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Frndak S, Cudjoe T, Thorpe RJ, Deng Z, Ward-Caviness CK, Clarke KA, Dickerson AS. Social cohesion as a modifier of joint air pollution exposure and incident dementia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 949:175149. [PMID: 39084376 DOI: 10.1016/j.scitotenv.2024.175149] [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: 01/19/2024] [Revised: 06/19/2024] [Accepted: 07/28/2024] [Indexed: 08/02/2024]
Abstract
Social cohesion can reduce stress, increase social interaction, and improve cognitive reserve. These social mechanisms may modify the effects of air pollution on dementia risk. This cohort study examines the potential moderating effect of social cohesion on associations between joint air pollution exposure and incident dementia leveraging data from 5112 community-dwelling adults ≥65 years of age enrolled in the National Health and Aging Trends Study (NHATS). Study participants were enrolled in 2011 and followed through 2018. We assigned 2010 residential census tract-level exposures to five air pollutants, particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide, using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Dementia status was determined based on self- or proxy-reported dementia diagnosis or "probable dementia" according to NHATS cognitive screening tools. Participants' self-rated neighborhood social cohesion was evaluated based on three questions: neighbors knowing each other, being helpful, and being trustworthy. Social cohesion was dichotomized at the median into high vs low social cohesion. Associations between air pollutants and incident dementia were assessed using quantile g-computation Cox proportional hazard models and stratified by high vs low social cohesion, adjusting for age, sex, education, partner status, urbanicity, annual income, race and ethnicity, years lived at current residence, neighborhood disadvantage index, and tract segregation. High social cohesion (HR = 1.20, 95 % CI = 0.98, 1.47) and air pollution (HR = 1.08, 95 % CI = 0.92, 1.28) were not associated with incident dementia alone. However, when stratified, greater joint air pollution exposure increased dementia risk among participants at low (HR = 1.34, 95 % CI = 1.04, 1.72), but not high (HR = 1.00, 95 % CI = 0.93, 1.06) social cohesion. Air pollution was a risk factor for dementia only when reported social cohesion was low, suggesting that social interaction may play a protective role, mitigating dementia risk via air pollution exposure.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Thomas Cudjoe
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, United States of America
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, United States of America; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, United States of America
| | - Zhengyi Deng
- Department of Urology, Stanford School of Medicine, United States of America
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, United States of America
| | - Kayan A Clarke
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, United States of America; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, United States of America.
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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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Yanosky JD, Washington A, Foulke GT, Guck D, Butt M, Helm MF. Air pollution and incident sarcoidosis in central Pennsylvania. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2024; 87:763-772. [PMID: 38922578 DOI: 10.1080/15287394.2024.2369255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Sarcoidosis is a chronic granulomatous disease predominantly affecting the lungs and inducing significant morbidity and elevated mortality rate. The etiology of the disease is unknown but may involve exposure to an antigenic agent and subsequent inflammatory response resulting in granuloma formation. Various environmental and occupational risk factors have been suggested by previous observations, such as moldy environments, insecticides, and bird breeding. Our study investigated the association of air pollution with diagnosis of sarcoidosis using a case-control design. Penn State Health electronic medical records from 2005 to 2018 were examined for adult patients with (cases) and without (controls) an International Classification of Disease (ICD)-9 or -10 code for sarcoidosis. Patient addresses were geocoded and 24-hr residential-level air pollution concentrations were estimated using spatio-temporal models of particulate matter <2.5 μm (PM2.5), ozone, and PM2.5 elemental carbon (EC) and moving averages calculated. In total, 877 cases and 34,510 controls were identified. Logistic regression analysis did not identify significant associations between sarcoidosis incidence and air pollution exposure estimates. However, the odds ratio (OR) for EC for exposures occurring 7-10 years prior did approach statistical significance, and ORs exhibited an increasing trend for longer averaging periods. Data suggested a latency period of more than 6 years for PM2.5 and EC for reasons that are unclear. Overall, results for PM2.5 and EC suggest that long-term exposure to traffic-related air pollution may contribute to the development of sarcoidosis and emphasize the need for additional research and, if the present findings are substantiated, for public health interventions addressing air quality as well as increasing disease surveillance in areas with a large burden of PM2.5 and EC.
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Affiliation(s)
- Jeff D Yanosky
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Abigail Washington
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Galen T Foulke
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Daniel Guck
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Matthew F Helm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Power MC, Lynch KM, Bennett EE, Ying Q, Park ES, Xu X, Smith RL, Stewart JD, Yanosky JD, Liao D, van Donkelaar A, Kaufman JD, Sheppard L, Szpiro AA, Whitsel EA. A comparison of PM 2.5 exposure estimates from different estimation methods and their associations with cognitive testing and brain MRI outcomes. ENVIRONMENTAL RESEARCH 2024; 256:119178. [PMID: 38768885 PMCID: PMC11186721 DOI: 10.1016/j.envres.2024.119178] [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: 01/31/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Reported associations between particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) and cognitive outcomes remain mixed. Differences in exposure estimation method may contribute to this heterogeneity. OBJECTIVES To assess agreement between PM2.5 exposure concentrations across 11 exposure estimation methods and to compare resulting associations between PM2.5 and cognitive or MRI outcomes. METHODS We used Visit 5 (2011-2013) cognitive testing and brain MRI data from the Atherosclerosis Risk in Communities (ARIC) Study. We derived address-linked average 2000-2007 PM2.5 exposure concentrations in areas immediately surrounding the four ARIC recruitment sites (Forsyth County, NC; Jackson, MS; suburbs of Minneapolis, MN; Washington County, MD) using 11 estimation methods. We assessed agreement between method-specific PM2.5 concentrations using descriptive statistics and plots, overall and by site. We used adjusted linear regression to estimate associations of method-specific PM2.5 exposure estimates with cognitive scores (n = 4678) and MRI outcomes (n = 1518) stratified by study site and combined site-specific estimates using meta-analyses to derive overall estimates. We explored the potential impact of unmeasured confounding by spatially patterned factors. RESULTS Exposure estimates from most methods had high agreement across sites, but low agreement within sites. Within-site exposure variation was limited for some methods. Consistently null findings for the PM2.5-cognitive outcome associations regardless of method precluded empirical conclusions about the potential impact of method on study findings in contexts where positive associations are observed. Not accounting for study site led to consistent, adverse associations, regardless of exposure estimation method, suggesting the potential for substantial bias due to residual confounding by spatially patterned factors. DISCUSSION PM2.5 estimation methods agreed across sites but not within sites. Choice of estimation method may impact findings when participants are concentrated in small geographic areas. Understanding unmeasured confounding by factors that are spatially patterned may be particularly important in studies of air pollution and cognitive or brain health.
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Affiliation(s)
- Melinda C Power
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA.
| | - Katie M Lynch
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Erin E Bennett
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Qi Ying
- Zachry Department of Civil & Environmental Engineering, Texas A&M University, 201 Dwight Look, College Station, TX, 77840, USA
| | - Eun Sug Park
- Texas A&M Transportation Institute, Texas A&M University System, 3135 TAMU, College Station, TX, 77843, USA
| | - Xiaohui Xu
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Richard L Smith
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, 318 E Cameron Ave, Chapel Hill, NC, 27599, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Daur Dr, Chapel Hill, NC, 27516, USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Daur Dr, Chapel Hill, NC, 27516, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 700 HMC Cres Rd, Hershey, PA, 17033, USA
| | - Duanping Liao
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 700 HMC Cres Rd, Hershey, PA, 17033, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental, and Chemical Engineering McKelvey School of Engineering, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Joel D Kaufman
- Department of Medicine, School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA; Department of Biostatistics, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Daur Dr, Chapel Hill, NC, 27516, USA; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St, Chapel Hill, NC, 27599, USA
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Nichols E, Jones RN, Gross AL, Hayat S, Zaninotto P, Lee J. Development and assessment of analytic methods to improve the measurement of cognition in longitudinal studies of aging through the use of substudies with comprehensive neuropsychological testing. Alzheimers Dement 2024. [PMID: 39099175 DOI: 10.1002/alz.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/11/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION The Health and Retirement Study International Partner Surveys (HRS IPS) have rich longitudinal data, but the brevity of cognitive batteries is a limitation. METHODS We used data from a substudy of the English Longitudinal Study of Ageing (ELSA) administering detailed cognitive assessments with the Harmonized Cognitive Assessment Protocol (ELSA-HCAP) (N = 1273) to inform approaches for estimating cognition in ELSA (N = 11,213). We compared two novel approaches: confirmatory factor analysis (CFA)- and regression-based prediction. RESULTS Compared to estimates from the full HCAP battery, estimated cognitive functioning derived using regression models or CFA had high correlations (regression: r = 0.85 [95% confidence interval [CI]: 0.83 to 0.87]; CFA: r = 0.83 [95% CI: 0.81 to 0.85]) and reasonable mean squared error (regression: 0.25 [0.22 to 0.27]; CFA: 0.29 [0.26 to 0.32]) in held-out data. The use of additional items from waves 7 to 9 improved performance. DISCUSSION Both approaches are recommended for future research; the similarity in approaches may be due to the brevity of available cognitive assessments in ELSA. HIGHLIGHTS Estimates of cognitive functioning informed by English Longitudinal Study of Ageing-Harmonized Cognitive Assessment Protocol (ELSA-HCAP) data had an adequate performance. Standard errors were smaller for associations with example risks when using measures informed by ELSA-HCAP. Performance was better when including additional cognitive measures available in waves 7 to 9. Conceptual advantages to the confirmatory factor analysis (CFA) approach were not important in practice due to the brevity of the ELSA cognitive battery.
