This ecological study aimed to assess the association between long-term exposures to outdoor environmental factors and mortality rate from cardiovascular disease (CVD) in a diverse and spatially distributed population from 3,094 counties within the U.S. (n > 3,780,000 CVD deaths) using satellite-derived data of PM2.5 concentrations, sunlight, and maximum heat index. Multivariable logistic regression analyses were conducted to determine whether PM2.5, sunlight and maximum heat index were related to the odds of the total CVD death rate based on gender, race, and age taking into consideration the confounding risk factors of diabetes, obesity, leisure- time physical inactivity, smoking and socioeconomic status. The study has shown that elevated levels of PM2.5, sunlight and heat long-term exposures are significantly associated with an increase in the odds ratio of the total CVD mortality. The results suggest a 9.8% (95% CI = 6.3% - 13.4%), 0.9% (95% CI = 0.5% - 1.2%), and 0.7% (95% CI = 0.5% - 11.2%) increase in total CVD mortality associated with 10 μg/m3 increase in PM2.5 concentrations, 1,000 kJ/m2 increases in sunlight, and 1 oF increase in heat index, respectively. The odds ratios for the CVD death rate due to long-term exposures of PM2.5, sunlight, and heat index were significantly greater than 1.0 for all categories except for Asians, Hispanics, and American Indians, indicating that the effect of long-term exposures to particulate matter, sunlight radiation, and maximum heat on CVD mortality is trivial for Asians, Hispanics, and American Indians. Among the categories of age, the group of 65 years and older had the highest odds ratios, suggesting that the age group of 65 years and older are the most vulnerable group to the environmental exposures of PM2.5 (OR = 1.179, 95% CI = 1.124 - 1.237), sunlight (OR = 1.047, 95% CI = 1.041 - 1.053), and maximum heat (OR = 1.014, 95% CI = 1.011 - 1.016). The odds ratios of CVD mortality due to the environmental exposures were higher for Blacks than those for Whites. The odds ratios for all categories were attenuated with the inclusion of diabetes, obesity, leisure-time physical inactivity, smoking, and income covariates, reflecting the effect of other medical conditions, lifestyle, behavioral and socioeconomic factors on the CVD death rate besides the environmental factors.
Keywords: Fine particulate matter; cardiovascular disease; remote sensing; sunlight, heat index.