Older adult susceptibility to air pollution health effects is well-recognized. Advanced age may act as a partial surrogate for conditions associated with aging. The authors investigated whether gerontologic frailty (a clinical health status metric) modified the effects of ambient ozone or particulate matter (PM10) air pollution on lung function in 3382 older adults using 7 years of followup data from the Cardiovascular Health Study (CHS) and the CHS Environmental Factors Ancillary Study. Monthly average pollution and annual frailty assessments were related to up to 3 repeated measurements of lung function using novel cumulative summaries of pollution and frailty histories that account for duration as well as concentration. Frailty history was found to modify long-term pollution effects on Forced Vital Capacity (FVC). For example, the decrease in FVC associated with a 70 ppb-month increase in the cumulative sum of monthly average O3 exposure was 8.8 mL (95% confidence interval (CI): 7.4, 10.1) for a woman who had spent the prior 7 years prefrail or frail compared to 3.3 mL (95% CI: 2.7, 4.0) for a similar not frail woman (interaction P<0.001).



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