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Affiliation(s)
- Emma Nichols
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shabina Hayat
- Department of Epidemiology and Public Health, UCL, London, London, UK
- Department of Behavioural Science and Health, UCL, London, London, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, UCL, London, London, UK
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
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Lin YC, Fan KC, Wu CD, Pan WC, Chen JC, Chao YP, Lai YJ, Chiu YL, Chuang YF. Yearly change in air pollution and brain aging among older adults: A community-based study in Taiwan. ENVIRONMENT INTERNATIONAL 2024; 190:108876. [PMID: 39002330 DOI: 10.1016/j.envint.2024.108876] [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: 02/04/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Air pollution is recognized as a modifiable risk factor for dementia, and recent evidence suggests that improving air quality could attenuate cognitive decline and reduce dementia risk. However, studies have yet to explore the effects of improved air quality on brain structures. This study aims to investigate the impact of air pollution reduction on cognitive functions and structural brain differences among cognitively normal older adults. METHODS Four hundred and thirty-one cognitively normal older adults were from the Epidemiology of Mild Cognitive Impairment study in Taiwan (EMCIT), a community-based cohort of adults aged 60 and older, between year 2017- 2021. Annual concentrations of PM2.5, NO2, O3, and PM10 at participants' residential addresses during the 10 years before enrollment were estimated using ensemble mixed spatial models. The yearly rate of change (slope) in air pollutants was estimated for each participant. Cognitive functions and structural brain images were collected during enrollment. The relationships between the rate of air pollution change and cognitive functions were examined using linear regression models. For air pollutants with significant findings in relation to cognitive function, we further explored the association with brain structure. RESULTS Overall, all pollutant concentrations, except O3, decreased over the 10-year period. The yearly rates of change (slopes) in PM2.5 and NO2 were correlated with better attention (PM2.5: r = -0.1, p = 0.047; NO2: r = -0.1, p = 0.03) and higher white matter integrity in several brain regions. These regions included anterior thalamic radiation, superior longitudinal fasciculus, inferior longitudinal fasciculus, corticospinal tract, and inferior fronto-occipital fasciculus. CONCLUSIONS Greater rate of reduction in air pollution was associated with better attention and attention-related white matter integrity. These results provide insight into the mechanism underlying the relationship between air pollution, brain health, and cognitive aging among older adults.
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Affiliation(s)
- Ying-Cen Lin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kang-Chen Fan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Innovation and Development Center of Sustainable Agriculture, National Chung Hsing University, Taichung, Taiwan; Research Center for Precision Environmental Medicine, Koahsiung Medical University, Koahsiung, Taiwan
| | - Wen-Chi Pan
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Yi-Ping Chao
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yen-Jun Lai
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yen-Ling Chiu
- Department of Medical Research, Far Eastern Memorial Hospital, Taipei, Taiwan; Graduate Program in Biomedical Informatics and Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Fang Chuang
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; International Health Program, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei, Taiwan; Health Innovation Center, National Yang Ming Chao Tung Univeristy, Taipei, Taiwan.
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Lin F, Wang L, Shi Y, Chen X, Lin Y, Zheng J, Chen K, Ye Q, Cai G. Association of Exposure to Ambient Air Pollutants With Cognitive Performance and Dementia Risk and the Mediating Role of Pulmonary Function: Evidence From the UK Biobank. J Gerontol A Biol Sci Med Sci 2024; 79:glae139. [PMID: 38784975 DOI: 10.1093/gerona/glae139] [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: 10/27/2023] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The pathways by which air pollution affects cognition remain to be explored. This study aimed to explore how single air pollutants [including nitrogen oxide (NOX), nitrogen dioxide (NO2), particulate matter with a diameter of 2.5 micrometers (PM2.5), PM10, and PM2.5-10], and air pollution mixture could affect cognitive function and the incidence of dementia, and determine whether pulmonary function (PF) could play a mediating role in the relationship. METHODS Multiple statistical methods were employed to evaluate association of 5 air pollutants (NOX, NO2, PM2.5, PM10, and PM2.5-10) with cognitive function. Bootstrap method was used to estimate mediating role of PF in the association of air pollutants with cognition or the incidence of dementia. RESULTS A mixture of air pollutants was associated with performance on 5 cognitive tests, and global cognition (p < .05). Significantly negative association was also identified between mixture of air pollutants and PF (β= -0.020, 95% confidence interval (CI) = -0.029 to -0.011). In addition, as PF scores increase, performance on all cognitive tests significantly improve, although the risk of dementia correspondingly decreases. It was noted that PF was shown to mediate the effects of air pollution mixtures on all cognitive tests as well as global cognition. For global cognition, PF mediated 6.08% of the association. PF was also found to have a mediating role in the association between NOX, NO2, PM2.5, and the risk of dementia. CONCLUSIONS Mixed air pollution may impact cognitive function, with PF potentially mediating this relationship.
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Affiliation(s)
- Fabin Lin
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lili Wang
- Department of Neurology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Yisen Shi
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Xuanjie Chen
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Yixiang Lin
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Jiayi Zheng
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Ke Chen
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Qinyong Ye
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Guoen Cai
- Department of Neurology, Center for Cognitive Neurology, Institute of Clinical Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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8
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Frndak S, Deng Z, Ward-Caviness CK, Gorski-Steiner I, Thorpe RJ, Dickerson AS. Risk of dementia due to Co-exposure to air pollution and neighborhood disadvantage. ENVIRONMENTAL RESEARCH 2024; 251:118709. [PMID: 38493859 DOI: 10.1016/j.envres.2024.118709] [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: 11/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Co-exposure to air pollution and neighborhood disadvantage may influence cognition decline. We tested these associations in the context of dementia risk. METHODS We leveraged a cohort of adults ≥65 years (n = 5397) enrolled from 2011 to 2018 in the National Health and Aging Trends Study (NHATS). Particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide - and neighborhood disadvantage were tested for joint associations with dementia risk. Pollutant concentrations at the 2010 census tract level were assigned using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Neighborhood disadvantage was defined using the tract Social Deprivation Index (SDI). Dementia was determined through self- or proxy-report or scores indicative of "probable dementia" according to NHATS screening tools. Joint effects of air pollutants and SDI were tested using quantile g-computation Cox proportional hazards models. We also stratified joint air pollution effects across SDI tertiles. Analyses adjusted for age at enrollment, sex, education, partner status, urbanicity, income, race and ethnicity, years at residence, census segregation, and census region. RESULTS SDI score (aHR = 1.08; 95% CI 0.96, 1.22), joint air pollution (aHR = 1.03, 95% CI 0.92, 1.16) and joint SDI with air pollution (aHR = 1.04, 95% CI 0.89, 1.22) were not associated with dementia risk. After accounting for competing risk of death, joint SDI with air pollution was not associated with dementia risk (aHR = 1.06; 95% CI 0.87, 1.29). In stratified models, joint air pollution was associated with greater risk of dementia at high (aHR = 1.19; 95% CI 0.87, 1.63), but not at medium or low SDI. CONCLUSION Air pollution was associated with greater dementia risk in disadvantaged areas after accounting for competing risks. Air pollution associations with dementia incidence may be attenuated when other risk factors are more prominent in disadvantaged neighborhoods.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Zhengyi Deng
- Department of Urology, Stanford School of Medicine, USA
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, USA
| | - Irena Gorski-Steiner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA
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Zhang B, Mendes de Leon CF, Langa KM, Weuve J, Szpiro A, Faul J, D’Souza J, Kaufman JD, Hirth RA, Lisabeth LD, Gao J, Adar SD. Source-Specific Air Pollution and Loss of Independence in Older Adults Across the US. JAMA Netw Open 2024; 7:e2418460. [PMID: 38941096 PMCID: PMC11214115 DOI: 10.1001/jamanetworkopen.2024.18460] [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: 12/09/2023] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Importance Air pollution is a recognized risk factor associated with chronic diseases, including respiratory and cardiovascular conditions, which can lead to physical and cognitive impairments in later life. Although these losses of function, individually or in combination, reduce individuals' likelihood of living independently, little is known about the association of air pollution with this critical outcome. Objective To investigate associations between air pollution and loss of independence in later life. Design, Setting, and Participants This cohort study was conducted as part of the Environmental Predictors Of Cognitive Health and Aging study and used 1998 to 2016 data from the Health and Retirement Study. Participants included respondents from this nationally representative, population-based cohort who were older than 50 years and had not previously reported a loss of independence. Analyses were performed from August 31 to October 15, 2023. Exposures Mean 10-year pollutant concentrations (particulate matter less than 2.5 μm in diameter [PM2.5] or ranging from 2.5 μm to 10 μm in diameter [PM10-2.5], nitrogen dioxide [NO2], and ozone [O3]) were estimated at respondent addresses using spatiotemporal models along with PM2.5 levels from 9 emission sources. Main Outcomes and Measures Loss of independence was defined as newly receiving care for at least 1 activity of daily living or instrumental activity of daily living due to health and memory problems or moving to a nursing home. Associations were estimated with generalized estimating equation regression adjusting for potential confounders. Results Among 25 314 respondents older than 50 years (mean [SD] baseline age, 61.1 [9.4] years; 11 208 male [44.3%]), 9985 individuals (39.4%) experienced lost independence during a mean (SD) follow-up of 10.2 (5.5) years. Higher exposure levels of mean concentration were associated with increased risks of lost independence for total PM2.5 levels (risk ratio [RR] per 1-IQR of 10-year mean, 1.05; 95% CI, 1.01-1.10), PM2.5 levels from road traffic (RR per 1-IQR of 10-year mean, 1.09; 95% CI, 1.03-1.16) and nonroad traffic (RR per 1-IQR of 10-year mean, 1.13; 95% CI, 1.03-1.24), and NO2 levels (RR per 1-IQR of 10-year mean, 1.05; 95% CI, 1.01-1.08). Compared with other sources, traffic-generated pollutants were most consistently and robustly associated with loss of independence; only road traffic-related PM2.5 levels remained associated with increased risk after adjustment for PM2.5 from other sources (RR per 1-IQR increase in 10-year mean concentration, 1.10; 95% CI, 1.00-1.21). Other pollutant-outcome associations were null, except for O3 levels, which were associated with lower risks of lost independence (RR per 1-IQR increase in 10-year mean concentration, 0.94; 95% CI, 0.92-0.97). Conclusions and Relevance This study found that long-term exposure to air pollution was associated with the need for help for lost independence in later life, with especially large and consistent increases in risk for pollution generated by traffic-related sources. These findings suggest that controlling air pollution could be associated with diversion or delay of the need for care and prolonged ability to live independently.
