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Acharyya S, Kumar SH, Chouksey A, Soni N, Nazeer N, Mishra PK. The enigma of mitochondrial epigenetic alterations in air pollution-induced neurodegenerative diseases. Neurotoxicology 2024:S0161-813X(24)00120-7. [PMID: 39374796 DOI: 10.1016/j.neuro.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/13/2024] [Accepted: 10/02/2024] [Indexed: 10/09/2024]
Abstract
The incidence of neurodegenerative diseases is a growing concern worldwide, affecting individuals from diverse backgrounds. Although these pathologies are primarily associated with aging and genetic susceptibility, their severity varies among the affected population. Numerous studies have indicated air pollution as a significant contributor to the increasing prevalence of neurodegeneration. Cohort studies have provided compelling evidence of the association between prolonged exposure to different air toxicants and cognitive decline, behavioural deficits, memory impairment, and overall neuronal health deterioration. Furthermore, molecular research has revealed that air pollutants can disrupt the body's protective mechanisms, participate in neuroinflammatory pathways, and cause neuronal epigenetic modifications. The mitochondrial epigenome is particularly interesting to the scientific community due to its potential to significantly impact our understanding of neurodegenerative diseases' pathogenesis and their release in the peripheral circulation. While protein hallmarks have been extensively studied, the possibility of using circulating epigenetic signatures, such as methylated DNA fragments, miRNAs, and genome-associated factors, as diagnostic tools and therapeutic targets requires further groundwork. The utilization of circulating epigenetic signatures holds promise for developing novel prognostic strategies, creating paramount point-of-care devices for disease diagnosis, identifying therapeutic targets, and developing clinical data-based disease models utilizing multi-omics technologies and artificial intelligence, ultimately mitigating the threat and prevalence of neurodegeneration.
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Affiliation(s)
- Sayanti Acharyya
- Division of Environmental Biotechnology, Genetics & Molecular Biology (EBGMB), ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, India
| | - Sruthy Hari Kumar
- Division of Environmental Biotechnology, Genetics & Molecular Biology (EBGMB), ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, India
| | - Apoorva Chouksey
- Division of Environmental Biotechnology, Genetics & Molecular Biology (EBGMB), ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, India
| | - Nikita Soni
- Division of Environmental Biotechnology, Genetics & Molecular Biology (EBGMB), ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, India
| | - Nazim Nazeer
- Division of Environmental Biotechnology, Genetics & Molecular Biology (EBGMB), ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, India
| | - Pradyumna Kumar Mishra
- Division of Environmental Biotechnology, Genetics & Molecular Biology (EBGMB), ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, India; Faculty of Medical Research, Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
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Song Z, Lynch K, Parker-Allotey NA, Bennett EE, Xu X, Whitsel EA, Smith R, Stewart JD, Park ES, Ying Q, Power MC. Association of midlife air pollution exposures and residential road proximity with incident dementia: The Atherosclerosis Risk in Communities (ARIC) study. ENVIRONMENTAL RESEARCH 2024; 258:119425. [PMID: 38879108 PMCID: PMC11323165 DOI: 10.1016/j.envres.2024.119425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Increasing evidence links higher air pollution exposures to increased risk of cognitive impairment. While midlife risk factors are often most strongly linked to dementia risk, few studies have considered associations between midlife roadway proximity or ambient air pollution exposure and incident dementia decades later, in late life. OBJECTIVES Our objective was to determine if midlife exposures to ambient air pollution or roadway proximity are associated with increased risk of dementia in the Atherosclerosis Risk in Communities (ARIC) study over up to 29 years of follow-up. METHODS Our eligible sample included Black and White ARIC participants without dementia at Visit 2 (1990-1992). Participants were followed through Visit 7 (2018-2019), with dementia status and onset date defined based on formal dementia ascertainment at study visits, informant interviews, and surveillance efforts. We used adjusted Weibull survival models to assess the associations of midlife ambient air pollution and road proximity with incident dementia. RESULTS The median age at baseline (1990-1992, Visit 2) of the 12,700 eligible ARIC participants was 57.0 years; 56.0% were female, 24.2% were Black, and 78.9% had at least a high school education. Over up to 29 years of follow-up, 2511 (19.8%) persons developed dementia. No associations were found between ambient air pollutants and proximity to major roadways with risk of incident dementia. In exploratory analyses, living closer to roadways in midlife increased dementia risk in individuals younger at baseline and those without midlife hypertension, and there was evidence of increased risk of dementia with increased midlife exposure to NOx, several PM2.5 components, and trace metals among those with diabetes in midlife. CONCLUSIONS Midlife exposure to ambient air pollution and midlife roadway proximity was not associated with dementia risk over decades of follow-up. Further investigation to explore potential for greater susceptibility among specific subgroups identified here is needed.
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Affiliation(s)
- Ziwei Song
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Katie Lynch
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Naa Adoley Parker-Allotey
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Erin E Bennett
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Xiaohui Xu
- School of Public Health, Texas A&M Health Science Center, College Station, TX, United States
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Richard Smith
- Department of Statistics and Operations Research, College of Arts and Sciences, University of North Carolina, Chapel Hill, NC, United States; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Eun Sug Park
- Texas A&M Transportation Institute, Texas A&M University System, College Station, TX, United States
| | - Qi Ying
- Zachry Department of Civil Engineering, Texas A&M University, College Station, TX, 77843, United States
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
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Mohammadzadeh M, Khoshakhlagh AH, Grafman J. Air pollution: a latent key driving force of dementia. BMC Public Health 2024; 24:2370. [PMID: 39223534 PMCID: PMC11367863 DOI: 10.1186/s12889-024-19918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024] Open
Abstract
Many researchers have studied the role of air pollutants on cognitive function, changes in brain structure, and occurrence of dementia. Due to the wide range of studies and often contradictory results, the present systematic review was conducted to try and clarify the relationship between air pollutants and dementia. To identify studies for this review, a systematic search was conducted in Scopus, PubMed, and Web of Science databases (without historical restrictions) until May 22, 2023. The PECO statement was created to clarify the research question, and articles that did not meet the criteria of this statement were excluded. In this review, animal studies, laboratory studies, books, review articles, conference papers and letters to the editors were avoided. Also, studies focused on the effect of air pollutants on cellular and biochemical changes (without investigating dementia) were also excluded. A quality assessment was done according to the type of design of each article, using the checklist developed by the Joanna Briggs Institute (JBI). Finally, selected studies were reviewed and discussed in terms of Alzheimer's dementia and non-Alzheimer's dementia. We identified 14,924 articles through a systematic search in databases, and after comprehensive reviews, 53 articles were found to be eligible for inclusion in the current systematic review. The results showed that chronic exposure to higher levels of air pollutants was associated with adverse effects on cognitive abilities and the presence of dementia. Studies strongly supported the negative effects of PM2.5 and then NO2 on the brain and the development of neurodegenerative disorders in old age. Because the onset of brain structural changes due to dementia begins decades before the onset of disease symptoms, and that exposure to air pollution is considered a modifiable risk factor, taking preventive measures to reduce air pollution and introducing behavioral interventions to reduce people's exposure to pollutants is advisable.
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Affiliation(s)
- Mahdiyeh Mohammadzadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Climate Change and Health Research Center (CCHRC), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Khoshakhlagh
- Department of Occupational Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran.
| | - Jordan Grafman
- Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine & Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
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Oudin A, Raza W, Flanagan E, Segersson D, Jalava P, Kanninen KM, Rönkkö T, Giugno R, Sandström T, Muala A, Topinka J, Sommar J. Exposure to source-specific air pollution in residential areas and its association with dementia incidence: a cohort study in Northern Sweden. Sci Rep 2024; 14:15521. [PMID: 38969679 PMCID: PMC11226641 DOI: 10.1038/s41598-024-66166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
The aim of this study was to investigate the relationship between source-specific ambient particulate air pollution concentrations and the incidence of dementia. The study encompassed 70,057 participants from the Västerbotten intervention program cohort in Northern Sweden with a median age of 40 years at baseline. High-resolution dispersion models were employed to estimate source-specific particulate matter (PM) concentrations, such as PM10 and PM2.5 from traffic, exhaust, and biomass (mainly wood) burning, at the residential addresses of each participant. Cox regression models, adjusted for potential confounding factors, were used for the assessment. Over 884,847 person-years of follow-up, 409 incident dementia cases, identified through national registers, were observed. The study population's average exposure to annual mean total PM10 and PM2.5 lag 1-5 years was 9.50 µg/m3 and 5.61 µg/m3, respectively. Increased risks were identified for PM10-Traffic (35% [95% CI 0-82%]) and PM2.5-Exhaust (33% [95% CI - 2 to 79%]) in the second exposure tertile for lag 1-5 years, although no such risks were observed in the third tertile. Interestingly, a negative association was observed between PM2.5-Wood burning and the risk of dementia. In summary, this register-based study did not conclusively establish a strong association between air pollution exposure and the incidence of dementia. While some evidence indicated elevated risks for PM10-Traffic and PM2.5-Exhaust, and conversely, a negative association for PM2.5-Wood burning, no clear exposure-response relationships were evident.
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Affiliation(s)
- Anna Oudin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden.
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Wasif Raza
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Katja M Kanninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Topi Rönkkö
- Aerosol Physics Laboratory, Physics Unit, Tampere University, Tampere, Finland
| | - Rosalba Giugno
- Computer Science Department, University of Verona, Verona, Italy
| | - Thomas Sandström
- Division of Medicine/Respiratory Medicine, Department of Toxicology and Molecular Epidemiology, Umeå University, Umeå, Sweden
| | - Ala Muala
- Division of Medicine/Respiratory Medicine, Department of Toxicology and Molecular Epidemiology, Umeå University, Umeå, Sweden
| | - Jan Topinka
- Department of Genetic Toxicology and Epigenetics, Institute of Experimental Medicine of the CAS, Prague, Czech Republic
| | - Johan Sommar
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
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Libby TE, Ilango SD, Leary CS, Semmens EO, Adam CE, Fitzpatrick AL, Kaufman JD, Hajat A. An assessment of the mediating role of hypertension in the effect of long-term air pollution exposure on dementia. Environ Epidemiol 2024; 8:e306. [PMID: 38799261 PMCID: PMC11115980 DOI: 10.1097/ee9.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 05/29/2024] Open
Abstract
Background Growing evidence links air pollution exposure to the risk of dementia. We hypothesized that hypertension may partially mediate this effect. Methods We previously documented an association between air pollution and dementia in the Ginkgo Evaluation of Memory Study, a randomized, placebo-controlled trial of 3069 adults ≥75 years across four US sites who were evaluated for dementia every 6 months from 2000-2008. We utilized a two-stage regression approach for causal mediation analysis to decompose the total effect of air pollution on dementia into its natural direct and indirect effect through prevalent hypertension. Exposure to air pollution in the 10 or 20 years before enrollment was assigned using estimates from fine-scale spatial-temporal models for PM2.5, PM10, and NO2. We used Poisson regression models for hypertension and Cox proportional hazard models for time-to-incident all-cause dementia, adjusting for a priori confounders. Results Participants were free of mild cognitive impairment at baseline (n = 2564 included in analyses); 69% had prevalent hypertension at baseline. During follow-up, 12% developed all-cause dementia (Alzheimer's disease [AD] = 212; vascular dementia with or without AD [VaD/AD mixed] = 97). We did not find an adverse effect of any air pollutant on hypertension. Hypertension was associated with VaD/AD mixed (HR, 1.92 [95% CI = 1.14, 3.24]) but not AD. We did not observe mediation through hypertension for the effect of any pollutant on dementia outcomes. Conclusions The lack of mediated effect may be due to other mechanistic pathways and the minimal effect of air pollution on hypertension in this cohort of older adults.
