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Pollution-Related Mortality and Educational Level
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To the Editor: Dr Pope and colleagues1 found that long-term exposure to air pollution is a risk factor for death from cardiopulmonary disease and lung cancer. It is puzzling that increased mortality risk was observed only in the 41.1% of the population with 12 or fewer years of education. Although this might be a chance finding related to subgroup analysis, a similar result was observed in the reanalysis of the Harvard Six-Cities Air Pollution Study.2 That study also found no pollution-related risk in the 34% of the population with more than 12 years of education. Why are individuals with more education apparently immune to the adverse effects of air pollutants? It is possible that education is a surrogate for some more proximal factors that modify risk, such as lifestyle factors, subsequent occupational exposures, and income.
Income is strongly associated with education. Correlates of income include access to medical care3 and . . . [Full Text of this Article]
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