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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
| | - Adam Szpiro
- Department of Biostatistics, University of Washington, Seattle
| | - Jessica Faul
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Jennifer D’Souza
- Department of Epidemiology, University of Michigan School of Public Health, 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
| | - 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
| | - Lynda D. Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Jiaqi Gao
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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10
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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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11
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Lynch KM, Bennett EE, Ying Q, Park ES, Xu X, Smith RL, Stewart JD, Liao D, Kaufman JD, Whitsel EA, Power MC. Association of Gaseous Ambient Air Pollution and Dementia-Related Neuroimaging Markers in the ARIC Cohort, Comparing Exposure Estimation Methods and Confounding by Study Site. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67010. [PMID: 38922331 PMCID: PMC11218707 DOI: 10.1289/ehp13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Evidence linking gaseous air pollution to late-life brain health is mixed. OBJECTIVE We explored associations between exposure to gaseous pollutants and brain magnetic resonance imaging (MRI) markers among Atherosclerosis Risk in Communities (ARIC) Study participants, with attention to the influence of exposure estimation method and confounding by site. METHODS We considered data from 1,665 eligible ARIC participants recruited from four US sites in the period 1987-1989 with valid brain MRI data from Visit 5 (2011-2013). We estimated 10-y (2001-2010) mean carbon monoxide (CO), nitrogen dioxide (NO 2 ), nitrogen oxides (NO x ), and 8- and 24-h ozone (O 3 ) concentrations at participant addresses, using multiple exposure estimation methods. We estimated site-specific associations between pollutant exposures and brain MRI outcomes (total and regional volumes; presence of microhemorrhages, infarcts, lacunes, and severe white matter hyperintensities), using adjusted linear and logistic regression models. We compared meta-analytically combined site-specific associations to analyses that did not account for site. RESULTS Within-site exposure distributions varied across exposure estimation methods. Meta-analytic associations were generally not statistically significant regardless of exposure, outcome, or exposure estimation method; point estimates often suggested associations between higher NO 2 and NO x and smaller temporal lobe, deep gray, hippocampal, frontal lobe, and Alzheimer disease signature region of interest volumes and between higher CO and smaller temporal and frontal lobe volumes. Analyses that did not account for study site more often yielded significant associations and sometimes different direction of associations. DISCUSSION Patterns of local variation in estimated air pollution concentrations differ by estimation method. Although we did not find strong evidence supporting impact of gaseous pollutants on brain changes detectable by MRI, point estimates suggested associations between higher exposure to CO, NO x , and NO 2 and smaller regional brain volumes. Analyses of air pollution and dementia-related outcomes that do not adjust for location likely underestimate uncertainty and may be susceptible to confounding bias. https://doi.org/10.1289/EHP13906.
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Affiliation(s)
- Katie M. Lynch
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Erin E. Bennett
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Qi Ying
- Zachry Department of Civil & Environmental Engineering, Texas A&M University, College Station, Texas, USA
| | - Eun Sug Park
- Texas A&M Transportation Institute, Texas A&M University System, College Station, Texas, USA
| | - Xiaohui Xu
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center School of Public Health, College Station, Texas, USA
| | - Richard L. Smith
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James D. Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Duanping Liao
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Joel D. Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melinda C. Power
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
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12
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Wu YT, Kitwiroon N, Beevers S, Barratt B, Brayne C, Cerin E, Franklin R, Houlden V, Woods B, Zied Abozied E, Prina M, Matthews F. The longitudinal associations between ambient air pollution exposure and dementia in the UK: results from the cognitive function and ageing study II and Wales. BMC Public Health 2024; 24:1233. [PMID: 38702710 PMCID: PMC11069162 DOI: 10.1186/s12889-024-18723-3] [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: 11/25/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Air pollution has been recognised as a potential risk factor for dementia. Yet recent epidemiological research shows mixed evidence. The aim of this study is to investigate the longitudinal associations between ambient air pollution exposure and dementia in older people across five urban and rural areas in the UK. METHODS This study was based on two population-based cohort studies of 11329 people aged ≥ 65 in the Cognitive Function and Ageing Study II (2008-2011) and Wales (2011-2013). An algorithmic diagnosis method was used to identify dementia cases. Annual concentrations of four air pollutants (NO2, O3, PM10, PM2.5) were modelled for the year 2012 and linked via the participants' postcodes. Multistate modelling was used to examine the effects of exposure to air pollutants on incident dementia incorporating death and adjusting for sociodemographic factors and area deprivation. A random-effect meta-analysis was carried out to summarise results from the current and nine existing cohort studies. RESULTS Higher exposure levels of NO2 (HR: 1.04; 95% CI: 0.94, 1.14), O3 (HR: 0.90; 95% CI: 0.70, 1.15), PM10 (HR: 1.17; 95% CI: 0.86, 1.58), PM2.5 (HR: 1.41; 95% CI: 0.71, 2.79) were not strongly associated with dementia in the two UK-based cohorts. Inconsistent directions and strengths of the associations were observed across the two cohorts, five areas, and nine existing studies. CONCLUSIONS In contrast to the literature, this study did not find clear associations between air pollution and dementia. Future research needs to investigate how methodological and contextual factors can affect evidence in this field and clarity the influence of air pollution exposure on cognitive health over the lifecourse.
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Affiliation(s)
- Yu-Tzu Wu
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK.
| | - Nutthida Kitwiroon
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Benjamin Barratt
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Rachel Franklin
- Centre for Urban and Regional Development Studies (CURDS), School of Geography, Politics and Sociology, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, Gwynedd, UK
| | - Eman Zied Abozied
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
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13
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [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: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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14
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Lefèvre-Arbogast S, Chaker J, Mercier F, Barouki R, Coumoul X, Miller GW, David A, Samieri C. Assessing the contribution of the chemical exposome to neurodegenerative disease. Nat Neurosci 2024; 27:812-821. [PMID: 38684891 DOI: 10.1038/s41593-024-01627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
Over the past few decades, numerous environmental chemicals from solvents to pesticides have been suggested to be involved in the development and progression of neurodegenerative diseases. Most of the evidence has accumulated from occupational or cohort studies in humans or laboratory research in animal models, with a range of chemicals being implicated. What has been missing is a systematic approach analogous to genome-wide association studies, which have identified dozens of genes involved in Alzheimer's disease, Parkinson's disease and other neurodegenerative diseases. Fortunately, it is now possible to study hundreds to thousands of chemical features under the exposome framework. This Perspective explores how advances in mass spectrometry make it possible to generate exposomic data to complement genomic data and thereby better understand neurodegenerative diseases.
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Affiliation(s)
- S Lefèvre-Arbogast
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - J Chaker
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - F Mercier
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - R Barouki
- Université Paris Cité, T3S, INSERM UMR-S 1124, Paris, France
| | - X Coumoul
- Université Paris Cité, T3S, INSERM UMR-S 1124, Paris, France
| | - G W Miller
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - A David
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - C Samieri
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.
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15
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Liddie JM, Vieira CLZ, Coull BA, Sparrow D, Koutrakis P, Weisskopf MG. Associations between solar and geomagnetic activity and cognitive function in the Normative Aging study. ENVIRONMENT INTERNATIONAL 2024; 187:108666. [PMID: 38648690 PMCID: PMC11146138 DOI: 10.1016/j.envint.2024.108666] [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: 10/14/2023] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Studies show that changes in solar and geomagnetic activity (SGA) influence melatonin secretion and the autonomic nervous system. We evaluated associations between solar and geomagnetic activity and cognitive function in the Normative Aging Study from 1992 to 2013. METHODS We used logistic and linear generalized estimating equations and regressions to evaluate the associations between moving averages of sunspot number (SSN) and Kp index (a measure of geomagnetic activity) and a binary measure for Mini-Mental State Examination (MMSE) scores (≤25 or > 25) and six other cognitive tests as continuous measures, combined into one global composite score and considered separately. RESULTS A one-IQR increase in same-day SSN and Kp index were associated with 17% (95% CI: 3%, 34%) and 19% (95% CI: 4%, 36%) increases in the odds of low MMSE score. We observed small increases in the global cognitive score with increasing SSN, although we observed decreases specifically in relation to the backwards digit span test. CONCLUSIONS Periods of high SGA were associated with cognitive function. SGA may not equally impact all aspects of cognitive function, as evidenced by differences in associations observed for the MMSE, global cognitive score, and individual cognitive tests. Given that much of the pathology of cognitive decline in the elderly remains unexplained, studies specifically targeting decline and with longer follow-up periods are warranted.
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Affiliation(s)
- Jahred M Liddie
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Carolina L Z Vieira
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Sparrow
- VA Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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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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17
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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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Wood D, Evangelopoulos D, Beevers S, Kitwiroon N, Demakakos P, Katsouyanni K. Exposure to ambient air pollution and cognitive function: an analysis of the English Longitudinal Study of Ageing cohort. Environ Health 2024; 23:35. [PMID: 38575976 PMCID: PMC10996194 DOI: 10.1186/s12940-024-01075-1] [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: 09/12/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND An increasing number of studies suggest adverse effects of exposure to ambient air pollution on cognitive function, but the evidence is still limited. We investigated the associations between long-term exposure to air pollutants and cognitive function in the English Longitudinal Study of Ageing (ELSA) cohort of older adults. METHODS Our sample included 8,883 individuals from ELSA, based on a nationally representative study of people aged ≥ 50 years, followed-up from 2002 until 2017. Exposure to air pollutants was modelled by the CMAQ-urban dispersion model and assigned to the participants' residential postcodes. Cognitive test scores of memory and executive function were collected biennially. The associations between these cognitive measures and exposure to ambient concentrations of NO2, PM10, PM2.5 and ozone were investigated using mixed-effects models adjusted for time-varying age, physical activity and smoking status, as well as baseline gender and level of education. RESULTS Increasing long-term exposure per interquartile range (IQR) of NO2 (IQR: 13.05 μg/m3), PM10 (IQR: 3.35 μg/m3) and PM2.5 (IQR: 2.7 μg/m3) were associated with decreases in test scores of composite memory by -0.10 (95% confidence interval [CI]: -0.14, -0.07), -0.02 [-0.04, -0.01] and -0.08 [-0.11, -0.05], respectively. The same increases in NO2, PM10 and PM2.5 were associated with decreases in executive function score of -0.31 [-0.38, -0.23], -0.05 [-0.08, -0.02] and -0.16 [-0.22, -0.10], respectively. The association with ozone was inverse across both tests. Similar results were reported for the London-dwelling sub-sample of participants. CONCLUSIONS The present study was based on a long follow-up with several repeated measurements per cohort participant and long-term air pollution exposure assessment at a fine spatial scale. Increasing long-term exposure to NO2, PM10 and PM2.5 was associated with a decrease in cognitive function in older adults in England. This evidence can inform policies related to modifiable environmental exposures linked to cognitive decline.