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Affiliation(s)
- Tanya E. Libby
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Sindana D. Ilango
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Cindy S. Leary
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Erin O. Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Claire E. Adam
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Joel D. Kaufman
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, Washington
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Mei Y, Christensen GM, Li Z, Waller LA, Ebelt S, Marcus M, Lah JJ, Wingo AP, Wingo TS, Hüls A. Joint effects of air pollution and neighborhood socioeconomic status on cognitive decline - Mediation by depression, high cholesterol levels, and high blood pressure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 923:171535. [PMID: 38453069 DOI: 10.1016/j.scitotenv.2024.171535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Air pollution and neighborhood socioeconomic status (N-SES) are associated with adverse cardiovascular health and neuropsychiatric functioning in older adults. This study examines the degree to which the joint effects of air pollution and N-SES on the cognitive decline are mediated by high cholesterol levels, high blood pressure (HBP), and depression. In the Emory Healthy Aging Study, 14,390 participants aged 50+ years from Metro Atlanta, GA, were assessed for subjective cognitive decline using the cognitive function instrument (CFI). Information on the prior diagnosis of high cholesterol, HBP, and depression was collected through the Health History Questionnaire. Participants' census tracts were assigned 3-year average concentrations of 12 air pollutants and 16 N-SES characteristics. We used the unsupervised clustering algorithm Self-Organizing Maps (SOM) to create 6 exposure clusters based on the joint distribution of air pollution and N-SES in each census tract. Linear regression analysis was used to estimate the effects of the SOM cluster indicator on CFI, adjusting for age, race/ethnicity, education, and neighborhood residential stability. The proportion of the association mediated by high cholesterol levels, HBP, and depression was calculated by comparing the total and direct effects of SOM clusters on CFI. Depression mediated up to 87 % of the association between SOM clusters and CFI. For example, participants living in the high N-SES and high air pollution cluster had CFI scores 0.05 (95 %-CI:0.01,0.09) points higher on average compared to those from the high N-SES and low air pollution cluster; after adjusting for depression, this association was attenuated to 0.01 (95 %-CI:-0.04,0.05). HBP mediated up to 8 % of the association between SOM clusters and CFI and high cholesterol up to 5 %. Air pollution and N-SES associated cognitive decline was partially mediated by depression. Only a small portion (<10 %) of the association was mediated by HBP and high cholesterol.
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Affiliation(s)
- Yiyang Mei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Aliza P Wingo
- Division of Mental Health, Atlanta VA Medical Center, Decatur, GA, USA; Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas S Wingo
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA; Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Tian F, Qian Z, Zhang Z, Liu Y, Wu G, Wang C, McMillin SE, Bingheim E, Lin H. Air pollution, APOE genotype and risk of dementia among individuals with cardiovascular diseases: A population-based longitudinal study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 347:123758. [PMID: 38492747 DOI: 10.1016/j.envpol.2024.123758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
Individuals with cardiovascular disease (CVD) are particularly vulnerable to dementia, but it remains unclear whether air pollution exposure links with higher risk of dementia among those with CVD. The data were derived from the UK Biobank study (UKB). Dementia-free participants with CVD at baseline were included. Air pollution exposure was assessed through land use regression models, including particulate matter (PM2.5, PM2.5-10, and PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOX). A Cox proportional hazards model was used to investigate the associations between air pollution exposure and incident dementia among individuals with CVD. Air pollution was associated with dementia among individuals with CVD, and the hazard ratios of dementia associated with each interquartile range (IQR) μg/m3 increase in air pollution were 1.07 (95% CI: 1.02, 1.12) for PM2.5, 1.10 (95% CI: 1.04, 1.15) for PM10, 1.08 (95% CI: 1.03, 1.14) for NO2 and 1.05 (95% CI: 1.00, 1.09) for NOx. Associations between air pollution and all-cause dementia were found to be significant among individuals with hypertension. Adverse effects of air pollution were also observed for Alzheimer's dementia (AD) and vascular dementia (VaD), with a higher effect for AD. Observed associations remained similar in subgroups of APOE ε4 carriers and noncarriers, although there was a higher risk difference across different air pollution concentration among these individuals carrying APOE ε4. Air pollution emerges as a critical risk factor for dementia among individuals with CVD, regardless of genetic susceptibility indicated by the APOE genotype. Notably, individuals with hypertension might be susceptible to the adverse effects of air pollution, leading to a higher incidence of dementia. Understanding these impacts on dementia among individuals with CVD may promote better targeted prevention and clinical management strategies.
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Affiliation(s)
- Fei Tian
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Gan Wu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | | | - Elizabeth Bingheim
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Wu P. Association between polycyclic aromatic hydrocarbons exposure with red cell width distribution and ischemic heart disease: insights from a population-based study. Sci Rep 2024; 14:196. [PMID: 38168482 PMCID: PMC10762247 DOI: 10.1038/s41598-023-50794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
This study investigates the association between polycyclic aromatic hydrocarbon (PAH) exposure, red blood cell distribution width (RDW), and ischemic heart disease (IHD) in a sample of 3003 participants from the National Health and Nutrition Examination Survey (NHANES). We hypothesize that RDW may mediate the effect of hydroxylated PAHs (OH-PAH) on IHD. Logistic regression models reveal significant associations between increased urinary PAH metabolite concentrations and IHD, as well as positive associations between PAH metabolites and RDW. Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) analyses confirm the significant associations of the OH-PAH mixture with IHD and RDW. Mediation analysis demonstrates that RDW partially mediates the relationship between PAH exposure and IHD, accounting for 2-4.6% of the total effects. Our findings highlight the potential underlying mechanisms linking PAH exposure, RDW, and IHD and emphasize the importance of addressing environmental pollutants like PAHs in maintaining cardiovascular health and informing public health policies.
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Affiliation(s)
- Pin Wu
- Department of Hematology, Jiangnan University Medical Center, No. 68 Zhongshan Road, Wuxi, Jiangsu, China.
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Bachand AM, Dell LD. Can Incorrect Analysis of Time-Dependent Exposure Explain Associations between PM2.5 Exposure and Risk of Dementia? J Alzheimers Dis 2024; 97:1931-1937. [PMID: 38339933 DOI: 10.3233/jad-231046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Background Epidemiological studies have reported positive associations between long-term exposure to particulate matter of 2.5 microns or less in diameter (PM2.5) and risk of Alzheimer's disease and other clinical dementia. Many of these studies have analyzed data using Cox Proportional Hazards (PH) regression, which estimates a hazard ratio (HR) for the treatment (in this case, exposure) effect on the time-to-event outcome while adjusting for influential covariates. PM2.5 levels vary over time. As air quality standards for PM2.5 have become more stringent over time, average outdoor PM2.5 levels have decreased substantially. Objective Investigate whether a Cox PH analysis that does not properly account for exposure that varies over time could produce a biased HR of similar magnitude to the HRs reported in recent epidemiological studies of PM2.5 and dementia risk. Methods Simulation analysis. Results We found that the biased HR can affect statistical analyses that consider exposure levels at event times only, especially if PM2.5 levels decreased consistently over time. Furthermore, the direction of such bias is away from the null and of a magnitude that is consistent with the reported estimates of dementia risk in several epidemiological studies of PM2.5 exposure (HR≈1.2 to 2.0). Conclusions This bias can be avoided by correctly assigning exposure to study subjects throughout the entire follow-up period. We recommend that investigators provide a detailed description of how time-dependent exposure variables were accounted for in their Cox PH analyses when they report their results.
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Duchesne J, Carrière I, Artero S, Brickman AM, Maller J, Meslin C, Chen J, Vienneau D, de Hoogh K, Jacquemin B, Berr C, Mortamais M. Ambient Air Pollution Exposure and Cerebral White Matter Hyperintensities in Older Adults: A Cross-Sectional Analysis in the Three-City Montpellier Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:107013. [PMID: 37878794 PMCID: PMC10599635 DOI: 10.1289/ehp12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Growing epidemiological evidence suggests an adverse relationship between exposure to air pollutants and cognitive health, and this could be related to the effect of air pollution on vascular health. OBJECTIVE We aim to evaluate the association between air pollution exposure and a magnetic resonance imaging (MRI) marker of cerebral vascular burden, white matter hyperintensities (WMH). METHODS This cross-sectional analysis used data from the French Three-City Montpellier study. Randomly selected participants 65-80 years of age underwent an MRI examination to estimate their total and regional cerebral WMH volumes. Exposure to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and black carbon (BC) at the participants' residential address during the 5 years before the MRI examination was estimated with land use regression models. Multinomial and binomial logistic regression assessed the associations between exposure to each of the three pollutants and categories of total and lobar WMH volumes. RESULTS Participants' (n = 582 ) median age at MRI was 70.7 years [interquartile range (IQR): 6.1], and 52% (n = 300 ) were women. Median exposure to air pollution over the 5 years before MRI acquisition was 24.3 (IQR: 1.7) μ g / m 3 for PM 2.5 , 48.9 (14.6) μ g / m 3 for NO 2 , and 2.66 (0.60) 10 - 5 / m for BC. We found no significant association between exposure to the three air pollutants and total WMH volume. We found that PM 2.5 exposure was significantly associated with higher risk of temporal lobe WMH burden [odds ratio (OR) for an IQR increase = 1.82 (95% confidence interval: 1.41, 2.36) for the second volume tercile, 2.04 (1.59, 2.61) for the third volume tercile, reference: first volume tercile]. Associations for other regional WMH volumes were inconsistent. CONCLUSION In this population-based study in older adults, PM 2.5 exposure was associated with increased risk of high WMH volume in the temporal lobe, strengthening the evidence on PM 2.5 adverse effect on the brain. Further studies looking at different markers of cerebrovascular damage are still needed to document the potential vascular effects of air pollution. https://doi.org/10.1289/EHP12231.
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Affiliation(s)
- Jeanne Duchesne
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - Isabelle Carrière
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - Sylvaine Artero
- Institute of Functional Genomics (IGF), University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Adam M. Brickman
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, USA
| | - Jerome Maller
- Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia
- General Electric Healthcare, Richmond, Victoria, Australia
| | - Chantal Meslin
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Jie Chen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Bénédicte Jacquemin
- Irset Institut de Recherche en Santé, Environnement et Travail, UMR-S 1085, Inserm, University of Rennes, EHESP, Rennes, France
| | - Claudine Berr
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - Marion Mortamais
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
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Grande G, Hooshmand B, Vetrano DL, Smith DA, Refsum H, Fratiglioni L, Ljungman P, Wu J, Bellavia A, Eneroth K, Bellander T, Rizzuto D. Association of Long-term Exposure to Air Pollution and Dementia Risk: The Role of Homocysteine, Methionine, and Cardiovascular Burden. Neurology 2023; 101:e1231-e1240. [PMID: 37442622 PMCID: PMC10516275 DOI: 10.1212/wnl.0000000000207656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Growing evidence links air pollution with dementia risk, but the biological mechanisms are largely unknown. We investigated the role played by homocysteine (tHcy) and methionine in this association and explored whether this could be explained by cardiovascular diseases (CVDs). METHODS Data were extracted from the ongoing Swedish National study on Aging and Care in Kungsholmen (SNAC-K), a longitudinal population-based study. At baseline, 2,512 dementia-free participants were examined up to 2013 (mean follow-up: 5.18 ± 2.96 years). Two air pollutants (particulate matter ≤2.5 μm [PM2.5] and nitrogen oxides [NOx]) were assessed yearly from 1990 until 2013 using dispersion models at residential addresses. The hazard ratio of dementia over air pollution levels was estimated using Cox models adjusted for age, sex, education, smoking, socioeconomic status, physical activity, retirement age, creatinine, year of assessment, and the use of supplements. The total effect of air pollutants on dementia was decomposed into 4 pathways involving tHcy/methionine: (1) direct effect; (2) indirect effect (mediation); (3) effect due to interaction; and (4) effect due to both mediation and interaction. To test whether the association was independent from CVDs (ischemic heart disease, atrial fibrillation, heart failure, and stroke), we repeated the analyses excluding those individuals who developed CVDs. RESULTS The mean age of the study participants was 73.4 years (SD: 10.4), and 62.1% were female individuals. During an average period of 5 years (mean: 5.18; SD: 2.96 years), 376 cases with incident dementia were identified. There was a 70% increased hazard of dementia per unit increase of PM2.5 during the 5 years before baseline (hazard ratio [HR]: 1.71; 95% CI 1.33-2.09). Overall, 50% (51.6%; 95% CI 9.0-94.1) of the total effect of PM2.5 on dementia was due to mediation of tHcy (6.6%; 95% CI 1.6-11.6) and/or interaction (47.8%; 95% CI 4.9-91.7) with tHcy and 48.4% (p = 0.03) to the direct effect of PM2.5 on dementia. High levels of methionine reduced the dementia hazard linked to PM2.5 by 31% (HR: 0.69; 95% CI 0.56-0.85) with 24.8% attributable to the interaction with methionine and 25.9% (p = 0.001) to the direct effect of PM2.5. No mediation effect was found through methionine. Attenuated results were obtained for NOx. Findings for tHcy were attenuated after excluding those who developed CVDs, while remained similar for methionine. DISCUSSION High levels of homocysteine enhanced the dementia risk attributed to air pollution, while high methionine concentrations reduced this risk. The impact of homocysteine on cardiovascular conditions partly explains this association. Alternative pathways other than cardiovascular mechanisms may be at play between methionine and dementia.
