INTRODUCTION
Air pollution is a risk factor for a variety of cardiopulmonary diseases and
is a contributing factor to cancer, diabetes, and cognitive impairment. The impact on
mortality is not clearly elucidated. Objectives: The goal of this study is to determine the
impact (if any) of air pollution on the 5-year mortality of patients in the American Family
Cohort (AFC) dataset. Methods: The AFC dataset is derived from the American Board of
Family Medicine PRIME Registry electronic health record data. It includes longitudinal
information from 6.6 million unique patients from an estimated 800 primary care practices
across 47 states, with 40% coming from rural areas. The Environmental Protection Agency’s
Air Quality Index (AQI) measures were downloaded for the study period (2016–2022).
Using the Python library pandas, the AFC and EPA datasets were merged with respect to
date, time, and location. Cox Regression Models were performed on the merged dataset to
determine the impact (if any) of air quality on patients’ five-year survival. In the model,
AQI was handled as a time-independent (time-fixed) covariate. Results: The group with
AQI > 50 had an adjusted hazard of death that was 4.02 times higher than the hazard
of death in the group with AQI ≤ 50 (95% CI: 3.36, 4.82, p < 0.05). The hazard of death
was 6.73 times higher in persons older than 80 years of age (95% CI: 5.47, 8.28; p < 0.05)
compared to those younger than 80 years of age. Black/African American patients had a
4.27 times higher hazard of death (95%CI: 3.47, 5.26; p < 0.05) compared to other races. We
also found that regional effects played a role in survival. Conclusions: Poor air quality
was associated with a higher hazard of mortality, and this phenomenon was particularly
pronounced in Black/African American patients and patients older than 80 years of age.
Air pollution is an important social determinant of health. Public health initiatives that
improve air quality are necessary to improve health outcomes.
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