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Affiliation(s)
- Dylan Wood
- Environmental Research Group, School of Public Health, Imperial College, Sir Michael Uren Hub, 86 Wood Ln, London, W12 0BZ, UK.
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College, London, W12 0BZ, UK.
- NIHR HPRU in Environmental Exposures and Health, Imperial College, London, UK.
| | - Dimitris Evangelopoulos
- Environmental Research Group, School of Public Health, Imperial College, Sir Michael Uren Hub, 86 Wood Ln, London, W12 0BZ, UK
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College, London, W12 0BZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College, London, UK
| | - Sean Beevers
- Environmental Research Group, School of Public Health, Imperial College, Sir Michael Uren Hub, 86 Wood Ln, London, W12 0BZ, UK
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College, London, W12 0BZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College, London, UK
| | - Nutthida Kitwiroon
- Environmental Research Group, School of Public Health, Imperial College, Sir Michael Uren Hub, 86 Wood Ln, London, W12 0BZ, UK
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College, London, W12 0BZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College, London, UK
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Klea Katsouyanni
- Environmental Research Group, School of Public Health, Imperial College, Sir Michael Uren Hub, 86 Wood Ln, London, W12 0BZ, UK
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College, London, W12 0BZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College, London, UK
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Casey E, Li Z, Liang D, Ebelt S, Levey AI, Lah JJ, Wingo TS, Hüls A. Association between Fine Particulate Matter Exposure and Cerebrospinal Fluid Biomarkers of Alzheimer's Disease among a Cognitively Healthy Population-Based Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47001. [PMID: 38567968 PMCID: PMC10989269 DOI: 10.1289/ehp13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Epidemiological evidence suggests air pollution adversely affects cognition and increases the risk of Alzheimer's disease (AD), but little is known about the biological effects of fine particulate matter (PM 2.5 , particulate matter with aerodynamic diameter ≤ 2.5 μ m ) on early predictors of future disease risk. OBJECTIVES We investigated the association between 1-, 3-, and 5-y exposure to ambient and traffic-related PM 2.5 and cerebrospinal fluid (CSF) biomarkers of AD. METHODS We conducted a cross-sectional analysis using data from 1,113 cognitively healthy adults (45-75 y of age) from the Emory Healthy Brain Study in Georgia in the United States. CSF biomarker concentrations of A β 42 , tTau, and pTau, were collected at enrollment (2016-2020) and analyzed with the Roche Elecsys system. Annual ambient and traffic-related residential PM 2.5 concentrations were estimated at a 1 -km and 250 -m resolution, respectively, and computed for each participant's geocoded address, using three exposure time periods based on specimen collection date. Associations between PM 2.5 and CSF biomarker concentrations, considering continuous and dichotomous (dichotomized at clinical cutoffs) outcomes, were estimated with multiple linear/logistic regression, respectively, controlling for potential confounders (age, gender, race, ethnicity, body mass index, and neighborhood socioeconomic status). RESULTS Interquartile range (IQR; IQR = 0.845 ) increases in 1-y [β : - 0.101 ; 95% confidence interval (CI): - 0.18 , - 0.02 ] and 3-y (β : - 0.078 ; 95% CI: - 0.15 , - 0.00 ) ambient PM 2.5 exposures were negatively associated with A β 42 CSF concentrations. Associations between ambient PM 2.5 and A β 42 were similar for 5-y estimates (β : - 0.076 ; 95% CI: - 0.160 , 0.005). Dichotomized CSF variables revealed similar associations between ambient PM 2.5 and A β 42 . Associations with traffic-related PM 2.5 were similar but not significant. Associations between PM 2.5 exposures and tTau, pTau tTau / A β 42 , or pTau / A β 42 levels were mainly null. CONCLUSION In our study, consistent trends were found between 1-y PM 2.5 exposure and decreased CSF A β 42 , which suggests an accumulation of amyloid plaques in the brain and an increased risk of developing AD. https://doi.org/10.1289/EHP13503.
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Affiliation(s)
- Emma Casey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Donghai Liang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stefanie Ebelt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Allan I. Levey
- Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - James J. Lah
- Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Thomas S. Wingo
- Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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20
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Christensen GM, Li Z, Liang D, Ebelt S, Gearing M, Levey AI, Lah JJ, Wingo A, Wingo T, Hüls A. Association of PM 2.5 Exposure and Alzheimer Disease Pathology in Brain Bank Donors-Effect Modification by APOE Genotype. Neurology 2024; 102:e209162. [PMID: 38382009 DOI: 10.1212/wnl.0000000000209162] [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: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Fine particulate matter (PM2.5) exposure has been found to be associated with Alzheimer disease (AD) and is hypothesized to cause inflammation and oxidative stress in the brain, contributing to neuropathology. The APOE gene, a major genetic risk factor of AD, has been hypothesized to modify the association between PM2.5 and AD. However, little prior research exists to support these hypotheses. This study investigates the association between traffic-related PM2.5 and AD hallmark pathology, including effect modification by APOE genotype, in an autopsy cohort. METHODS A cross-sectional study was conducted using brain tissue donors enrolled in the Emory Goizueta AD Research Center who died before 2020 (n = 224). Donors were assessed for AD pathology including the Braak stage, Consortium to Establish a Registry for AD (CERAD) score, and combined AD neuropathologic change (ABC) score. Traffic-related PM2.5 concentrations were modeled for the metro-Atlanta area during 2002-2019 with a spatial resolution of 200-250 m. One-year, 3-year, and 5-year average PM2.5 concentrations before death were matched to participants' home address. We assessed the association between traffic-related PM2.5 and AD hallmark pathology and effect modification by APOE genotype, using adjusted ordinal logistic regression models. RESULTS Among the 224 participants, the mean age of death was 76 years, and 57% had at least 1 APOE ε4 copy. Traffic-related PM2.5 was significantly associated with the CERAD score for the 1-year exposure window (odds ratio [OR] 1.92; 95% CI 1.12-3.30) and the 3-year exposure window (OR 1.87; 95% CI 1.01-3.17). PM2.5 was also associated with higher Braak stage and ABC score albeit nonsignificantly. The strongest associations between PM2.5 and neuropathology markers were among those without APOE ε4 alleles (e.g., for the CERAD score and 1-year exposure window, OR 2.31; 95% CI 1.36-3.94), though interaction between PM2.5 and APOE genotype was not statistically significant. DISCUSSION Our study found traffic-related PM2.5 exposure was associated with the CERAD score in an autopsy cohort, contributing to epidemiologic evidence that PM2.5 affects β-amyloid deposition in the brain. This association was particularly strong among donors without APOE ε4 alleles. Future studies should further investigate the biological mechanisms behind this association.
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Affiliation(s)
- Grace M Christensen
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Zhenjiang Li
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Donghai Liang
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Stefanie Ebelt
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Marla Gearing
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Allan I Levey
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - James J Lah
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Aliza Wingo
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Thomas Wingo
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
| | - Anke Hüls
- From the Department of Epidemiology (G.M.C., D.L., S.E., A.H.), Gangarosa Department of Environmental Health (Z.L., D.L., S.E., A.H.), Rollins School of Public Health, and Department of Pathology and Laboratory Medicine (M.G.), Emory University; Department of Neurology (M.G., A.I.L., J.J.L., T.W.), Emory University School of Medicine, Atlanta; Division of Mental Health (A.W.), Atlanta VA Medical Center, Decatur; Department of Psychiatry (A.W.), Emory University School of Medicine; and Department of Human Genetics (T.W.), Emory University, Atlanta, GA
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21
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Casey JA, Kioumourtzoglou MA, Padula A, González DJX, Elser H, Aguilera R, Northrop AJ, Tartof SY, Mayeda ER, Braun D, Dominici F, Eisen EA, Morello-Frosch R, Benmarhnia T. Measuring long-term exposure to wildfire PM 2.5 in California: Time-varying inequities in environmental burden. Proc Natl Acad Sci U S A 2024; 121:e2306729121. [PMID: 38349877 PMCID: PMC10895344 DOI: 10.1073/pnas.2306729121] [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: 05/02/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
Wildfires have become more frequent and intense due to climate change and outdoor wildfire fine particulate matter (PM2.5) concentrations differ from relatively smoothly varying total PM2.5. Thus, we introduced a conceptual model for computing long-term wildfire PM2.5 and assessed disproportionate exposures among marginalized communities. We used monitoring data and statistical techniques to characterize annual wildfire PM2.5 exposure based on intermittent and extreme daily wildfire PM2.5 concentrations in California census tracts (2006 to 2020). Metrics included: 1) weeks with wildfire PM2.5 < 5 μg/m3; 2) days with non-zero wildfire PM2.5; 3) mean wildfire PM2.5 during peak exposure week; 4) smoke waves (≥2 consecutive days with <15 μg/m3 wildfire PM2.5); and 5) mean annual wildfire PM2.5 concentration. We classified tracts by their racial/ethnic composition and CalEnviroScreen (CES) score, an environmental and social vulnerability composite measure. We examined associations of CES and racial/ethnic composition with the wildfire PM2.5 metrics using mixed-effects models. Averaged 2006 to 2020, we detected little difference in exposure by CES score or racial/ethnic composition, except for non-Hispanic American Indian and Alaska Native populations, where a 1-SD increase was associated with higher exposure for 4/5 metrics. CES or racial/ethnic × year interaction term models revealed exposure disparities in some years. Compared to their California-wide representation, the exposed populations of non-Hispanic American Indian and Alaska Native (1.68×, 95% CI: 1.01 to 2.81), white (1.13×, 95% CI: 0.99 to 1.32), and multiracial (1.06×, 95% CI: 0.97 to 1.23) people were over-represented from 2006 to 2020. In conclusion, during our study period in California, we detected disproportionate long-term wildfire PM2.5 exposure for several racial/ethnic groups.