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Affiliation(s)
- Giulia Grande
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden.
| | - Babak Hooshmand
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Davide Liborio Vetrano
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - David A Smith
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Helga Refsum
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Laura Fratiglioni
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Petter Ljungman
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Jing Wu
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Andrea Bellavia
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Kristina Eneroth
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Tom Bellander
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
| | - Debora Rizzuto
- From the Aging Research Center (G.G., B.H., D.L.V., L.F., J.W., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Department of Clinical Geriatrics (B.H.), Klinikum Ingolstadt, Germany; Stockholm Gerontology Research Centre (D.L.V., L.F., D.R.), Sweden; OPTIMA (D.S., H.R.), Department of Pharmacology, University of Oxford, United Kingdom; Department of Nutrition (H.R.), Institute of Basic Medical Sciences University of Oslo, Norway; Institute of Environmental Medicine (IMM) (P.L., T.B.), Karolinska Institutet; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; Department of Environmental Health (A.B.), Harvard T.H. Chan School of Public Health, Boston, MA; and Environment and Health Administration (K.E.), City of Stockholm, Sweden
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Zhang B, Langa KM, Weuve J, D’Souza J, Szpiro A, Faul J, Mendes de Leon C, Kaufman JD, Lisabeth L, Hirth RA, Adar SD. Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia. JAMA Netw Open 2023; 6:e2333470. [PMID: 37728927 PMCID: PMC10512106 DOI: 10.1001/jamanetworkopen.2023.33470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/04/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Fine particulate matter air pollution (PM2.5) has been consistently associated with cardiovascular disease, which, in turn, is associated with an increased risk of dementia. As such, vascular dysfunction might be a mechanism by which PM2.5 mediates dementia risk, yet few prior epidemiological studies have examined this potential mechanism. Objective To investigate whether hypertension and stroke serve as mediators and modifiers of the association of PM2.5 with incident dementia. Design, Setting, and Participants As part of the Environmental Predictors of Cognitive Health and Aging (EPOCH) Project, this cohort study used biennial survey data collected between 1998 and 2016 from respondents of the Health and Retirement Study (HRS), a nationally representative, population-based, cohort in the US. Eligible participants were those over 50 years of age who were free of dementia at baseline and had complete exposure, mediator, outcome, and demographic data from the HRS. Data analysis was conducted from August to November 2022. Exposures Exposure to PM2.5, calculated for the 10 years preceding each person's baseline examination according to residential histories and spatiotemporal models. Main Outcomes and Measures Incident dementia was identified using a validated algorithm based on cognitive testing and informant reports. The 4-way decomposition causal mediation analysis method was used to quantify the degree to which hypertension and stroke mediated or modified the association of PM2.5 with incident dementia after adjustment for individual-level and area-level covariates. Results Among 27 857 participants (mean [SD] age at baseline, 61 [10] years; 15 747 female participants [56.5%]; 19 249 non-Hispanic White participants [69.1%]), 4105 (14.7%) developed dementia during the follow-up period (mean [SD], 10.2 [5.6] years). Among participants with dementia, 2204 (53.7%) had a history of hypertension at baseline and 386 (9.4%) received a diagnosis of hypertension during the follow up. A total of 378 participants (9.2%) had a history of stroke at baseline and 673 (16.4%) developed stroke over the follow-up period. The IQR of baseline PM2.5 concentrations was 10.9 to 14.9 μg/m3. In fully adjusted models, higher levels of PM2.5 (per IQR) were not associated with increased risk of incident dementia (HR, 1.04; 95% CI, 0.98 to 1.11). Although there were positive associations of prevalent stroke (HR, 1.67; 95% CI, 1.48 to 1.88) and hypertension (HR, 1.15; 95% CI, 1.08 to 1.23) with incident dementia compared with those free of stroke and hypertension during follow-up, there was no statistically significant association of PM2.5 with stroke (odds ratio per IQR increment in PM2.5, 1.08; 95%CI, 0.91 to 1.29) and no evidence of an association of PM2.5 with hypertension (odds ratio per IQR increment in PM2.5, 0.99; 95%CI, 0.92 to 1.07). Concordantly, there was no evidence that hypertension or stroke acted as mediators or modifiers of the association of PM2.5 with incident dementia. Although the nonmediated interaction between PM2.5 and hypertension accounted for 39.2% of the total excess association (95% CI, -138.5% to 216.9%), the findings were not statistically significant. Conclusions and Relevance These findings suggest that although hypertension may enhance the susceptibility of individuals to air pollution, hypertension and stroke do not significantly mediate or modify the association of PM2.5 with dementia, indicating the need to investigate other pathways and potential mediators of risk.
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Affiliation(s)
- Boya Zhang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Kenneth M. Langa
- Institute for Social Research, University of Michigan, Ann Arbor
- University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer D’Souza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Adam Szpiro
- Department of Biostatistics, University of Washington, Seattle
| | - Jessica Faul
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Joel D. Kaufman
- Department of Epidemiology, University of Washington, Seattle
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
| | - Lynda Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Richard A. Hirth
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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Song X, Ma Y, Tang J, Peng J, Hu Y, Han Y, Fu X, Luo X, Li X, Ge L, Yang K, Chen Y. Use of GRADE in systematic reviews of health effects on pollutants and extreme temperatures: A cross-sectional survey. J Clin Epidemiol 2023; 159:206-213. [PMID: 37253394 DOI: 10.1016/j.jclinepi.2023.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES (i) To analyze trends and gaps in evidence of health effects on pollutants and extreme temperatures by evidence mapping; (ii) to conduct a cross-sectional survey on the use of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in systematic reviews or meta-analyses (SR/MAs) of health effects on pollutants and extreme temperatures. STUDY DESIGN AND SETTING PubMed, Embase, the Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched until July 7, 2022. SR/MAs investigated health effects of pollutants and extreme temperatures were included. RESULTS Out of 22,658 studies, 312 SR/MAs were included in evidence mapping, and the effects of pollutants on cancer and congenital malformations were new research hotspots. Among 16 SR/MAs involving 108 outcomes that were rated using GRADE, the certainty of evidence was mostly downgraded for inconsistency (50, 42.7%), imprecision (33, 28.2%), and risk of bias (24, 20.5%). In contrast, concentration-response gradient (26, 65.0%) was the main upgrade factor. CONCLUSION GRADE is not widely used in SR/MAs of health effects on pollutants and extreme temperatures. The certainty of evidence is generally low, mainly because of the serious inconsistency or imprecision. Use of the GRADE in SR/MAs of health effects on pollutants and extreme temperatures should strengthen.
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Affiliation(s)
- Xuping Song
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China; McMaster Health Forum, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S4L8, Canada
| | - Yan Ma
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jing Tang
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiali Peng
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yue Hu
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yunze Han
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xinyu Fu
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
| | - Xufei Luo
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiuxia Li
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China
| | - Long Ge
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Kehu Yang
- Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Wang X, Yang C, Lu L, Bai J, Wu H, Chen T, Liao W, Duan Z, Chen D, Liu Z, Ju K. Assessing the causal effect of long-term exposure to air pollution on cognitive decline in middle-aged and older adults - Empirical evidence from a nationwide longitudinal cohort. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 255:114811. [PMID: 36963183 DOI: 10.1016/j.ecoenv.2023.114811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Air pollution remains a risk factor for the global burden of disease. Middle-aged and older people are more susceptible to air pollution because of their declining physical function and are more likely to develop diseases from long-term air pollution exposure. Studies of the effects of air pollution on cognitive function in middle-aged and older adults have been inconsistent. More representative and definitive evidence is needed. This study analysed data from the Chinese Family Panel Study, an ongoing nationwide prospective cohort study, collected in waves 2014, 2016 and 2018. Rigorously tested instrument was selected for analysis and participants' PM2.5 and instrument exposures were assessed using high-precision satellite data. The causal relationship between long-term exposure to air pollution and poor cognitive function in middle-aged and older adults was investigated using the Correlated Random Effects Control Function (CRE-CF) method within a quasi-experimental framework. This study included a total of 7042 participants aged 45 years or older. A comparison of CRE-CF with other models (OLS model, ordered probit model, and ordered probit-CRE model) demonstrated the necessity of using CRE-CF given the endogeneity of air pollution. The credibility and validity of the instrumental variable were verified. In the CRE-CF model, long-term exposure to PM2.5 was found to accelerate cognitive decline in middle-aged and older adults (coefficients of -0.159, -0.336 and -0.244 for the total cognitive, verbal and mathematical scores, respectively). Taken together, these results suggest that chronic exposure to ambient air pollution is associated with cognitive decline in middle-aged and older adults, which highlights the need for appropriate protective policies.
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Affiliation(s)
- Xu Wang
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenyu Yang
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Liyong Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Jing Bai
- Department of neurology, Xijing Hospital, Xi'an 710032, China
| | - Hao Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Ting Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Weibin Liao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongxin Duan
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dapeng Chen
- Department of Economics, Lehigh University, Bethlehem, PA 18015, United States
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
| | - Ke Ju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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15
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Tang J, Chen A, He F, Shipley M, Nevill A, Coe H, Hu Z, Zhang T, Kan H, Brunner E, Tao X, Chen R. Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China. ENVIRONMENTAL RESEARCH 2023; 223:115048. [PMID: 36529331 DOI: 10.1016/j.envres.2022.115048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/25/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM2.5 associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM2.5 exposure at ≥ 64.5 μg/m3 versus <63.5 μg/m3 and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM2.5 (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM10 (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.
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Affiliation(s)
- Jie Tang
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK; Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Anthony Chen
- Faculty of Sciences and Technology, Middlesex University, UK
| | - Fan He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, UK
| | - Alan Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Hugh Coe
- Centre for Atmospheric Science, University of Manchester, UK
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, China
| | - Tao Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Haidong Kan
- School of Public Health, Fudan University, China
| | - Eric Brunner
- Department of Epidemiology and Public Health, University College London, UK
| | - Xuguang Tao
- Division of Occupational and Environmental Medicine, Johns Hopkins School of Medicine, John Hopkins University, USA
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK; Division of Occupational and Environmental Medicine, Johns Hopkins School of Medicine, John Hopkins University, USA.
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16
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Shim JI, Byun G, Lee JTT. Long-term exposure to particulate matter and risk of Alzheimer's disease and vascular dementia in Korea: a national population-based Cohort Study. Environ Health 2023; 22:35. [PMID: 37060077 PMCID: PMC10105439 DOI: 10.1186/s12940-023-00986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND The prevalence of age-related neurodegenerative diseases has risen in conjunction with an increase in life expectancy. Although there is emerging evidence that air pollution might accelerate or worsen dementia progression, studies on Asian regions remains limited. This study aimed to investigate the relationship between long-term exposure to PM10 and the risk of developing Alzheimer's disease and vascular dementia in the elderly population in South Korea. METHODS The baseline population was 1.4 million people aged 65 years and above who participated in at least one national health checkup program from the National Health Insurance Service between 2008 and 2009. A nationwide retrospective cohort study was designed, and patients were followed from the date of cohort entry (January 1, 2008) to the date of dementia occurrence, death, moving residence, or the end of the study period (December 31, 2019), whichever came first. Long-term average PM10 exposure variable was constructed from national monitoring data considering time-dependent exposure. Extended Cox proportional hazard models with time-varying exposure were used to estimate hazard ratios (HR) for Alzheimer's disease and vascular dementia. RESULTS A total of 1,436,361 participants were selected, of whom 167,988 were newly diagnosed with dementia (134,811 with Alzheimer's disease and 12,215 with vascular dementia). The results show that for every 10 µg/m3 increase in PM10, the HR was 0.99 (95% CI 0.98-1.00) for Alzheimer's disease and 1.05 (95% CI 1.02-1.08) for vascular dementia. Stratified analysis according to sex and age group showed that the risk of vascular dementia was higher in men and in those under 75 years of age. CONCLUSION The results found that long-term PM10 exposure was significantly associated with the risk of developing vascular dementia but not with Alzheimer's disease. These findings suggest that the mechanism behind the PM10-dementia relationship could be linked to vascular damage.
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Affiliation(s)
- Jung-Im Shim
- College of Health Science, Korea University, Seoul, 02841, Republic of Korea.
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, 04933, Republic of Korea.
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Korea
| | - Jong-Tae T Lee
- College of Health Science, Korea University, Seoul, 02841, Republic of Korea.
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Korea.
