Background: The study aimed to determine latent patterns of geographical distribution of health-related air pollutants across the USA, and to evaluate real-world cumulative effects of these patterns on public health metrics. Methods: It was an ecological study using county-level data on the concentrations of 12 air pollutants (i.e., ozone, CO, NO2 and SO2, PM2.5 mass, and speciation, PM10 mass and speciation, HAPs, VOCs, NONOxNOy and lead) over 20 years, and the rigid measurements of population health including life expectancy at birth, age-specific mortality risks and cause-specific mortality rates (21 mutually exclusive disease groups). Latent class analysis (LCA) was used to identify the common clusters of life expectancy-associated air pollutants based on their concentration characteristics in the final studied counties (n=699). Multivariate linear regression analyses were then applied to assess the relationship between the LCA-derived clusters and health measurements with confounding adjustment. Results: PM2.5 mass, PM10 speciation, and NONOxNOy were associated with life expectancy and thus were included in LCA. Five clusters were identified: the ‘all low’ cluster (n=115, 16.5%), ‘all medium’ cluster (n=285, 40.8%), ‘high particulates’ cluster (n=152, 21.8%), ‘all high’ cluster (n=136, 19.5%) and ‘mixed profile’ cluster (n=11, 1.6%). Cluster with a more severe pollutant profile was associated with a decreasing life expectancy, an increasing mortality risk among the middle-aged and elderly populations (≥45 years), and an increasing mortality rate caused by chronic respiratory conditions, cardiovascular diseases, and neoplasms. Conclusions: Our study brings new perspectives of real-world geographical patterns of air pollution to explain health disparities across the USA.

Study Objectives: To investigate whether gas cooking stove exposure and elevated indoor nitrogen dioxide (NO2) concentration were associated with adverse sleep outcomes in a pediatric sample. Methods: Children from urban neighborhoods in Boston, Massachusetts underwent in-home sleep assessments. Indoor NO2 concentrations were measured continuously over 7 days by devices placed in the participants’ living areas. Primary outcomes were short sleep duration (average 7-day sleep duration <8 h by wrist actigraphy), and sleep-disordered breathing (SDB; ≥5 events/hour with ≥3% desaturation by a home sleep monitor). Associations between gas cooking stove exposure and elevated NO2 (≥ 69.48 ppb) with each sleep outcome were assessed through logistic regression models, adjusting for demographic and socioeconomic factors and season. Sensitivity analyses further adjusted for health conditions, kitchen ventilation, and various sources of indoor NO2. Results: Of the 242 children, 74% (n = 178) were exposed to gas cooking stoves. The median (interquartile range) of the average daily 95th percentile indoor NO2 was 41.1 (38.4) ppb. Children exposed to elevated indoor NO2 level were at a 2.88 increased adjusted odds (95% CI: 1.27, 6.55, p = .012) of short sleep duration compared to children exposed to lower levels. A positive but insignificant relationship between indoor NO2 exposure and SDB was found (odds ratios = 1.23, 0.61, 2.47). Gas cooking stove exposure was unassociated with any sleep outcome. Conclusions: Exposure to elevated indoor NO2 was associated with higher odds of short sleep duration in children. Interventions targeting indoor air quality may provide a novel approach for improving sleep health and reducing pediatric sleep disparities.

Air pollution has been one of the major threats to public health. The study aimed to determine latent patterns of geographical distribution of health-related air pollutants across the USA and to evaluate real-world cumulative effects of these patterns on public health metrics. It was an ecological study using county-level data on the concentrations of 12 air pollutants over 20 years. Latent class analysis was used to identify the common clusters of life expectancy-associated air pollutants based on their concentration characteristics in the final counties studied (n = 699). Multivariate linear regression analyses were then applied to assess the relationship between the LCA-derived clusters and health measurements with confounding adjustment. We found that PM_2.5 mass, PM₁₀ speciation, and NONO_xNO_y (the reactive nitrogen species) were associated with life expectancy and thus were included in LCA. Among five identified clusters, the one with a more severe pollutant profile was associated with a decreasing life expectancy, an increasing mortality risk among middle-aged and elderly populations (≥45 years), and an increasing mortality rate caused by chronic respiratory conditions, cardiovascular diseases, and neoplasms. Our study brings new perspectives on real-world geographical patterns of air pollution to explain health disparities across the USA.