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Affiliation(s)
- Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY10032
- Department of Environmental and Occupational Health, University of Washington School of Public Health, Seattle, WA98195
| | | | - Amy Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California San Francisco, San Francisco, CA94143
| | - David J. X. González
- Department of Environmental Policy, Science, and Management, University of California, Berkeley, CA94720
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA94704
| | - Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA19104
| | - Rosana Aguilera
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA92037
| | | | - Sara Y. Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA91101
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA90095
| | - Danielle Braun
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA02115
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA02215
| | - Francesca Dominici
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA02115
| | - Ellen A. Eisen
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA94704
| | - Rachel Morello-Frosch
- Department of Environmental Policy, Science, and Management, University of California, Berkeley, CA94720
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA94704
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA92037
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22
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Trentalange A, Renzi M, Michelozzi P, Guizzi M, Solimini AG. Association between air pollution and emergency room admission for eye diseases in Rome, Italy: A time-series analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123279. [PMID: 38160774 DOI: 10.1016/j.envpol.2023.123279] [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: 09/05/2023] [Revised: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
Eye diseases impose a significant burden on health services due to high case numbers. However, exposure to outdoor air pollution is seldom mentioned as potential harmful factor. We conducted a time-series analysis in Rome, Italy, to estimate the association between daily mean concentration of NO2, PM10 and PM2.5 and daily number of emergency room (ER) admissions for a selected cluster of eye diseases from 2006 to 2016. We used Poisson regression adjusted for time trend, population decrease during summer vacations and holidays, day of week, apparent temperature (hot and cold) and daily concentration of nine pollen species. We observed 581,868 ER admissions during the study period. 44.74% of cases were observed in subjects with less than 20 years, 19.50% in 51-65 age category and 13.4% among children (0-14 years). No differences between sexes were recorded. Mean values of pollutant concentrations were 54.75, 31.01 and 18.14 μg/m3 for NO2, PM10 and PM2.5 respectively. The air temperature ranged from -1 °C to 32.5 °C, with a mean value of 16 °C (SD = 6.88). The apparent temperature spaced from -3.58 °C to 34.08 °C (mean = 15.61 °C, SD = 8.5). The highest percent risk increases for 10 μg/m3 increases of the three pollutants were observed at lag0-1 day (1.3%, 0.63-1.98 for PM2.5; 1.03%, 0.56-1.51 for PM10 and 0.6%, 0.13-1.07 for NO2). Risk increased significantly also at lag0 and lag0-5 day for each pollutant. Secondary analyses showed higher effects in the elderly compared to younger subjects. No differences emerged between sexes. The dose response analysis suggested of possible effects on ER admission risk also at low-level concentrations of PM2.5. A strong confounding effect of pollen was not detected. RESULTS: of this study are coherent with previous analyses. Speculation can be done about the biological mechanisms that link air pollution to eye damage.
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Affiliation(s)
| | - Matteo Renzi
- Department of Epidemiology, Health Authority Service, ASL Rome 1, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Health Authority Service, ASL Rome 1, Rome, Italy
| | - Marco Guizzi
- ASL RM5, UOC Oculistica, Ospedale San Giovanni Evangelista, Tivoli, (RM), Italy
| | - Angelo Giuseppe Solimini
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy
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23
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Zhang S, Cao H, Chen K, Gao T, Zhao H, Zheng C, Wang T, Zeng P, Wang K. Joint Exposure to Multiple Air Pollutants, Genetic Susceptibility, and Incident Dementia: A Prospective Analysis in the UK Biobank Cohort. Int J Public Health 2024; 69:1606868. [PMID: 38426188 PMCID: PMC10901982 DOI: 10.3389/ijph.2024.1606868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives: This study aimed to evaluate the joint effects of multiple air pollutants including PM2.5, PM10, NO2, and NOx with dementia and examined the modifying effects of genetic susceptibility. Methods: This study included 220,963 UK Biobank participants without dementia at baseline. Weighted air pollution score reflecting the joint exposure to multiple air pollutants were constructed by cross-validation analyses, and inverse-variance weighted meta-analyses were performed to create a pooled effect. The modifying effect of genetic susceptibility on air pollution score was assessed by genetic risk score and APOE ε4 genotype. Results: The HR (95% CI) of dementia for per interquartile range increase of air pollution score was 1.13 (1.07∼1.18). Compared with the lowest quartile (Q1) of air pollution score, the HR (95% CI) of Q4 was 1.26 (1.13∼1.40) (P trend = 2.17 × 10-5). Participants with high air pollution score and high genetic susceptibility had higher risk of dementia compared to those with low air pollution score and low genetic susceptibility. Conclusion: Our study provides evidence that joint exposure to multiple air pollutants substantially increases the risk of dementia, especially among individuals with high genetic susceptibility.
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Affiliation(s)
- Shuo Zhang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hongyan Cao
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Keying Chen
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tongyu Gao
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Huashuo Zhao
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chu Zheng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Xuzhou Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ting Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ping Zeng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Xuzhou Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ke Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Xuzhou Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Bi J, Burnham D, Zuidema C, Schumacher C, Gassett AJ, Szpiro AA, Kaufman JD, Sheppard L. Evaluating low-cost monitoring designs for PM 2.5 exposure assessment with a spatiotemporal modeling approach. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123227. [PMID: 38147948 PMCID: PMC10922961 DOI: 10.1016/j.envpol.2023.123227] [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: 08/12/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 12/28/2023]
Abstract
Determining the most feasible and cost-effective approaches to improving PM2.5 exposure assessment with low-cost monitors (LCMs) can considerably enhance the quality of its epidemiological inferences. We investigated features of fixed-site LCM designs that most impact PM2.5 exposure estimates to be used in long-term epidemiological inference for the Adult Changes in Thought Air Pollution (ACT-AP) study. We used ACT-AP collected and calibrated LCM PM2.5 measurements at the two-week level from April 2017 to September 2020 (N of monitors [measurements] = 82 [502]). We also acquired reference-grade PM2.5 measurements from January 2010 to September 2020 (N = 78 [6186]). We used a spatiotemporal modeling approach to predict PM2.5 exposures with either all LCM measurements or varying subsets with reduced temporal or spatial coverage. We evaluated the models based on a combination of cross-validation and external validation at locations of LCMs included in the models (N = 82), and also based on an independent external validation with a set of LCMs not used for the modeling (N = 30). We found that the model's performance declined substantially when LCM measurements were entirely excluded (spatiotemporal validation R2 [RMSE] = 0.69 [1.2 μg/m3]) compared to the model with all LCM measurements (0.84 [0.9 μg/m3]). Temporally, using the farthest apart measurements (i.e., the first and last) from each LCM resulted in the closest model's performance (0.79 [1.0 μg/m3]) to the model with all LCM data. The models with only the first or last measurement had decreased performance (0.77 [1.1 μg/m3]). Spatially, the model's performance decreased linearly to 0.74 (1.1 μg/m3) when only 10% of LCMs were included. Our analysis also showed that LCMs located in densely populated, road-proximate areas improved the model more than those placed in moderately populated, road-distant areas.
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Affiliation(s)
- Jianzhao Bi
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA.
| | - Dustin Burnham
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA
| | - Christopher Zuidema
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA
| | - Cooper Schumacher
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA
| | - Amanda J Gassett
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA; Department of Medicine, University of Washington, Seattle, USA; Department of Epidemiology, University of Washington, USA
| | - Lianne Sheppard
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, USA; Department of Biostatistics, University of Washington, Seattle, USA
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25
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Del Río SG, Plans-Beriso E, Ramis R, Ortolá R, Pastor R, Sotos-Prieto M, Castelló A, Requena RO, Moleón JJJ, Félix BMF, Muriel A, Miret M, Mateos JLA, Choi YH, Rodríguez-Artalejo F, Fernández-Navarro P, García-Esquinas E. Exposure to residential traffic and trajectories of unhealthy ageing: results from a nationally-representative cohort of older adults. Environ Health 2024; 23:15. [PMID: 38303067 PMCID: PMC10832178 DOI: 10.1186/s12940-024-01057-3] [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: 05/08/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown. METHODS Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces. RESULTS At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities. CONCLUSIONS Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age.
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Affiliation(s)
- Sergio Gómez Del Río
- Department of Preventive Medicine, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Elena Plans-Beriso
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Rebeca Ramis
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Rosario Ortolá
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roberto Pastor
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Mercedes Sotos-Prieto
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Adela Castelló
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Rocío Olmedo Requena
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - José Juan Jiménez Moleón
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Borja María Fernández Félix
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Alfonso Muriel
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Department of Nursery and Physiotherapy, Universidad de Alcalá, Madrid, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consortium for Biomedical Research in Mental Health (CIBER en Salud Mental - CIBERSAM), Madrid, Spain
| | - Jose Luis Ayuso Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consortium for Biomedical Research in Mental Health (CIBER en Salud Mental - CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Madrid, Spain
| | - Yoon-Hyeong Choi
- School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea
| | - Fernando Rodríguez-Artalejo
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Pablo Fernández-Navarro
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| | - Esther García-Esquinas
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
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26
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Blanco MN, Shaffer RM, Li G, Adar SD, Carone M, Szpiro AA, Kaufman JD, Larson TV, Hajat A, Larson EB, Crane PK, Sheppard L. Traffic-related air pollution and dementia incidence in the Adult Changes in Thought Study. ENVIRONMENT INTERNATIONAL 2024; 183:108418. [PMID: 38185046 PMCID: PMC10873482 DOI: 10.1016/j.envint.2024.108418] [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: 10/13/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND While epidemiologic evidence links higher levels of exposure to fine particulate matter (PM2.5) to decreased cognitive function, fewer studies have investigated links with traffic-related air pollution (TRAP), and none have examined ultrafine particles (UFP, ≤100 nm) and late-life dementia incidence. OBJECTIVE To evaluate associations between TRAP exposures (UFP, black carbon [BC], and nitrogen dioxide [NO2]) and late-life dementia incidence. METHODS We ascertained dementia incidence in the Seattle-based Adult Changes in Thought (ACT) prospective cohort study (beginning in 1994) and assessed ten-year average TRAP exposures for each participant based on prediction models derived from an extensive mobile monitoring campaign. We applied Cox proportional hazards models to investigate TRAP exposure and dementia incidence using age as the time axis and further adjusting for sex, self-reported race, calendar year, education, socioeconomic status, PM2.5, and APOE genotype. We ran sensitivity analyses where we did not adjust for PM2.5 and other sensitivity and secondary analyses where we adjusted for multiple pollutants, applied alternative exposure models (including total and size-specific UFP), modified the adjustment covariates, used calendar year as the time axis, assessed different exposure periods, dementia subtypes, and others. RESULTS We identified 1,041 incident all-cause dementia cases in 4,283 participants over 37,102 person-years of follow-up. We did not find evidence of a greater hazard of late-life dementia incidence with elevated levels of long-term TRAP exposures. The estimated hazard ratio of all-cause dementia was 0.98 (95 % CI: 0.92-1.05) for every 2000 pt/cm3 increment in UFP, 0.95 (0.89-1.01) for every 100 ng/m3 increment in BC, and 0.96 (0.91-1.02) for every 2 ppb increment in NO2. These findings were consistent across sensitivity and secondary analyses. DISCUSSION We did not find evidence of a greater hazard of late-life dementia risk with elevated long-term TRAP exposures in this population-based prospective cohort study.