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17
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Wilker EH, Osman M, Weisskopf MG. Ambient air pollution and clinical dementia: systematic review and meta-analysis. BMJ 2023; 381:e071620. [PMID: 37019461 PMCID: PMC10498344 DOI: 10.1136/bmj-2022-071620] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To investigate the role of air pollutants in risk of dementia, considering differences by study factors that could influence findings. DESIGN Systematic review and meta-analysis. DATA SOURCES EMBASE, PubMed, Web of Science, Psycinfo, and OVID Medline from database inception through July 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that included adults (≥18 years), a longitudinal follow-up, considered US Environmental Protection Agency criteria air pollutants and proxies of traffic pollution, averaged exposure over a year or more, and reported associations between ambient pollutants and clinical dementia. Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using the Risk of Bias In Non-randomised Studies of Exposures (ROBINS-E) tool. A meta-analysis with Knapp-Hartung standard errors was done when at least three studies for a given pollutant used comparable approaches. RESULTS 2080 records identified 51 studies for inclusion. Most studies were at high risk of bias, although in many cases bias was towards the null. 14 studies could be meta-analysed for particulate matter <2.5 µm in diameter (PM2.5). The overall hazard ratio per 2 μg/m3 PM2.5 was 1.04 (95% confidence interval 0.99 to 1.09). The hazard ratio among seven studies that used active case ascertainment was 1.42 (1.00 to 2.02) and among seven studies that used passive case ascertainment was 1.03 (0.98 to 1.07). The overall hazard ratio per 10 μg/m3 nitrogen dioxide was 1.02 ((0.98 to 1.06); nine studies) and per 10 μg/m3 nitrogen oxide was 1.05 ((0.98 to 1.13); five studies). Ozone had no clear association with dementia (hazard ratio per 5 μg/m3 was 1.00 (0.98 to 1.05); four studies). CONCLUSION PM2.5 might be a risk factor for dementia, as well as nitrogen dioxide and nitrogen oxide, although with more limited data. The meta-analysed hazard ratios are subject to limitations that require interpretation with caution. Outcome ascertainment approaches differ across studies and each exposure assessment approach likely is only a proxy for causally relevant exposure in relation to clinical dementia outcomes. Studies that evaluate critical periods of exposure and pollutants other than PM2.5, and studies that actively assess all participants for outcomes are needed. Nonetheless, our results can provide current best estimates for use in burden of disease and regulatory setting efforts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021277083.
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Affiliation(s)
- Elissa H Wilker
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Environmental Heath, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marwa Osman
- Department of Environmental Heath, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Environmental Heath, Harvard TH Chan School of Public Health, Boston, MA, USA
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18
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Zhang Z, Chen L, Wang X, Wang C, Yang Y, Li H, Cai M, Lin H. Associations of Air Pollution and Genetic Risk With Incident Dementia: A Prospective Cohort Study. Am J Epidemiol 2023; 192:182-194. [PMID: 36269005 DOI: 10.1093/aje/kwac188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/02/2022] [Accepted: 10/18/2022] [Indexed: 02/07/2023] Open
Abstract
Evidence on the association between air pollution and dementia is accumulating but still inconclusive, and the potential effect modification by genetics is unclear. We investigated the joint effects of air pollution exposure and genetic risk on incident dementia in a prospective cohort study, the UK Biobank study. Land use regression models were used to estimate exposure to ambient particulate matter (PM) in 3 fraction sizes (PM with diameter < 2.5 μm (PM2.5), coarse particles (PM with diameter 2.5-10 μm (PMc)), and PM with diameter < 10 μm (PM10)), PM2.5 absorbance, nitrogen dioxide levels, and nitrogen oxide levels at each individual's baseline residence. A polygenic risk score was calculated as a quantitative measure of genetic dementia risk. Incident cases of dementia were ascertained through linkage to health administrative data sets. Among the 227,840 participants included in the analysis, 3,774 incident dementia cases (including 1,238 cases of Alzheimer disease and 563 cases of vascular dementia) were identified. After adjustment for a variety of covariates, including genetic factors, positive associations were found between exposure to air pollution-particularly PM10, PM2.5 absorbance, and nitrogen dioxide-and incident all-cause dementia and Alzheimer disease but not vascular dementia. No significant interaction between air pollution and genetics was found, either on the multiplicative scale or on the additive scale. Exposure to air pollution was associated with a higher risk of developing dementia regardless of genetic risk.
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19
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Xie J, Lu C. Is there a casual relation between air pollution and dementia? ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:23248-23262. [PMID: 36322355 PMCID: PMC9628405 DOI: 10.1007/s11356-022-23226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Dementia has been cited as a critical public health risk in the contemporary world, while few empirical researchers try to reveal the casual relationship between air pollutant concentrations (APCs) and dementia, especially given the increasing prevalence of air pollution on a global scale. Accordingly, this paper tries to infer the causal relationship between APCs and dementia. The 59,605 valid data was compiled through a combination of the statistic from the China Family Panel Study, China Environmental Statistics Yearbook, World Meteorological Association and China National Bureau of Statistics. The RD design of this study utilizes the discontinuous variation in APCs and dementia as one crosses the Huai River boundary, which is an arbitrary heating policy that causes the significant difference in APCs between the north and south of China. We used stata17.0 to analyze the data. The results of the RD regression indicated that a 100 μ g/m3 rise in APCs led to an increase of 42.4% in the hazard ratio of suffering dementia (Coeff=-0.58, SD= 0.23, P < 0.05). Meanwhile, heterogeneous models revealed that the hazard ratio of suffering dementia by APCs was more significant in the older compared to younger (coeff= 1.35 vs coeff= 1.55, P < 0.05), male compared to female (coeff= 1.62 vs coeff= 0.71, P < 0.05), smoking compared to non-smoke (coeff= 2.12 vs coeff= 0.93, P < 0.05), and thin groups compared to medium and obesity (coeff= 2.05 vs coeff= 1.22, coeff= 1.28, P < 0.05). In addition, the O3 and SO2 were the air pollutants with the highest (coeff= 1.54, P < 0.05) and lowest effects (coeff= 0.81, P < 0.05) on the hazard ratio of suffering dementia among the five APCs, respectively. And the robustness of the results was ensured by changing the RD bandwidth, polynomial order. The results indicated that APCs significantly induced the hazard ratio of suffering dementia of Chinese residents, which provides empirical evidence in supporting the Chinese government to invest more in combating air pollution and ensure the public health of Chinese residents.
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Affiliation(s)
- Jinchen Xie
- Department of sociology, Xian Jiaotong University, Beilin street, Xian, 86-710000 Shannxi China
| | - Chuntian Lu
- Department of sociology, Xian Jiaotong University, Beilin street, Xian, 86-710000 Shannxi China
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20
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Abolhasani E, Hachinski V, Ghazaleh N, Azarpazhooh MR, Mokhber N, Martin J. Air Pollution and Incidence of Dementia: A Systematic Review and Meta-analysis. Neurology 2023; 100:e242-e254. [PMID: 36288998 DOI: 10.1212/wnl.0000000000201419] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies of association between air pollution and incidence of dementia have shown discrepant results. The aim of this study was to evaluate the association between air pollution and dementia. METHODS In this systematic review and meta-analysis, PubMed, MEDLINE, EMBASE, PsycINFO, Scopus, and Web of Science were searched and updated in August 2021. Population-based cohort studies that reported on hazard ratio (HR) of dementia in association with exposure to fine particulate matter (PM2·5), nitrogen oxides (NOX), nitrogen dioxide (NO2), or ozone (O3) in those aged >40 years were included. Data were extracted by 2 independent investigators. The main outcome was the pooled HR for dementia per increment of pollutant, calculated using a random-effects model. Results were reported in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (registration number: CRD42020219036). RESULTS A total of 20 studies were included in the systematic review, and 17 provided data for the meta-analysis. The total included population was 91,391,296, with 5,521,111 (6%) being diagnosed with dementia. A total of 12, 5, 6, and 4 studies were included in the meta-analyses of PM2·5, NOX, NO2, and O3, respectively. The risk of dementia increased by 3% per 1 μg/m3 increment in PM2·5 (HR, 1.03; 95% CI [1.02-1.05]; I2 = 100%). The association between dementia per 10 μg/m3 increment in NOX (HR, 1.05; 95% CI [0.99-1.13]; I2 = 61%), NO2 (HR, 1.03; 95% CI [1.00-1.07]; I2 = 94%), and O3 levels (HR, 1.01; 95% CI [0.91-1.11]; I2 = 82%) was less clear, although a significant association could not be ruled out, and there was high heterogeneity across studies. DISCUSSION Existing evidence suggests a significant association between exposure to PM2·5 and incidence of dementia and nonsignificant association between dementia and NOX, NO2, and O3 exposure. However, results should be interpreted in light of the small number of studies and high heterogeneity of effects across studies.
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Affiliation(s)
- Ehsan Abolhasani
- From the Department of Epidemiology and Biostatistics (E.A., V.H., M.R.A., J.M), Clinical Neurological Sciences (V.H., M.R.A.), and Neuroscience Program (N.G.), Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Psychiatry (N.M.), Schulich School of Medicine and Dentistry, University of Western Ontario, London; and Department of Anesthesia and Perioperative Medicine (J.M.), MEDICI Centre, Western University, London, ON, Canada
| | - Vladimir Hachinski
- From the Department of Epidemiology and Biostatistics (E.A., V.H., M.R.A., J.M), Clinical Neurological Sciences (V.H., M.R.A.), and Neuroscience Program (N.G.), Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Psychiatry (N.M.), Schulich School of Medicine and Dentistry, University of Western Ontario, London; and Department of Anesthesia and Perioperative Medicine (J.M.), MEDICI Centre, Western University, London, ON, Canada
| | - Nargess Ghazaleh
- From the Department of Epidemiology and Biostatistics (E.A., V.H., M.R.A., J.M), Clinical Neurological Sciences (V.H., M.R.A.), and Neuroscience Program (N.G.), Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Psychiatry (N.M.), Schulich School of Medicine and Dentistry, University of Western Ontario, London; and Department of Anesthesia and Perioperative Medicine (J.M.), MEDICI Centre, Western University, London, ON, Canada
| | - Mahmoud Reza Azarpazhooh
- From the Department of Epidemiology and Biostatistics (E.A., V.H., M.R.A., J.M), Clinical Neurological Sciences (V.H., M.R.A.), and Neuroscience Program (N.G.), Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Psychiatry (N.M.), Schulich School of Medicine and Dentistry, University of Western Ontario, London; and Department of Anesthesia and Perioperative Medicine (J.M.), MEDICI Centre, Western University, London, ON, Canada
| | - Naghmeh Mokhber
- From the Department of Epidemiology and Biostatistics (E.A., V.H., M.R.A., J.M), Clinical Neurological Sciences (V.H., M.R.A.), and Neuroscience Program (N.G.), Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Psychiatry (N.M.), Schulich School of Medicine and Dentistry, University of Western Ontario, London; and Department of Anesthesia and Perioperative Medicine (J.M.), MEDICI Centre, Western University, London, ON, Canada
| | - Janet Martin
- From the Department of Epidemiology and Biostatistics (E.A., V.H., M.R.A., J.M), Clinical Neurological Sciences (V.H., M.R.A.), and Neuroscience Program (N.G.), Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Psychiatry (N.M.), Schulich School of Medicine and Dentistry, University of Western Ontario, London; and Department of Anesthesia and Perioperative Medicine (J.M.), MEDICI Centre, Western University, London, ON, Canada.
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21
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Letellier N, Gutierrez LA, Duchesne J, Chen C, Ilango S, Helmer C, Berr C, Mortamais M, Benmarhnia T. Air quality improvement and incident dementia: Effects of observed and hypothetical reductions in air pollutant using parametric g-computation. Alzheimers Dement 2022; 18:2509-2517. [PMID: 35142029 DOI: 10.1002/alz.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/23/2021] [Accepted: 01/03/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION No evidence exists about the impact of air pollution reduction on incidence of dementia. The aim of this study was to quantify how air quality improvement leads to dementia-incidence benefits. METHODS In the French Three-City cohort (12 years of follow-up), we used parametric g-computation to quantify the expected number of prevented dementia cases under different hypothetical interventions with particulate matter measuring <2.5 μm (PM2.5 ) reductions. RESULTS Among 7051 participants, 789 participants developed dementia. The median PM2.5 reduction between 1990 and 2000 was 12.2 (μg/m3 ). Such a reduction reduced the risk of all-cause dementia (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.76 to 0.95). If all study participants were enjoying a hypothetical reduction of more than 13.10 μg/m3 (median reduction observed in the city of Montpellier), the rate difference was -0.37 (95% CI, -0.57 to -0.17) and the rate ratio was 0.67 (95% CI, 0.50 to 0.84). DISCUSSION These findings highlight the possible substantial benefits of reducing air pollution in the prevention of dementia.
