exposure to traffic-related emissions may improve the long-term prognosis of HF patients.

Keywords: air pollution; epidemiology; follow-up studies; heart failure; survival.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Air Pollutants / toxicity*
  • Air Pollution / adverse effects*
  • Environmental Exposure / adverse effects*
  • Female
  • Heart Failure / mortality*
  • Humans
  • Insurance Claim Review
  • Male
  • Motor Vehicles*
  • Prognosis
  • Proportional Hazards Models
  • Residence Characteristics / statistics & numerical data


  • Air Pollutants