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Affiliation(s)
- Magali N Blanco
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Rachel M Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Ge Li
- VA Northwest Network Mental Illness Research, Education, and Clinical Center, Virginia Puget Sound Health Care System, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center, Virginia Puget Sound Health Care System, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sara D Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Timothy V Larson
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Civil & Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
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27
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Sheikh HA, Maher BA, Woods AW, Tung PY, Harrison RJ. Efficacy of green infrastructure in reducing exposure to local, traffic-related sources of airborne particulate matter (PM). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166598. [PMID: 37634712 DOI: 10.1016/j.scitotenv.2023.166598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
One aim of roadside green infrastructure (GI) is to mitigate exposure to local, traffic-generated pollutants. Here, we determine the efficacy of roadside GI in improving local air quality through the deposition and/or dispersion of airborne particulate matter (PM). PM was collected on both pumped air filters and on the leaves of a recently installed 'tredge' (trees managed as a head-high hedge) at an open road environment next to a primary school in Manchester, U.K. The magnetic properties of PM deposited on leaves and filters (size fractions PM10 and PM2.5) were deduced from hysteresis loops, first-order reversal curves (FORCs), and low-temperature remanence measurements. These were complemented with electron microscopy to identify changes in magnetic PM concentration downwind of the tredge/GI. We show that the tredge is permeable to airflow using a simple CO2 tracer experiment; hence, it allows interception and subsequent deposition of PM on its leaves. Magnetic loadings per m3 of air from filters (PM10 saturation magnetisation, Ms, at 5 K) were reduced by 40 % behind the tredge and a further 63 % in the playground; a total reduction of 78 % compared to roadside air. For the PM2.5 fraction, the reduction in magnetic loading behind the tredge was remarkable (82 %), reflecting efficient diffusional capture of sub-5 nm Fe-oxide particles by the tredge. Some direct mixing of roadside and playground air occurs at the back of the playground, caused by air flow over, and/or through gaps in, the slowly-permeable tredge. The magnetic loading on tredge leaves increased over successive days, capturing ~23 % of local, traffic-derived PM10. Using a heuristic two-dimensional turbulent mixing model, we assess the limited dispersion of PM < 22.5 μm induced by eddies in the tredge wake. This study demonstrates that PM deposition on leaves reduces exposure significantly in this school playground setting; hence, providing a cost-effective mitigation strategy.
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Affiliation(s)
- H A Sheikh
- Department of Earth Sciences, University of Cambridge, Downing Site, CB2 3EQ, UK.
| | - B A Maher
- Center for Environmental Magnetism and Palaeomagnetism, University of Lancaster, LA1 4YQ, UK
| | - A W Woods
- Department of Earth Sciences, University of Cambridge, Downing Site, CB2 3EQ, UK
| | - P Y Tung
- Department of Earth Sciences, University of Cambridge, Downing Site, CB2 3EQ, UK; Department of Materials Science and Metallurgy, University of Cambridge, CB3 0FS, UK
| | - R J Harrison
- Department of Earth Sciences, University of Cambridge, Downing Site, CB2 3EQ, UK
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28
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Zhang Z, Lin H. Air Pollution: A Pressing Threat to Functioning in the Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:2307-2308. [PMID: 37536283 DOI: 10.1093/gerona/glad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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29
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Gharbi-Meliani A, Husson F, Vandendriessche H, Bayen E, Yaffe K, Bachoud-Lévi AC, Cleret de Langavant L. Identification of high likelihood of dementia in population-based surveys using unsupervised clustering: a longitudinal analysis. Alzheimers Res Ther 2023; 15:209. [PMID: 38031083 PMCID: PMC10688099 DOI: 10.1186/s13195-023-01357-9] [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: 06/23/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Dementia is defined as a cognitive decline that affects functional status. Longitudinal ageing surveys often lack a clinical diagnosis of dementia though measure cognition and daily function over time. We used unsupervised machine learning and longitudinal data to identify transition to probable dementia. METHODS Multiple Factor Analysis was applied to longitudinal function and cognitive data of 15,278 baseline participants (aged 50 years and more) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) (waves 1, 2 and 4-7, between 2004 and 2017). Hierarchical Clustering on Principal Components discriminated three clusters at each wave. We estimated probable or "Likely Dementia" prevalence by sex and age, and assessed whether dementia risk factors increased the risk of being assigned probable dementia status using multistate models. Next, we compared the "Likely Dementia" cluster with self-reported dementia status and replicated our findings in the English Longitudinal Study of Ageing (ELSA) cohort (waves 1-9, between 2002 and 2019, 7840 participants at baseline). RESULTS Our algorithm identified a higher number of probable dementia cases compared with self-reported cases and showed good discriminative power across all waves (AUC ranged from 0.754 [0.722-0.787] to 0.830 [0.800-0.861]). "Likely Dementia" status was more prevalent in older people, displayed a 2:1 female/male ratio, and was associated with nine factors that increased risk of transition to dementia: low education, hearing loss, hypertension, drinking, smoking, depression, social isolation, physical inactivity, diabetes, and obesity. Results were replicated in ELSA cohort with good accuracy. CONCLUSIONS Machine learning clustering can be used to study dementia determinants and outcomes in longitudinal population ageing surveys in which dementia clinical diagnosis is lacking.
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Affiliation(s)
- Amin Gharbi-Meliani
- Neuropsychologie Interventionnelle, U955 E01, Institut Mondor de Recherche Biomédicale & Département d'études Cognitives, INSERM, Ecole Normale Supérieure, Université PSL, Université Paris-Est Créteil, Creteil, 94000, France
| | - François Husson
- Institut Agro, Univ Rennes1, CNRS, IRMAR, Rennes, 35000, France
| | - Henri Vandendriessche
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d'études Cognitives, Ecole Normale Supérieure, Université PSL, INSERM, Paris, 75005, France
| | - Eleonore Bayen
- Département de Rééducation Neurologique, Sorbonne Université, Hôpital Pitié-Salpêtrière-Assistance Publique Hôpitaux de Paris, Paris, 75013, France
- Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA
| | - Kristine Yaffe
- Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA
- Departments of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco, CA, 94143, USA
| | - Anne-Catherine Bachoud-Lévi
- Neuropsychologie Interventionnelle, U955 E01, Institut Mondor de Recherche Biomédicale & Département d'études Cognitives, INSERM, Ecole Normale Supérieure, Université PSL, Université Paris-Est Créteil, Creteil, 94000, France
- Service de Neurologie, Centre de référence maladie de Huntington, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 1 rue Gustave Eiffel, Creteil, 94000, France
| | - Laurent Cleret de Langavant
- Neuropsychologie Interventionnelle, U955 E01, Institut Mondor de Recherche Biomédicale & Département d'études Cognitives, INSERM, Ecole Normale Supérieure, Université PSL, Université Paris-Est Créteil, Creteil, 94000, France.
- Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA.
- Service de Neurologie, Centre de référence maladie de Huntington, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 1 rue Gustave Eiffel, Creteil, 94000, France.
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30
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Lelieveld J, Haines A, Burnett R, Tonne C, Klingmüller K, Münzel T, Pozzer A. Air pollution deaths attributable to fossil fuels: observational and modelling study. BMJ 2023; 383:e077784. [PMID: 38030155 PMCID: PMC10686100 DOI: 10.1136/bmj-2023-077784] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To estimate all cause and cause specific deaths that are attributable to fossil fuel related air pollution and to assess potential health benefits from policies that replace fossil fuels with clean, renewable energy sources. DESIGN Observational and modelling study. METHODS An updated atmospheric composition model, a newly developed relative risk model, and satellite based data were used to determine exposure to ambient air pollution, estimate all cause and disease specific mortality, and attribute them to emission categories. DATA SOURCES Data from the global burden of disease 2019 study, observational fine particulate matter and population data from National Aeronautics and Space Administration (NASA) satellites, and atmospheric chemistry, aerosol, and relative risk modelling for 2019. RESULTS Globally, all cause excess deaths due to fine particulate and ozone air pollution are estimated at 8.34 million (95% confidence interval 5.63 to 11.19) deaths per year. Most (52%) of the mortality burden is related to cardiometabolic conditions, particularly ischaemic heart disease (30%). Stroke and chronic obstructive pulmonary disease both account for 16% of mortality burden. About 20% of all cause mortality is undefined, with arterial hypertension and neurodegenerative diseases possibly implicated. An estimated 5.13 million (3.63 to 6.32) excess deaths per year globally are attributable to ambient air pollution from fossil fuel use and therefore could potentially be avoided by phasing out fossil fuels. This figure corresponds to 82% of the maximum number of air pollution deaths that could be averted by controlling all anthropogenic emissions. Smaller reductions, rather than a complete phase-out, indicate that the responses are not strongly non-linear. Reductions in emission related to fossil fuels at all levels of air pollution can decrease the number of attributable deaths substantially. Estimates of avoidable excess deaths are markedly higher in this study than most previous studies for these reasons: the new relative risk model has implications for high income (largely fossil fuel intensive) countries and for low and middle income countries where the use of fossil fuels is increasing; this study accounts for all cause mortality in addition to disease specific mortality; and the large reduction in air pollution from a fossil fuel phase-out can greatly reduce exposure. CONCLUSION Phasing out fossil fuels is deemed to be an effective intervention to improve health and save lives as part the United Nations' goal of climate neutrality by 2050. Ambient air pollution would no longer be a leading, environmental health risk factor if the use of fossil fuels were superseded by equitable access to clean sources of renewable energy.