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Affiliation(s)
- Noémie Letellier
- Herbert Wertheim School of Public Health and Human Longevity Science & Scripps Institution of Oceanography, UC San Diego, San Diego, California, USA
| | - Laure-Anne Gutierrez
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Jeanne Duchesne
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Chen Chen
- Herbert Wertheim School of Public Health and Human Longevity Science & Scripps Institution of Oceanography, UC San Diego, San Diego, California, USA
| | - Sindana Ilango
- Department of Epidemiology, University of Washington School of Public Health, Seattle, USA
| | - Catherine Helmer
- Bordeaux Population Health Research Center, Université de Bordeaux, INSERM, UMR 1219, Bordeaux, France
| | - Claudine Berr
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.,Memory Research and Resources Center, Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Marion Mortamais
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science & Scripps Institution of Oceanography, UC San Diego, San Diego, California, USA
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22
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Hu K, He Q. Associations of PM 2.5 intensity and duration with cognitive impairment: A longitudinal analysis of middle-aged and older adults in China. ENVIRONMENTAL RESEARCH 2022; 215:114261. [PMID: 36096172 DOI: 10.1016/j.envres.2022.114261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/22/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Long-term exposure to air pollution is associated with a higher risk of cognitive impairment; however, the understanding of this association is incomplete. We aimed to explore the relationship between fine particulate matter (PM2.5) exposure and cognitive function using a prospective cohort of ageing adults, including 19,389 respondents in four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) linked with the historical PM2.5 concentrations (2000-2018) in China. By extending the measurement of PM2.5 exposure from exposure intensity (averaged PM2.5 concentrations) to exposure duration (the number of months with higher PM2.5 concentrations), we employed two linear models, the fixed-effect and mixed-effect linear models, to estimate the associations between PM2.5 exposure and cognitive impairment, with adjustments for individual and regional covariates. Our findings show that the higher PM2.5 intensity was associated with worse cognitive function, but the associations were only statistically significant in a longer exposure period (more than one year), especially in the 10-year exposure (Coefficient: -0.13; 95% Confidence Interval: -0.22, -0.04). Similar patterns were seen for fully adjusted models of PM2.5 duration: a longer duration in PM2.5 exposure was associated with lower cognitive scores, and the duration with higher cut-off points had stronger effects on cognitive function except for the duration at 75 μg/m3, suggesting a possible coincidence of increasing air pollution and economic development. The stronger exposure to PM2.5 was associated with poorer cognitive function among Chinese adults, while more work is necessary to explore the causal effect of air pollution, independent of individual and contextual background characteristics.
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Affiliation(s)
- Kai Hu
- Department of Sociology, School of Social and Public Administration, East China University of Science and Technology, 130 Meilong Road, Xuhui District, Shanghai, 200237, China; School of Geography and Sustainable Development, University of St Andrews, KY16 9AL, UK.
| | - Qingqing He
- School of Resource and Environmental Engineering, Wuhan University of Technology, Wuhan, 430070, China.
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Trevenen ML, Heyworth J, Almeida OP, Yeap BB, Hankey GJ, Golledge J, Etherton-Beer C, Robinson S, Nieuwenhuijsen MJ, Flicker L. Ambient air pollution and risk of incident dementia in older men living in a region with relatively low concentrations of pollutants: The Health in Men Study. ENVIRONMENTAL RESEARCH 2022; 215:114349. [PMID: 36116491 DOI: 10.1016/j.envres.2022.114349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In areas with moderate to severe air pollution, pollutant concentrations are associated with dementia risk. It is unclear whether the same relationship is present in regions with lower ambient air pollution. OBJECTIVE To determine whether exposure to air pollution is associated with risk of incident dementia in general, and Alzheimer's disease and vascular dementia in particular, in older men living in a relatively low ambient air pollution region. METHODS The cohort comprised 11,243 men residing in Perth, Australia. Participants were aged ≥65 years and free of a dementia diagnosis at time of recruitment in 1996-1999. Incident dementia was identified from recruitment to 2018 via ICD diagnosis codes and subsequent study waves. Concentrations for three air pollutants, nitrogen dioxide (NO2), fine particulate matter less than 2.5 μm in diameter (PM2.5), and black carbon (BC) were estimated at participants' home addresses using land-use regression models. We used Cox proportional hazards regression models adjusting for smoking status, physical activity, BMI, education, and socio-economic status. RESULTS Of 3053 (27.2%) incident cases of dementia, 1670 (54.7%) and 355 (11.6%) had documented Alzheimer's disease and vascular dementia. The average concentration of NO2 was 13.5 (SD 4.4) μg/m3, of PM2.5 was 4.54 (SD 1.6) μg/m3 and of BC was 0.97 (SD 0.29) ×10-5 m-1. None of the air pollutants were associated with incident dementia or Alzheimer's disease. In the unadjusted model, increased exposure to PM2.5 was associated with an increased risk of vascular dementia (for a 5 μg/m3 increase: HR 1.62, 95% CI 1.13, 2.31). However, this association was attenuated following adjustment for confounders (HR 1.39, 95% CI 0.93, 2.08). NO2 and BC were not associated with vascular dementia incidence. DISCUSSION Exposure to air pollution is not associated with increased risk of incident dementia in older men living in a region with relatively low ambient air pollution.
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Affiliation(s)
- Michelle L Trevenen
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
| | - Jane Heyworth
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Osvaldo P Almeida
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Townsville, Queensland, Australia
| | - Christopher Etherton-Beer
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | | | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
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Andersen ZJ, Zhang J, Jørgensen JT, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Monique Verschuren WM, Jöckel KH, So R, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, van der Schouw YT, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH. Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study. ENVIRONMENT INTERNATIONAL 2022; 170:107581. [PMID: 36244228 DOI: 10.1016/j.envint.2022.107581] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Ambient air pollution is an established risk factor for premature mortality from chronic cardiovascular, respiratory and metabolic diseases, while evidence on neurodegenerative diseases and psychiatric disorders remains limited. We examined the association between long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in seven European cohorts. Within the multicenter project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven European cohorts from six countries. Based on the residential addresses, annual mean levels of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), ozone (O3), and 8 PM2.5 components were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and mortality from dementia, psychiatric disorders, and suicide. Of 271,720 participants, 900 died from dementia, 241 from psychiatric disorders, and 164 from suicide, during a mean follow-up of 19.7 years. In fully adjusted models, we observed positive associations of NO2 (hazard ratio [HR] = 1.38; 95 % confidence interval [CI]: 1.13, 1.70 per 10 µg/m3), PM2.5 (HR = 1.29; 95 % CI: 0.98, 1.71 per 5 µg/m3), and BC (HR = 1.37; 95 % CI: 1.11, 1.69 per 0.5 × 10-5/m) with psychiatric disorders mortality, as well as with suicide (NO2: HR = 1.13 [95 % CI: 0.92, 1.38]; PM2.5: HR = 1.19 [95 % CI: 0.76, 1.87]; BC: HR = 1.08 [95 % CI: 0.87, 1.35]), and no association with dementia mortality. We did not detect any positive associations of O3 and 8 PM2.5 components with any of the three mortality outcomes. Long-term exposure to NO2, PM2.5, and BC may lead to premature mortality from psychiatric disorders and suicide.
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Affiliation(s)
- Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Bai L, Benmarhnia T, Chen C, Kwong JC, Burnett RT, van Donkelaar A, Martin RV, Kim J, Kaufman JS, Chen H. Chronic Exposure to Fine Particulate Matter Increases Mortality Through Pathways of Metabolic and Cardiovascular Disease: Insights From a Large Mediation Analysis. J Am Heart Assoc 2022; 11:e026660. [PMID: 36346052 PMCID: PMC9750078 DOI: 10.1161/jaha.122.026660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022]
Abstract
Background Long-term exposure to outdoor fine particulate matter (PM2.5) is the leading environmental risk factor for premature mortality worldwide. Characterizing important pathways through which PM2.5 increases individuals' mortality risk can clarify the PM2.5-mortality relationship and identify possible points of interventions. Recent evidence has linked PM2.5 to the onset of diabetes and cardiovascular disease, but to what extent these associations contribute to the effect of PM2.5 on mortality remains poorly understood. Methods and Results We conducted a population-based cohort study to investigate how the effect of PM2.5 on nonaccidental mortality is mediated by its impacts on incident diabetes, acute myocardial infarction, and stroke. Our study population comprised ≈200 000 individuals aged 20 to 90 years who participated in population-based health surveys in Ontario, Canada, from 1996 to 2014. Follow-up extended until December 2017. Using causal mediation analyses with Aalen additive hazards models, we decomposed the total effect of PM2.5 on mortality into a direct effect and several path-specific indirect effects mediated by diabetes, each cardiovascular event, or both combined. A series of sensitivity analyses were also conducted. After adjusting for various individual- and neighborhood-level covariates, we estimated that for every 1000 adults, each 10 μg/m3 increase in PM2.5 was associated with ≈2 incident cases of diabetes, ≈1 major cardiovascular event (acute myocardial infarction and stroke combined), and ≈2 deaths annually. Among PM2.5-related deaths, 31.7% (95% CI, 17.2%-53.2%) were attributable to diabetes and major cardiovascular events in relation to PM2.5. Specifically, 4.5% were explained by PM2.5-induced diabetes, 22.8% by PM2.5-induced major cardiovascular events, and 4.5% through their interaction. Conclusions This study suggests that a significant portion of the estimated effect of long-term exposure to PM2.5 on deaths can be attributed to its effect on diabetes and cardiovascular diseases, highlighting the significance of PM2.5 on deteriorating cardiovascular health. Our findings should raise awareness among professionals that improving metabolic and cardiovascular health may reduce mortality burden in areas with higher exposure to air pollution.
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Affiliation(s)
| | - Tarik Benmarhnia
- Scripps Institution of OceanographyUniversity of CaliforniaSan Diego, La JollaCA
- Department of Family Medicine and Public HealthUniversity of CaliforniaSan Diego, La JollaCA
| | - Chen Chen
- Scripps Institution of OceanographyUniversity of CaliforniaSan Diego, La JollaCA
| | - Jeffrey C. Kwong
- ICESTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoOntarioCanada
| | - Richard T. Burnett
- Environmental Health Science and Research BureauHealth CanadaOttawaOntarioCanada
| | - Aaron van Donkelaar
- Department of Energy, Environment and Chemical EngineeringWashington UniversitySt LouisMOUSA
| | - Randall V. Martin
- Department of Energy, Environment and Chemical EngineeringWashington UniversitySt LouisMOUSA
| | - JinHee Kim
- Public Health OntarioTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoOntarioCanada
| | - Jay S. Kaufman
- Department of Epidemiology and BiostatisticsMcGill UniversityMontrealQuebecCanada
- Institute for Health and Social PolicyMcGill UniversityMontrealQuebecCanada
| | - Hong Chen
- ICESTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoOntarioCanada
- Environmental Health Science and Research BureauHealth CanadaOttawaOntarioCanada
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26
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Guo J, Xie X, Wu J, Yang L, Ruan Q, Xu X, Wei D, Wen Y, Wang T, Hu Y, Lin Y, Chen M, Wu J, Lin S, Li H, Wu S. Association between fine particulate matter and coronary heart disease: A miRNA microarray analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 313:120163. [PMID: 36122657 DOI: 10.1016/j.envpol.2022.120163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
Several studies have reported an association between residential surrounding particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and coronary heart disease (CHD). However, the underlying biological mechanism remains unclear. To fill this research gap, this study enrolled a residentially stable sample of 942 patients with CHD and 1723 controls. PM2.5 concentration was obtained from satellite-based annual global PM2.5 estimates for the period 1998-2019. MicroRNA microarray and pathway analysis of target genes was performed to elucidate the potential biological mechanism by which PM2.5 increases CHD risk. The results showed that individuals exposed to high PM2.5 concentrations had higher risks of CHD than those exposed to low PM2.5 concentrations (odds ratio = 1.22, 95% confidence interval: 1.00, 1.47 per 10 μg/m3 increase in PM2.5). Systolic blood pressure mediated 6.6% of the association between PM2.5 and CHD. PM2.5 and miR-4726-5p had an interaction effect on CHD development. Bioinformatic analysis demonstrated that miR-4726-5p may affect the occurrence of CHD by regulating the function of RhoA. Therefore, individuals in areas with high PM2.5 exposure and relative miR-4726-5p expression have a higher risk of CHD than their counterparts because of the interaction effect of PM2.5 and miR-4726-5p on blood pressure.
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Affiliation(s)
- Jianhui Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Jieyu Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Le Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Qishuang Ruan
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Xingyan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Donghong Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Yeying Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Tinggui Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Yuduan Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Yawen Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Mingjun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Jiadong Wu
- School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Shaowei Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, 350122, China
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, China.
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27
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Long-term particulate matter 2.5 exposure and dementia: a systematic review and meta-analysis. Public Health 2022; 212:33-41. [DOI: 10.1016/j.puhe.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
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Parra KL, Alexander GE, Raichlen DA, Klimentidis YC, Furlong MA. Exposure to air pollution and risk of incident dementia in the UK Biobank. ENVIRONMENTAL RESEARCH 2022; 209:112895. [PMID: 35149105 PMCID: PMC8976829 DOI: 10.1016/j.envres.2022.112895] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Air pollution may cause inflammatory and oxidative stress damage to the brain, leading to neurodegenerative disease. The association between air pollution and dementia, and modification by apolipoprotein E genotype 4 (APOE-ε4) has yet to be fully investigated. OBJECTIVES To examine associations of air pollution with three types of incident dementias (Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia (VAD)), and their potential modification by APOE-ε4 genotype. METHODS The UK Biobank enrolled >500,000 participants (2006-2010) with ongoing follow-up. We used annual averages of air pollution (PM2.5, PM10, PM2.5-10, PM2.5absorbance, NO2, NOX) for 2010 scaled to interquartile ranges (IQR). We included individuals aged ≥60 years, with no dementia diagnosis prior to January 1, 2010. Time to incident dementia and follow-up time were reported from baseline (January 01, 2010) to last censor event (death, last hospitalization, or loss to follow-up). Cox proportional hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated to estimate the association of air pollutants and incident dementia, and modification of these associations by APOE-ε4. RESULTS Our sample included 187,194 individuals (including N = 680 AD, N = 377 VAD, N = 63 FTD) with a mean follow-up of 7.04 years. We observed consistent associations of PM2.5 with greater risk of all-cause dementia (HR = 1.17, 95% CI: 1.10, 1.24) and AD (HR = 1.17, 95% CI: 1.06, 1.29). NO2 was also associated with greater risk of any incident dementia (HR = 1.18, 95% CI: 1.10, 1.25), AD (HR = 1.15, 95% CI: 1.04, 1.28) and VAD (HR = 1.18, 95% CI: 1.03, 1.35). APOE-ε4 did not modify the association between any air pollutants and dementia. DISCUSSION PM2.5 and NO2 levels were associated with several types of dementia, and these associations were not modified by APOE-ε4. Findings from the UK Biobank support and extend to other epidemiological evidence for the potential association of air pollutants with detrimental brain health during aging.
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Affiliation(s)
- Kimberly L Parra
- Department of Epidemiology & Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA.
| | - Gene E Alexander
- Departments of Psychology and Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, BIO5 Institute, and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - David A Raichlen
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, CA, USA
| | - Yann C Klimentidis
- Department of Epidemiology & Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Melissa A Furlong
- Department of Community, Environment, and Policy, Division of Environmental Health Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Gao Q, Zang E, Bi J, Dubrow R, Lowe SR, Chen H, Zeng Y, Shi L, Chen K. Long-term ozone exposure and cognitive impairment among Chinese older adults: A cohort study. ENVIRONMENT INTERNATIONAL 2022; 160:107072. [PMID: 34979350 PMCID: PMC8821373 DOI: 10.1016/j.envint.2021.107072] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 06/12/2023]
Abstract
Ambient particulate matter pollution has been linked to impaired cognitive performance, but the effect of ambient ozone exposure on cognitive function remains largely unknown. We examined the association of long-term ozone exposure with the risk of cognitive impairment among a national representative cohort of 9,544 Chinese older adults (aged 65 years and over) with baseline normal cognition from the Chinese Longitudinal Healthy Longevity Survey (2005-2018). The ozone exposure of each participant was measured by annual mean ozone concentrations for the county of residence. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We defined cognitive impairment as an MMSE score below 18 points accompanied by an MMSE score that declined ≥ 4 points from baseline. Cox proportional hazards models were applied to explore the association of ozone exposure with cognitive impairment. During the mean follow-up time of 6.5 years, 2,601 older adults developed cognitive impairment. Each 10-μg/m3 increase in annual mean ozone exposure was associated with a 10.4% increased risk of cognitive impairment. The exposure-response relationship between ozone exposure and risk of cognitive impairment showed a linear trend. Sensitivity analyses revealed the association to be robust. We found that older adults from Eastern, Central, and Southern China were particularly susceptible. Our results show that ozone is a risk factor for late-life cognitive decline. Reducing ambient ozone pollution may help delay the onset of cognitive impairment among older adults.
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Affiliation(s)
- Qi Gao
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, United States; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut, United States
| | - Emma Zang
- Department of Sociology, Yale University, New Haven, Connecticut, United States
| | - Jun Bi
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China.
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, United States; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut, United States
| | - Sarah R Lowe
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut, United States; Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States
| | - Huashuai Chen
- Business School of Xiangtan University, Xiangtan, Hunan, China; Center for the Study of Aging and Human Development, Duke Medical School, Durham, NC, United States
| | - Yi Zeng
- Center for the Study of Aging and Human Development, Duke Medical School, Durham, NC, United States; Center for Healthy Aging and Development Studies, National School of Development, Raissun Institute for Advanced Studies, Peking University, Beijing, China
| | - Liuhua Shi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, United States; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut, United States.
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Wu J, Grande G, Stafoggia M, Ljungman P, Laukka EJ, Eneroth K, Bellander T, Rizzuto D. Air pollution as a risk factor for Cognitive Impairment no Dementia (CIND) and its progression to dementia: A longitudinal study. ENVIRONMENT INTERNATIONAL 2022; 160:107067. [PMID: 35032863 DOI: 10.1016/j.envint.2021.107067] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND AIM Accumulation of evidence has raised concern regarding the harmful effect of air pollution on cognitive function, but results are diverging. We aimed to investigate the longitudinal association of long-term exposure to air pollutants and cognitive impairment and its further progression to dementia in older adults residing in an urban area. METHODS Data were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Cognitive impairment, no dementia (CIND) was assessed by a comprehensive neuropsychological battery (scoring ≥1.5 standard deviations below age-specific means in ≥1 cognitive domain). We assessed long-term residential exposure to particulate matters (PM2.5 and PM10) and nitrogen oxides (NOx) with dispersion modeling. The association with CIND was estimated using Cox proportional hazards models with 3-year moving average air pollution exposure. We further estimated the effect of long-term air pollution exposure on the progression of CIND to dementia using Cox proportional hazards models. RESULTS Among 1987 cognitively intact participants, 301 individuals developed CIND during the 12-year follow-up. A 1-μg/m3 increment in PM2.5 exposure was associated with a 75% increased risk of incident CIND (HR = 1.75, 95 %CI: 1.54, 1.99). Weaker associations were found for PM10 (HR for 1-μg/m3 = 1.08, 95 %CI: 1.03-1.14) and NOx (HR for 10 μg/m3 = 1.18, 95 %CI: 1.04-1.33). Among those with CIND at baseline (n = 607), 118 participants developed dementia during follow-up. Results also show that exposure to air pollution was a risk factor for the conversion from CIND to dementia (PM2.5: HR for 1-μg/m3 = 1.90, 95 %CI: 1.48-2.43; PM10: HR for 1-μg/m3 = 1.14, 95 %CI: 1.03-1.26; and NOx: HR for 10 μg/m3 = 1.34, 95 %CI: 1.07-1.69). CONCLUSION We found evidence of an association between long-term exposure to ambient air pollutants and incidence of CIND. Of special interest is that air pollution also was a risk factor for the progression from CIND to dementia.
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Affiliation(s)
- Jing Wu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Massimo Stafoggia
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Service, ASL Rome 1, Rome, Italy
| | - Petter Ljungman
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Kristina Eneroth
- Environment and Health Administration, City of Stockholm, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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A national cohort study (2000-2018) of long-term air pollution exposure and incident dementia in older adults in the United States. Nat Commun 2021; 12:6754. [PMID: 34799599 PMCID: PMC8604909 DOI: 10.1038/s41467-021-27049-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022] Open
Abstract
Air pollution may increase risk of Alzheimer’s disease and related dementias (ADRD) in the U.S., but the extent of this relationship is unclear. Here, we constructed two national U.S. population-based cohorts of those aged ≥65 from the Medicare Chronic Conditions Warehouse (2000–2018), combined with high-resolution air pollution datasets, to investigate the association of long-term exposure to ambient fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with dementia and AD incidence, respectively. We identified ~2.0 million incident dementia cases (N = 12,233,371; dementia cohort) and ~0.8 million incident AD cases (N = 12,456,447; AD cohort). Per interquartile range (IQR) increase in the 5-year average PM2.5 (3.2 µg/m3), NO2 (11.6 ppb), and warm-season O3 (5.3 ppb) over the past 5 years prior to diagnosis, the hazard ratios (HRs) were 1.060 (95% confidence interval [CI]: 1.054, 1.066), 1.019 (95% CI: 1.012, 1.026), and 0.990 (95% CI: 0.987, 0.993) for incident dementias, and 1.078 (95% CI: 1.070, 1.086), 1.031 (95% CI: 1.023, 1.039), and 0.982 (95%CI: 0.977, 0.986) for incident AD, respectively, for the three pollutants. For both outcomes, concentration-response relationships for PM2.5 and NO2 were approximately linear. Our study suggests that exposures to PM2.5 and NO2 are associated with incidence of dementia and AD. Air pollution has been linked to neurodegenerative disease. Here the authors carried out a population-based cohort study to investigate the association between long-term exposure to PM2.5, NO2, and warm-season O3 on dementia and Alzheimer’s disease incidence in the United States.
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Weuve J, Bennett EE, Ranker L, Gianattasio KZ, Pedde M, Adar SD, Yanosky JD, Power MC. Exposure to Air Pollution in Relation to Risk of Dementia and Related Outcomes: An Updated Systematic Review of the Epidemiological Literature. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:96001. [PMID: 34558969 PMCID: PMC8462495 DOI: 10.1289/ehp8716] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Dementia is a devastating neurologic condition that is common in older adults. We previously reviewed the epidemiological evidence examining the hypothesis that long-term exposure to air pollution affects dementia risk. Since then, the evidence base has expanded rapidly. OBJECTIVES With this update, we collectively review new and previously identified epidemiological studies on air pollution and late-life cognitive health, highlighting new developments and critically discussing the merits of the evidence. METHODS Using a registered protocol (PROSPERO 2020 CRD42020152943), we updated our literature review to capture studies published through 31 December 2020, extracted data, and conducted a bias assessment. RESULTS We identified 66 papers (49 new) for inclusion in this review. Cognitive level remained the most commonly considered outcome, and particulate matter (PM) remained the most commonly considered air pollutant. Since our prior review, exposure estimation methods in this research have improved, and more papers have looked at cognitive change, neuroimaging, and incident cognitive impairment/dementia, though methodological concerns remain common. Many studies continue to rely on administrative records to ascertain dementia, have high potential for selection bias, and adjust for putative mediating factors in primary models. A subset of 35 studies met strict quality criteria. Although high-quality studies of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) and cognitive decline generally supported an adverse association, other findings related to PM 2.5 and findings related to particulate matter with aerodynamic diameter ≤ 10 μ m (PM 10 , NO 2 , and NO x ) were inconclusive, and too few papers reported findings with ozone to comment on the likely direction of association. Notably, only a few findings on dementia were included for consideration on the basis of quality criteria. DISCUSSION Strong conclusions remain elusive, although the weight of the evidence suggests an adverse association between PM 2.5 and cognitive decline. However, we note a continued need to confront methodological challenges in this line of research. https://doi.org/10.1289/EHP8716.