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Affiliation(s)
- Jos Lelieveld
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany
- Climate and Atmosphere Research Center, Cyprus Institute, Nicosia, Cyprus
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Burnett
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Cathryn Tonne
- Barcelona Institute for Global Health and Pompeu Fabra University, Barcelona, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network, Madrid, Spain
| | - Klaus Klingmüller
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Andrea Pozzer
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany
- Climate and Atmosphere Research Center, Cyprus Institute, Nicosia, Cyprus
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Doheny BM, Inglis JJ, Boll KA, Lunos S, Surapaneni VL. Short animated video increases knowledge and perceived comfort in clinical counseling on inequitable health impacts of air pollution among interprofessional health learners and clinicians. BMC MEDICAL EDUCATION 2023; 23:858. [PMID: 37953249 PMCID: PMC10642052 DOI: 10.1186/s12909-023-04785-1] [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: 07/09/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Air pollution is a major health risk contributing to global morbidity and mortality, yet clinicians do not routinely engage in counseling patients on this topic. Clinicians cite their lack of education as a common barrier. We developed a two-minute animated video on mitigating air pollution health risks and evaluated the efficacy of this video as an educational tool. METHODS In March-June 2021, a convenience sample of Minnesota interprofessional health learners and clinicians viewed the video and completed an electronic survey that assessed pre-/post-video intervention changes in (a) didactic and clinically applied knowledge on health impacts of air pollution, (b) perceived comfort in identifying at-risk patients and counseling them on relevant preventive health behaviors, (c) intentions/barriers to counseling patients, (d) beliefs and attitudes related to the health harms of air pollution, and (e) perceptions of the overall acceptability of the intervention. RESULTS The 218 participants included learners and clinicians in medicine, nursing, and advanced practice provision. Respondents' knowledge scores and self-reported level of comfort in identifying high-risk patients and counseling them on preventative health behaviors increased significantly pre-/post-intervention. The video also effectively altered participants' misperceptions about the health impacts of air pollution. While less than half of participants (43.6%) reported they intended to engage in counseling patients as a result of watching the video, 52.3% indicated they might do so. Lack of time during clinical encounters and lack of training were reported as persistent barriers to engaging in this counseling. Overall, participants found the video to be an effective educational tool, indicating that they wanted their colleagues and patients to watch the video and would like to see further short, animated videos on other environmental health topics. CONCLUSIONS A two-minute animated educational video significantly improved knowledge of inequitable health impacts of air pollution and improved perceived comfort in identifying and counseling at-risk patients among health professional learners and clinicians regardless of profession, level of training, or pre-intervention knowledge level. Academic health professional training programs and health systems should consider adopting this modality as a tool for educating learners, clinicians, and patients on environmental health risks.
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Affiliation(s)
- Brenna M Doheny
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth campus, 1035 University Drive, Duluth, MN, 55812-3031, USA.
| | - Jack J Inglis
- Hennepin Healthcare, 701 Park Avenue, MN, Minneapolis, 55415, USA
| | - Karly A Boll
- Hennepin Healthcare, 701 Park Avenue, MN, Minneapolis, 55415, USA
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
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32
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Bennett EE, Song Z, Lynch KM, Liu C, Stapp EK, Xu X, Park ES, Ying Q, Smith RL, Stewart JD, Whitsel EA, Mosley TH, Wong DF, Liao D, Yanosky JD, Szpiro AA, Kaufman JD, Gottesman RF, Power MC. The association of long-term exposure to criteria air pollutants, fine particulate matter components, and airborne trace metals with late-life brain amyloid burden in the Atherosclerosis Risk in Communities (ARIC) study. ENVIRONMENT INTERNATIONAL 2023; 180:108200. [PMID: 37774459 PMCID: PMC10620775 DOI: 10.1016/j.envint.2023.108200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Studies suggest associations between long-term ambient air pollution exposure and outcomes related to Alzheimer's disease (AD). Whether a link exists between pollutants and brain amyloid accumulation, a biomarker of AD, is unclear. We assessed whether long-term air pollutant exposures are associated with late-life brain amyloid deposition in Atherosclerosis Risk in Communities (ARIC) study participants. METHODS We used a chemical transport model with data fusion to estimate ambient concentrations of PM2.5 and its components, NO2, NOx, O3 (24-hour and 8-hour), CO, and airborne trace metals. We linked concentrations to geocoded participant addresses and calculated 10-year mean exposures (2002 to 2011). Brain amyloid deposition was measured using florbetapir amyloid positron emission tomography (PET) scans in 346 participants without dementia in 2012-2014, and we defined amyloid positivity as a global cortical standardized uptake value ratio ≥ the sample median of 1.2. We used logistic regression models to quantify the association between amyloid positivity and each air pollutant, adjusting for putative confounders. In sensitivity analyses, we considered whether use of alternate air pollution estimation approaches impacted findings for PM2.5, NO2, NOx, and 24-hour O3. RESULTS At PET imaging, eligible participants (N = 318) had a mean age of 78 years, 56% were female, 43% were Black, and 27% had mild cognitive impairment. We did not find evidence of associations between long-term exposure to any pollutant and brain amyloid positivity in adjusted models. Findings were materially unchanged in sensitivity analyses using alternate air pollution estimation approaches for PM2.5, NO2, NOx, and 24-hour O3. CONCLUSIONS Air pollution may impact cognition and dementia independent of amyloid accumulation, though whether air pollution influences AD pathogenesis later in the disease course or at higher exposure levels deserves further consideration.
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Affiliation(s)
- Erin E Bennett
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Ziwei Song
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katie M Lynch
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Chelsea Liu
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Emma K Stapp
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Xiaohui Xu
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center School of Public Health, College Station, TX, USA
| | - Eun Sug Park
- Texas A&M Transportation Institute, College Station, TX, USA
| | - Qi Ying
- Zachry Department of Civil & Environmental Engineering, Texas A&M University, College Station, TX, USA
| | - Richard L Smith
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas H Mosley
- The University of Mississippi Medical Center, Jackson, MS, USA
| | - Dean F Wong
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Duanping Liao
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Melinda C Power
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
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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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34
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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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Ronaldson A, Stewart R, Mueller C, Das-Munshi J, Newbury JB, Mudway IS, Broadbent M, Fisher HL, Beevers S, Dajnak D, Hotopf M, Hatch SL, Bakolis I. Associations between air pollution and mental health service use in dementia: a retrospective cohort study. BMJ MENTAL HEALTH 2023; 26:e300762. [PMID: 37550086 PMCID: PMC10577765 DOI: 10.1136/bmjment-2023-300762] [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: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Little is known about the role of air pollution in how people with dementia use mental health services. OBJECTIVE We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia. METHODS In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models. FINDINGS In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function. CONCLUSIONS Residential air pollution exposure is associated with increased CMHT usage among people with dementia. CLINICAL IMPLICATIONS Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
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Affiliation(s)
- Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Joanne B Newbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
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Gan W, Manning KJ, Cleary EG, Fortinsky RH, Brugge D. Exposure to ultrafine particles and cognitive decline among older people in the United States. ENVIRONMENTAL RESEARCH 2023; 227:115768. [PMID: 36965813 PMCID: PMC10246447 DOI: 10.1016/j.envres.2023.115768] [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: 01/07/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Some studies suggest that ambient particulate air pollution is associated with cognitive decline. However, the findings are mixed, and there is no relevant research examining the influences of ultrafine particles (UFP), which may have more toxicity than larger particles. We therefore conducted this study to investigate whether residential UFP exposure is associated with cognitive decline using data from the Alzheimer's Disease Research Centers in the United States. METHODS This is a longitudinal study of participants who were aged 65 years and older and had normal cognitive status at baseline. Residential UFP exposure, expressed as particle number concentrations (PNC), was assessed in 2016-2017 using a nationwide land use regression model, and was assigned to each participant using their 3-digit residential ZIP codes. Cognitive functions including memory, attention, language, executive function, and global function were assessed annually using 15 neuropsychological tests from March 2015 to February 2022. Linear mixed-effects models were used to examine the associations after adjustment for covariates including baseline age, sex, APOE ε4 status, race, education, smoking status, history of diabetes, quartiles of neighborhood median household income, and interaction terms of follow-up time with each covariate. RESULTS This study included 5646 participants (mean age 76 years, 65% female). On average, each participant had 4 annual visits. When PNC was treated as a continuous variable, there were no statistically or clinically significant changes in annual decline of each cognitive function in relation to an interquartile range elevation in PNC (4026 particles/cm3). Similarly, when PNC was treated as a categorical variable including five exposure groups, there were no linear exposure-response trends in annual decline of each cognitive function across the five exposure groups. CONCLUSIONS This study found no meaningful associations between residential UFP exposure and cognitive decline in global and domain-specific functions. There is a need for further research that assigns UFP exposure at a finer geographic scale.
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Affiliation(s)
- Wenqi Gan
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Kevin J Manning
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Richard H Fortinsky
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA; UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Doug Brugge
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
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Gayraud L, Mortamais M, Schweitzer C, de Hoogh K, Cougnard-Grégoire A, Korobelnik JF, Delyfer MN, Rougier MB, Leffondré K, Helmer C, Vienneau D, Berr C, Delcourt C. Association of long-term exposure to ambient air pollution with retinal neurodegeneration: The prospective alienor study. ENVIRONMENTAL RESEARCH 2023:116364. [PMID: 37301495 DOI: 10.1016/j.envres.2023.116364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
Chronic exposure to air pollution may have adverse effects on neurodegenerative diseases. Glaucoma, the second leading cause of blindness worldwide, is a neurodegenerative disease of the optic nerve, characterized by progressive thinning of the retinal nerve fiber layer (RNFL). We investigated the relationship of air pollution exposure with longitudinal changes of RNFL thickness in the Alienor study, a population-based cohort of residents of Bordeaux, France, aged 75 years or more. Peripapillary RNFL thickness was measured using optical coherence tomography imaging every 2 years from 2009 to 2020. Measurements were acquired and reviewed by specially trained technicians to control quality. Air pollution exposure (particulate matter ≤2.5 μm (PM2.5), black carbon (BC), nitrogen dioxide (NO2)) was estimated at the participants' geocoded residential address using land-use regression models. For each pollutant, the 10-year average of past exposure at first RNFL thickness measurement was estimated. Associations of air pollution exposure with RNFL thickness longitudinal changes were assessed using linear mixed models adjusted for potential confounders, allowing for intra-eye and intra-individual correlation (repeated measurements). The study included 683 participants with at least one RNFL thickness measurement (62% female, mean age 82 years). The average RNFL was 90 μm (SD:14.4) at baseline. Exposure to higher levels of PM2.5 and BC in the previous 10 years was significantly associated with a faster RNFL thinning during the 11-year follow-up (-0.28 μm/year (95% confidence interval (CI) [-0.44;-0.13]) and -0.26 μm/year (95% CI [-0.40;-0.12]) per interquartile range increment; p < 0.001 for both). The size of the effect was similar to one year of age in the fitted model (-0.36 μm/year). No statistically significant associations were found with NO2 in the main models. This study evidenced a strong association of chronic exposure to fine particulate matter with retinal neurodegeneration, at air pollution levels below the current recommended thresholds in Europe.