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Affiliation(s)
- Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Erin E. Bennett
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Lynsie Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kan Z. Gianattasio
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Meredith Pedde
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jeff D. Yanosky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Melinda C. Power
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
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Wang X, Younan D, Petkus AJ, Beavers DP, Espeland MA, Chui HC, Resnick SM, Gatz M, Kaufman JD, Wellenius GA, Whitsel EA, Manson JE, Chen JC. Ambient Air Pollution and Long-Term Trajectories of Episodic Memory Decline among Older Women in the WHIMS-ECHO Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:97009. [PMID: 34516296 PMCID: PMC8437247 DOI: 10.1289/ehp7668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Episodic memory decline varies by age and underlying neuropathology. Whether ambient air pollution contributes to the heterogeneity of episodic memory decline in older populations remains unclear. OBJECTIVES We estimated associations between air pollution exposures and episodic memory decline according to pollutant, exposure time window, age, and latent class subgroups defined by episodic memory trajectories. METHODS Participants were from the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes. Older women (n = 2,056 ; 74-92 years of age) completed annual (2008-2018) episodic memory assessments using the telephone-based California Verbal Learning Test (CVLT). We estimated 3-y average fine particulate matter [PM with an aerodynamic diameter of ≤ 2.5 μ m (PM 2.5 )] and nitrogen dioxide (NO 2 ) exposures at baseline and 10 y earlier (recent and remote exposures, respectively), using regionalized national universal kriging. Separate latent class mixed models were used to estimate associations between interquartile range increases in exposures and CVLT trajectories in women ≤ 80 and > 80 years of age , adjusting for covariates. RESULTS Two latent classes were identified for women ≤ 80 years of age (n = 828 ), "slow-decliners" {slope = - 0.12 / y [95% confidence interval (CI): - 0.23 , - 0.01 ] and "fast-decliners" [slope = - 1.79 / y (95% CI: - 2.08 , - 1.50 )]}. In the slow-decliner class, but not the fast-decliner class, PM 2.5 exposures were associated with a greater decline in CVLT scores over time, with a stronger association for recent vs. remote exposures [- 0.16 / y (95% CI: - 2.08 , - 0.03 ) per 2.88 μ g / m 3 and - 0.11 / y (95% CI: - 0.22 , 0.01) per 3.27 μ g / m 3 , respectively]. Among women ≥ 80 years of age (n = 1,128 ), the largest latent class comprised "steady-decliners" [slope = - 1.35 / y (95% CI: - 1.53 , - 1.17 )], whereas the second class, "cognitively resilient", had no decline in CVLT on average. PM 2.5 was not associated with episodic memory decline in either class. A 6.25 -ppb increase in recent NO 2 was associated with nonsignificant acceleration of episodic memory decline in the ≤ 80 -y-old fast-decliner class [- 0.21 / y (95% CI: - 0.45 , 0.04)], and in the > 80 -y-old cognitively resilient class [- 0.10 / y (95% CI: - 0.24 , 0.03)] and steady-decliner class [- 0.11 / y (95% CI: - 0.27 , 0.05)]. Associations with recent NO 2 exposure in women > 80 years of age were stronger and statistically significant when 267 women with incident probable dementia were excluded [e.g., - 0.12 / y (95% CI: - 0.22 , - 0.02 ) for the cognitively resilient class]. In contrast with changes in CVLT over time, there were no associations between exposures and CVLT scores during follow-up in any subgroup. DISCUSSION In a community-dwelling U.S. population of older women, associations between late-life exposure to ambient air pollution and episodic memory decline varied by age-related cognitive trajectories, exposure time windows, and pollutants. https://doi.org/10.1289/EHP7668.
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Affiliation(s)
- Xinhui Wang
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Diana Younan
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Andrew J. Petkus
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Daniel P. Beavers
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Mark A. Espeland
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Helena C. Chui
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, Baltimore, Maryland, USA
| | - Margaret Gatz
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Joel D. Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine (General Internal Medicine), and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University, Boston, Massachusetts, USA
| | - Eric A. Whitsel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - JoAnn E. Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiu-Chiuan Chen
- Department of Neurology, University of Southern California, Los Angeles, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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34
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Shaffer RM, Blanco MN, Li G, Adar SD, Carone M, Szpiro AA, Kaufman JD, Larson TV, Larson EB, Crane PK, Sheppard L. Fine Particulate Matter and Dementia Incidence in the Adult Changes in Thought Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:87001. [PMID: 34347531 PMCID: PMC8336685 DOI: 10.1289/ehp9018] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Air pollution may be associated with elevated dementia risk. Prior research has limitations that may affect reliability, and no studies have evaluated this question in a population-based cohort of men and women in the United States. OBJECTIVES We evaluated the association between time-varying, 10-y average fine particulate matter (PM2.5) exposure and hazard of all-cause dementia. An additional goal was to understand how to adequately control for age and calendar-time-related confounding through choice of the time axis and covariate adjustment. METHODS Using the Adult Changes in Thought (ACT) population-based prospective cohort study in Seattle, we linked spatiotemporal model-based PM2.5 exposures to participant addresses from 1978 to 2018. Dementia diagnoses were made using high-quality, standardized, consensus-based protocols at biennial follow-ups. We conducted multivariable Cox proportional hazards regression to evaluate the association between time-varying, 10-y average PM2.5 exposure and time to event in a model with age as the time axis, stratified by apolipoprotein E (APOE) genotype, and adjusted for sex, education, race, neighborhood median household income, and calendar time. Alternative models used calendar time as the time axis. RESULTS We report 1,136 cases of incident dementia among 4,166 individuals with nonmissing APOE status. Mean [mean ± standard deviation (SD)] 10-y average PM2.5 was 10.1 (±2.9) μg/m3. Each 1-μg/m3 increase in the moving average of 10-y PM2.5 was associated with a 16% greater hazard of all-cause dementia [1.16 (95% confidence interval: 1.03, 1.31)]. Results using calendar time as the time axis were similar. DISCUSSION In this prospective cohort study with extensive exposure data and consensus-based outcome ascertainment, elevated long-term exposure to PM2.5 was associated with increased hazard of all-cause dementia. We found that optimal control of age and time confounding could be achieved through use of either age or calendar time as the time axis in our study. Our results strengthen evidence on the neurodegenerative effects of PM2.5. https://doi.org/10.1289/EHP9018.
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Affiliation(s)
- Rachel M. Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Magali N. Blanco
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Ge Li
- VA Northwest Network Mental Illness Research, Education, and Clinical Center, Virginia Puget Sound Health Care System, Seattle, Washington, USA
- Geriatric Research, Education, and Clinical Center, Virginia Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
- Departments of Medicine and Epidemiology, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Timothy V. Larson
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
- Department of Civil & Environmental Engineering, University of Washington, Seattle, Washington, USA
| | - Eric B. Larson
- School of Medicine, University of Washington, Seattle, Washington, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Paul K. Crane
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
- Department of Biostatistics, University of Washington Seattle School of Public Health, Seattle, Washington, USA
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35
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Dos Santos NV, Yariwake VY, Marques KDV, Veras MM, Fajersztajn L. Air Pollution: A Neglected Risk Factor for Dementia in Latin America and the Caribbean. Front Neurol 2021; 12:684524. [PMID: 34367051 PMCID: PMC8339300 DOI: 10.3389/fneur.2021.684524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
The risk of dementia and Alzheimer's disease in Latin America and the Caribbean (LAC) rises with increasing age and polluted air. Currently, at least 172 million people breathe unhealthy levels of air pollution in LAC countries. Several cohort studies have indicated that air pollution increases the risk of developing dementia and neurodegenerative diseases, but the mechanisms underlying the association are still not clear. Air pollution causes and aggravates five established risk factors for dementia (obesity, hypertension, stroke, diabetes mellitus, and heart diseases) and is linked to three other risk factors (physical inactivity, cognitive inactivity, and depression). Some of these risk factors could be mediating the association between air pollution and dementia. Reducing the risks for dementia is crucial and urgently needed in LAC countries. There is room for improving air quality in many urban areas in the LAC region and other low- and middle-income countries (LMICs), a routealready explored by many urban areas in developing regions. Moreover, reducing air pollution has proved to improve health outcomes before. In this article, we propose that despite the ongoing and valid scientific discussion, if air pollution can or cannot directly affect the brain and cause or aggravate dementia, we are ready to consider air pollution as a potentially modifiable risk factor for dementia in LAC and possibly in other LMICs. We suggest that controlling and reducing current air pollution levels in LAC and other LMIC regions now could strongly contribute.
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Affiliation(s)
- Nathália Villa Dos Santos
- Laboratório de Poluição Ambiental, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Departamento de Saude Ambiental, Faculdade de Saude Publica, Universidade de São Paulo, São Paulo, Brazil
| | - Victor Yuji Yariwake
- Laboratório de Poluição Ambiental, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Mariana Matera Veras
- Laboratório de Poluição Ambiental, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Laís Fajersztajn
- Laboratório de Poluição Ambiental, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Cong X, Zhang J, Sun R, Pu Y. Indoor unclean fuel cessation linked with adult cognitive performance in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 775:145518. [PMID: 33621876 DOI: 10.1016/j.scitotenv.2021.145518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/03/2021] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Both indoor unclean fuel use and CVD associates with cognitive function. Indoor fuel has transitioned from the use of unclean fuel to clean fuel in recent years in China. The aim of this study was to evaluate the association between adult cognitive function and such a transition and to investigate the potential role of CVD in this association. 7112 participants (26- to 98-years of age) with 12,676 observations living in twelve provinces of China from 1997 to 2015 were extracted based on having complete data. The associations, combined effects, and further mediation effects between indoor unclean fuel use and its transition, CVD, and cognitive function were tested using regression models, stratified analyses, the relative excess risk due to interaction (RERI), mediation analysis methods, and sensitivity analyses. Between 1997 and 2015, cooking fuel use coal and wood went down a lot in China, from a baseline of 26.9% to 6.1%, from 30.1% to 11.5%, respectively. Such a transition showed a positive association with delayed verbal recall (B = 0.288, p < 0.01), especially in rural area, subjects with age ≥ 65 years old, and women (all P < 0.05). The combined effect of the presence of hypertension during a baseline visit and such a transition on changes in delayed verbal recall was antagonistic (RERI = -0.529, p < 0.05). Moreover, the development of hypertension explained more than 50% of such a fuel transition-related decline of verbal memory. The transition of household energy to clean fuel was associated with a higher adult cognitive function. The presence or the development of CVD appeared to affect the association between indoor air pollution and cognitive function, which suggests a need to further optimize prevention of concurrent CVD and risk factor control in adults at higher risk for cognitive impairment and with indoor unclean cooking fuel, especially in potentially susceptible subgroups.
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Affiliation(s)
- Xiaowei Cong
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China
| | - Juan Zhang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China.
| | - Rongli Sun
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China
| | - Yuepu Pu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China.
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37
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Affiliation(s)
- Sindana D Ilango
- School of Public Health, San Diego State University, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Rachel M Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
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38
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Delgado-Saborit JM, Guercio V, Gowers AM, Shaddick G, Fox NC, Love S. A critical review of the epidemiological evidence of effects of air pollution on dementia, cognitive function and cognitive decline in adult population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 757:143734. [PMID: 33340865 DOI: 10.1016/j.scitotenv.2020.143734] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 05/24/2023]
Abstract
Dementia is arguably the most pressing public health challenge of our age. Since dementia does not have a cure, identifying risk factors that can be controlled has become paramount to reduce the personal, societal and economic burden of dementia. The relationship between exposure to air pollution and effects on cognitive function, cognitive decline and dementia has stimulated increasing scientific interest in the past few years. This review of the literature critically examines the available epidemiological evidence of associations between exposure to ambient air pollutants, cognitive performance, acceleration of cognitive decline, risk of developing dementia, neuroimaging and neurological biomarker studies, following Bradford Hill guidelines for causality. The evidence reviewed has been consistent in reporting associations between chronic exposure to air pollution and reduced global cognition, as well as impairment in specific cognitive domains including visuo-spatial abilities. Cognitive decline and dementia incidence have also been consistently associated with exposure to air pollution. The neuro-imaging studies reviewed report associations between exposure to air pollution and white matter volume reduction. Other reported effects include reduction in gray matter, larger ventricular volume, and smaller corpus callosum. Findings relating to ischemic (white matter hyperintensities/silent cerebral infarcts) and hemorrhagic (cerebral microbleeds) markers of cerebral small vessel disease have been heterogeneous, as have observations on hippocampal volume and air pollution. The few studies available on neuro-inflammation tend to report associations with exposure to air pollution. Several effect modifiers have been suggested in the literature, but more replication studies are required. Traditional confounding factors have been controlled or adjusted for in most of the reviewed studies. Additional confounding factors have also been considered, but the inclusion of these has varied among the different studies. Despite all the efforts to adjust for confounding factors, residual confounding cannot be completely ruled out, especially since the factors affecting cognition and dementia are not yet fully understood. The available evidence meets many of the Bradford Hill guidelines for causality. The reported associations between a range of air pollutants and effects on cognitive function in older people, including the acceleration of cognitive decline and the induction of dementia, are likely to be causal in nature. However, the diversity of study designs, air pollutants and endpoints examined precludes the attribution of these adverse effects to a single class of pollutant and makes meta-analysis inappropriate.
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Affiliation(s)
- Juana Maria Delgado-Saborit
- Universitat Jaume I, Perinatal Epidemiology, Environmental Health and Clinical Research, School of Medicine, Castellon, Spain; Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, UK; ISGlobal Barcelona Institute for Global Health, Barcelona Biomedical Research Park, Barcelona, Spain; Division of Environmental Health & Risk Management, School of Geography, Earth & Environmental Sciences, University of Birmingham, Birmingham, UK.
| | - Valentina Guercio
- Air Quality and Public Health Group, Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, UK
| | - Alison M Gowers
- Air Quality and Public Health Group, Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, UK
| | | | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, University College London, Institute of Neurology, London, UK
| | - Seth Love
- Institute of Clinical Neurosciences, University of Bristol, School of Medicine, Level 2 Learning and Research, Southmead Hospital, Bristol, UK
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39
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Grande G, Wu J, Ljungman PLS, Stafoggia M, Bellander T, Rizzuto D. Long-Term Exposure to PM2.5 and Cognitive Decline: A Longitudinal Population-Based Study. J Alzheimers Dis 2021; 80:591-599. [PMID: 33579834 DOI: 10.3233/jad-200852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A growing but contrasting evidence relates air pollution to cognitive decline. The role of cerebrovascular diseases in amplifying this risk is unclear. OBJECTIVES 1) Investigate the association between long-term exposure to air pollution and cognitive decline; 2) Test whether cerebrovascular diseases amplify this association. METHODS We examined 2,253 participants of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). One major air pollutant (particulate matter ≤2.5μm, PM2.5) was assessed yearly from 1990, using dispersion models for outdoor levels at residential addresses. The speed of cognitive decline (Mini-Mental State Examination, MMSE) was estimated as the rate of MMSE decline (linear mixed models) and further dichotomized into the upper (25%fastest cognitive decline), versus the three lower quartiles. The cognitive scores were used to calculate the odds of fast cognitive decline per levels of PM2.5 using regression models and considering linear and restricted cubic splines of 10 years exposure before the baseline. The potential modifier effect of cerebrovascular diseases was tested by adding an interaction term in the model. RESULTS We observed an inverted U-shape relationship between PM2.5 and cognitive decline. The multi-adjusted piecewise regression model showed an increased OR of fast cognitive decline of 81%(95%CI = 1.2-3.2) per interquartile range difference up to mean PM2.5 level (8.6μg/m3) for individuals older than 80. Above such level we observed no further risk increase (OR = 0.89;95%CI = 0.74-1.06). The presence of cerebrovascular diseases further increased such risk by 6%. CONCLUSION Low to mean PM2.5 levels were associated with higher risk of accelerated cognitive decline. Cerebrovascular diseases further amplified such risk.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jing Wu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Petter L S Ljungman
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd Hospital, Stockholm Sweden
| | - Massimo Stafoggia
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Service, ASL Rome 1, Rome, Italy
| | - Tom Bellander
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Grande G, Ljungman PLS, Eneroth K, Bellander T, Rizzuto D. Association Between Cardiovascular Disease and Long-term Exposure to Air Pollution With the Risk of Dementia. JAMA Neurol 2021; 77:801-809. [PMID: 32227140 PMCID: PMC7105952 DOI: 10.1001/jamaneurol.2019.4914] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question Does cardiovascular disease play a role in the association between long-term
exposure to air pollution and dementia? Findings In this cohort study of 2927 participants in the Swedish National Study on
Aging and Care in Kungsholmen, air pollution exposure was associated with
dementia risk despite comparatively low exposure levels. Heart failure and
ischemic heart disease enhanced this association, and the development of
stroke seemed to be an important intermediate condition. Meaning In this study, virtually all of the association between air pollution and
dementia seemed to occur through the presence or the development of
cardiovascular disease, which suggests a need to optimize treatment of
concurrent cardiovascular disease and risk factor control in older adults at
higher risk for dementia and living in polluted urban areas. Importance Emerging yet contrasting evidence associates air pollution with incident
dementia, and the potential role of cardiovascular disease (CVD) in this
association is unclear. Objective To investigate the association between long-term exposure to air pollution
and dementia and to assess the role of CVD in that association. Design, Setting, and Participants Data for this cohort study were extracted from the ongoing Swedish National
Study on Aging and Care in Kungsholmen (SNAC-K), a longitudinal
population-based study with baseline assessments from March 21, 2001,
through August 30, 2004. Of the 5111 randomly selected residents in the
Kungsholmen district of Stockholm 60 years or older and living at home or in
institutions, 521 were not eligible (eg, due to death before the start of
the study or no contact information). Among the remaining 4590 individuals,
3363 (73.3%) were assessed. For the current analysis, 2927 participants who
did not have dementia at baseline were examined, with follow-up to 2013
(mean [SD] follow-up time, 6.01 [2.56] years). Follow-up was completed
February 18, 2013, and data were analyzed from June 26, 2018, through June
20, 2019. Exposures Two major air pollutants (particulate matter ≤2.5 μm
[PM2.5] and nitrogen oxide [NOx]) were assessed
yearly from 1990, using dispersion models for outdoor levels at residential
addresses. Main Outcomes and Measures The hazard of dementia was estimated using Cox proportional hazards
regression models. The potential of CVD (ie, atrial fibrillation, ischemic
heart disease, heart failure, and stroke) to modify and mediate the
association between long-term exposure to air pollution and dementia was
tested using stratified analyses and generalized structural equation
modeling. Results At baseline, the mean (SD) age of the 2927 participants was 74.1 (10.7)
years, and 1845 (63.0%) were female. Three hundred sixty-four participants
with incident dementia were identified. The hazard of dementia increased by
as much as 50% per interquartile range difference in mean pollutant levels
during the previous 5 years at the residential address (hazard ratio [HR]
for difference of 0.88 μg/m3 PM2.5, 1.54 [95% CI,
1.33-1.78]; HR for difference of 8.35 μg/m3 NOx,
1.14 [95% CI, 1.01-1.29]). Heart failure (HR for PM2.5, 1.93 [95%
CI, 1.54-2.43]; HR for NOx, 1.43 [95% CI, 1.17-1.75]) and
ischemic heart disease (HR for PM2.5, 1.67 [95% CI, 1.32-2.12];
HR for NOx, 1.36 [95% CI, 1.07-1.71]) enhanced the dementia risk,
whereas stroke appeared to be the most important intermediate condition,
explaining 49.4% of air pollution–related dementia cases. Conclusions and Relevance This study found that long-term exposure to air pollution was associated with
a higher risk of dementia. Heart failure and ischemic heart disease appeared
to enhance the association between air pollution and dementia, whereas
stroke seemed to be an important intermediate condition between the
association of air pollution exposure with dementia.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Kristina Eneroth
- Environment and Health Administration, City of Stockholm, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Yu X, Zheng L, Jiang W, Zhang D. Exposure to air pollution and cognitive impairment risk: a meta-analysis of longitudinal cohort studies with dose-response analysis. J Glob Health 2020; 10:010417. [PMID: 32373333 PMCID: PMC7182361 DOI: 10.7189/jogh.10.010417] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We conducted a meta-analysis to explore the relationship between exposure to air pollution and the risk of cognitive impairment of longitudinal cohort studies. Methods PubMed, Web of Science and Wan Fang databases were searched for relevant articles of longitudinal cohort studies published between January 1950 and September 2019. The pooled relative ratio (RR) and 95% confidence interval (CI) were calculated using the random effect model. Results Ten articles involving 519 247 cases among 12 523 553 participants were included in this meta-analysis. The pooled RR of cognitive impairment per 5 μg/m3 increments in exposure to particulate matter ≤2.5 μm (PM2.5) was 1.08 (95% CI = 1.03, 1.13; I2 = 82.2%; Pheterogeneity <0.001). No association was found between nitrogen dioxide/nitrogen oxide (NO2/NOx) and ozone (O3) and cognitive impairment. For PM2.5 exposure, in subgroup analysis, the above-mentioned significant positive association was found among studies conducted in population (RR p er 5 μg/m 3 = 1.05; 95% CI = 1.01,1.09; I2 = 57.4%; Pheterogeneity = 0.016), in North America (RR per 5 μg/m 3 = 1.13; 95% CI = 1.01,1.26; I2 = 86.7%; Pheterogeneity <0.001) and with follow-up duration >10 years (RR p er 5 μg/m 3 = 1.10; 95% CI = 1.03,1.17; I2 = 86.3%; Pheterogeneity <0.001). Conclusions This meta-analysis suggests that exposure to PM2.5 might increase the risk of cognitive impairment.
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Affiliation(s)
- Xiaohui Yu
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, People's Republic of China
| | - Liwen Zheng
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, People's Republic of China
| | - Wenjie Jiang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, People's Republic of China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, People's Republic of China
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Smargiassi A, Sidi EAL, Robert LE, Plante C, Haddad M, Gamache P, Burnett R, Goudreau S, Liu L, Fournier M, Pelletier E, Yankoty I. Exposure to ambient air pollutants and the onset of dementia in Québec, Canada. ENVIRONMENTAL RESEARCH 2020; 190:109870. [PMID: 32739624 DOI: 10.1016/j.envres.2020.109870] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/20/2020] [Accepted: 06/20/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Effects of air pollutants are related to oxidative stress which is also linked to the pathogenesis of dementia including Alzheimer's and related diseases. OBJECTIVE We assessed associations between exposure to air pollutants and the onset of dementia; the association with the distance between residence and major roads was also assessed for the island of Montreal. METHODS We created an open cohort of adults aged 65 years and older starting in 2000 and ending in 2012 in the province of Québec, Canada using linked medico-administrative databases. New cases of dementia were defined based on a validated algorithm. Annual residential levels of nitrogen dioxide (NO2) and fine particles (PM2.5) at residential levels were estimated for each year of follow up using estimates based on satellite images and ground air monitoring data. Hazard ratios (HRs) were assessed with Extended (time dependent exposure) Cox models with age as the time axis and stratified for sex, for the annual exposure level at each residential address. Models were adjusted for the calendar year, area-wide social and material deprivation indexes and for NO2 or PM2.5; they were also indirectly adjusted for smoking. RESULTS 1,807,133 persons (13,242,270 person-years) were followed and 199,826 developed dementia. From models (adjusted for calendar year, social and material deprivation indexes), HRs for an interquartile range (IQR) increase in time-varying exposure to NO2 (IQR 13.26 ppb), PM2.5 (IQR 3.90 μg/m³), and distance to major roads (IQR 150 m, in Montreal only), were 1.005 (CI 95% 0.994-1.017), 1.016 (CI 95% 1.003-1.028) and 0.969 (CI 95% 0.958-0.980), respectively. CONCLUSIONS Results suggest that the onset of dementia may be related to residential exposure to PM2.5, NO2, and distance to major roads.
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Affiliation(s)
- Audrey Smargiassi
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; Institut national de la santé publique du Québec, Québec, Canada.
| | | | | | - Céline Plante
- Direction régionale de santé publique de Montréal, Québec, Canada
| | - Mona Haddad
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Philippe Gamache
- Institut national de la santé publique du Québec, Québec, Canada
| | - Rick Burnett
- Environmental Health Science and Research Bureau, Health, Canada
| | - Sophie Goudreau
- Direction régionale de santé publique de Montréal, Québec, Canada
| | - Ling Liu
- Environmental Health Science and Research Bureau, Health, Canada
| | - Michel Fournier
- Direction régionale de santé publique de Montréal, Québec, Canada
| | - Eric Pelletier
- Institut national de la santé publique du Québec, Québec, Canada
| | - Ines Yankoty
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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Hahad O, Lelieveld J, Birklein F, Lieb K, Daiber A, Münzel T. Ambient Air Pollution Increases the Risk of Cerebrovascular and Neuropsychiatric Disorders through Induction of Inflammation and Oxidative Stress. Int J Mol Sci 2020; 21:ijms21124306. [PMID: 32560306 PMCID: PMC7352229 DOI: 10.3390/ijms21124306] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023] Open
Abstract
Exposure to ambient air pollution is a well-established determinant of health and disease. The Lancet Commission on pollution and health concludes that air pollution is the leading environmental cause of global disease and premature death. Indeed, there is a growing body of evidence that links air pollution not only to adverse cardiorespiratory effects but also to increased risk of cerebrovascular and neuropsychiatric disorders. Despite being a relatively new area of investigation, overall, there is mounting recent evidence showing that exposure to multiple air pollutants, in particular to fine particles, may affect the central nervous system (CNS) and brain health, thereby contributing to increased risk of stroke, dementia, Parkinson's disease, cognitive dysfunction, neurodevelopmental disorders, depression and other related conditions. The underlying molecular mechanisms of susceptibility and disease remain largely elusive. However, emerging evidence suggests inflammation and oxidative stress to be crucial factors in the pathogenesis of air pollution-induced disorders, driven by the enhanced production of proinflammatory mediators and reactive oxygen species in response to exposure to various air pollutants. From a public health perspective, mitigation measures are urgent to reduce the burden of disease and premature mortality from ambient air pollution.
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Affiliation(s)
- Omar Hahad
- Center for Cardiology–Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Jos Lelieveld
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, 55128 Mainz, Germany;
- Climate and Atmosphere Research Center, The Cyprus Institute, Nicosia 1645, Cyprus
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- Leibniz Institute for Resilience Research, 55122 Mainz, Germany
| | - Andreas Daiber
- Center for Cardiology–Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
- Correspondence: (A.D.); (T.M.); Tel.: +49-(0)6131-176280 (A.D.); +49-(0)6131-177251 (T.M.)
| | - Thomas Münzel
- Center for Cardiology–Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
- Correspondence: (A.D.); (T.M.); Tel.: +49-(0)6131-176280 (A.D.); +49-(0)6131-177251 (T.M.)
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