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Affiliation(s)
- Laure Gayraud
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France
| | - Marion Mortamais
- Univ. Montpellier, Inserm, Institute for Neurosciences of Montpellier INM, UMR, 1298, 34091, Montpellier, France
| | - Cédric Schweitzer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Service d'Ophtalmologie, Bordeaux, France
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Audrey Cougnard-Grégoire
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France
| | - Jean-François Korobelnik
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Service d'Ophtalmologie, Bordeaux, France
| | - Marie-Noelle Delyfer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Service d'Ophtalmologie, Bordeaux, France
| | - Marie-Bénédicte Rougier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Service d'Ophtalmologie, Bordeaux, France
| | - Karen Leffondré
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Claudine Berr
- Univ. Montpellier, Inserm, Institute for Neurosciences of Montpellier INM, UMR, 1298, 34091, Montpellier, France
| | - Cécile Delcourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, 1219, F-33000, Bordeaux, France.
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Ilango SD, Leary CS, Ritchie E, Semmens EO, Park C, Fitzpatrick AL, Kaufman JD, Hajat A. An Examination of the Joint Effect of the Social Environment and Air Pollution on Dementia Among US Older Adults. Environ Epidemiol 2023; 7:e250. [PMID: 37304341 PMCID: PMC10256342 DOI: 10.1097/ee9.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Abstract
Evidence suggests exposure to air pollution increases the risk of dementia. Cognitively stimulating activities and social interactions, made available through the social environment, may slow cognitive decline. We examined whether the social environment buffers the adverse effect of air pollution on dementia in a cohort of older adults. Methods This study draws from the Ginkgo Evaluation of Memory Study. Participants aged 75 years and older were enrolled between 2000 and 2002 and evaluated for dementia semi-annually through 2008. Long-term exposure to particulate matter and nitrogen dioxide was assigned from spatial and spatiotemporal models. Census tract-level measures of the social environment and individual measures of social activity were used as measures of the social environment. We generated Cox proportional hazard models with census tract as a random effect and adjusted for demographic and study visit characteristics. Relative excess risk due to interaction was estimated as a qualitative measure of additive interaction. Results This study included 2,564 individuals. We observed associations between increased risk of dementia and fine particulate matter (µg/m3), coarse particulate matter (µg/m3), and nitrogen dioxide (ppb); HRs per 5 unit increase were 1.55 (1.01, 2.18), 1.31 (1.07, 1.60), and 1.18 (1.02, 1.37), respectively. We found no evidence of additive interaction between air pollution and the neighborhood social environment. Conclusions We found no consistent evidence to suggest a synergistic effect between exposure to air pollution and measures of the social environment. Given the many qualities of the social environment that may reduce dementia pathology, further examination is encouraged.
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Affiliation(s)
- Sindana D Ilango
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Cindy S Leary
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Emily Ritchie
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Erin O Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Christina Park
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Family Medicine and Global Health, University of Washington, Seattle, Washington, USA
| | - Joel D Kaufman
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Ogurtsova K, Soppa VJ, Weimar C, Jöckel KH, Jokisch M, Hoffmann B. Association of long-term air pollution and ambient noise with cognitive decline in the heinz nixdorf recall study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023:121898. [PMID: 37244536 DOI: 10.1016/j.envpol.2023.121898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
Little is known about the impact of long-term ambient air pollution (AP) and noise exposure on change in cognitive function over years in the elderly. In this study, we wanted to examine the association between long-term exposure to AP and noise with the rate of cognitive decline in a population aged 50 and older and susceptible groups with mild cognitive impairment or at a genetically higher risk of Alzheimer's disease (Apolipoprotein E ε4 positive). Participants in the German population-based Heinz Nixdorf Recall study carried out five neuropsychological tests. Individual tests scores at the first (T1 = 2006-2008) and second (T2 = 2011-2015) follow-up for each test were used as outcomes after standardization using predicted means adjusted for age and education. Global cognitive score (GCS) was defined as sum of five standardized scores of individual tests. Long-term exposures to particulate matter (PM2.5, PM10, PM2.5 absorbance), accumulation mode particle number (PNacc), a proxy of ultrafine particles, and nitrogen dioxide were estimated by the land-use regression and chemistry transport models. Noise exposures were assessed as outdoor weighted nighttime road traffic noise (Lnight) means. We performed linear regression analyses adjusted for sex, age, individual and neighborhood socio-economic status, and lifestyle variables. Effect modification in vulnerable groups was estimated using multiplicative interaction terms between exposure and a modifier. Overall, 2554 participants (49.5% men, median age is 63 (IQR = 12)) were included. We found weak associations between higher exposure to PM10 and PM2.5 with faster decline in the immediate verbal memory test. Adjustment for potential confounders and for co-exposures did not change the results. We saw no effects on GCS, and no effect of noise exposure. In susceptible groups, higher AP and noise exposure were tended to be associated with faster decline in GCS. Our results suggest that AP exposure may accelerate cognitive decline in older ages, particularly in susceptible groups.
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Affiliation(s)
- Katherine Ogurtsova
- Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Vanessa J Soppa
- Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Weimar
- BDH Clinic Elzach, Elzach, Germany; Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martha Jokisch
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Barbara Hoffmann
- Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Madronich S, Sulzberger B, Longstreth JD, Schikowski T, Andersen MPS, Solomon KR, Wilson SR. Changes in tropospheric air quality related to the protection of stratospheric ozone in a changing climate. Photochem Photobiol Sci 2023; 22:1129-1176. [PMID: 37310641 PMCID: PMC10262938 DOI: 10.1007/s43630-023-00369-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 06/14/2023]
Abstract
Ultraviolet (UV) radiation drives the net production of tropospheric ozone (O3) and a large fraction of particulate matter (PM) including sulfate, nitrate, and secondary organic aerosols. Ground-level O3 and PM are detrimental to human health, leading to several million premature deaths per year globally, and have adverse effects on plants and the yields of crops. The Montreal Protocol has prevented large increases in UV radiation that would have had major impacts on air quality. Future scenarios in which stratospheric O3 returns to 1980 values or even exceeds them (the so-called super-recovery) will tend to ameliorate urban ground-level O3 slightly but worsen it in rural areas. Furthermore, recovery of stratospheric O3 is expected to increase the amount of O3 transported into the troposphere by meteorological processes that are sensitive to climate change. UV radiation also generates hydroxyl radicals (OH) that control the amounts of many environmentally important chemicals in the atmosphere including some greenhouse gases, e.g., methane (CH4), and some short-lived ozone-depleting substances (ODSs). Recent modeling studies have shown that the increases in UV radiation associated with the depletion of stratospheric ozone over 1980-2020 have contributed a small increase (~ 3%) to the globally averaged concentrations of OH. Replacements for ODSs include chemicals that react with OH radicals, hence preventing the transport of these chemicals to the stratosphere. Some of these chemicals, e.g., hydrofluorocarbons that are currently being phased out, and hydrofluoroolefins now used increasingly, decompose into products whose fate in the environment warrants further investigation. One such product, trifluoroacetic acid (TFA), has no obvious pathway of degradation and might accumulate in some water bodies, but is unlikely to cause adverse effects out to 2100.
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Affiliation(s)
- S Madronich
- National Center for Atmospheric Research, Boulder, USA.
- USDA UV-B Monitoring and Research Program, Natural Resource Ecology Laboratory, Colorado State University, Fort Collins, USA.
| | - B Sulzberger
- Academic Guest after retirement from Eawag: Swiss Federal Institute of Aquatic Science and Technology, CH-8600, Duebendorf, Switzerland
| | - J D Longstreth
- The Institute for Global Risk Research, LLC, Bethesda, USA
| | - T Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany
| | - M P Sulbæk Andersen
- Department of Chemistry and Biochemistry, California State University, Northridge, USA
| | - K R Solomon
- School of Environmental Sciences, University of Guelph, Guelph, Canada
| | - S R Wilson
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia.
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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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Gore J, Denno B, Omura JD, Baumgart M, McGuire LC, O'Brien K. Promoting Healthy Aging to Reduce the Risk of Dementia: A Public Health Imperative. GENERATIONS (SAN FRANCISCO, CALIF.) 2023; 47:1-11. [PMID: 38560360 PMCID: PMC10979652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Alzheimer's disease and related dementias place an enormous burden on individuals, families, health and long-term care systems, and governmental budgets. As the burden escalates with rising prevalence, attention has increasingly focused on how the risk of developing dementia can be reduced. Evidence indicates there are ways, from a population perspective, to reduce the risk of cognitive decline and possibly dementia, including through healthier lifestyles. It is imperative that the public health community lead the effort to address modifiable risk factors and social determinants of health for dementia and promote healthy aging through public health action.
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Affiliation(s)
- Janelle Gore
- ORISE fellow for the Alzheimer's Disease program at the CDC
| | - Benjamin Denno
- health policy specialist for the Alzheimer's Association
| | | | | | | | - Kelly O'Brien
- Prevention at UsAgainstAlzheimer's in Washington, DC
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Christensen GM, Li Z, Liang D, Ebelt S, Gearing M, Levey AI, Lah JJ, Wingo AP, Wingo TS, Huels A. Fine particulate air pollution and neuropathology markers of Alzheimer's disease in donors with and without APOE ε4 alleles - results from an autopsy cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.07.23288288. [PMID: 37066193 PMCID: PMC10104229 DOI: 10.1101/2023.04.07.23288288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Introduction Higher fine particulate matter (PM2.5) exposure has been found to be associated with Alzheimer's disease (AD). PM2.5 has been hypothesized to cause inflammation and oxidative stress in the brain, contributing to neuropathology. A major genetic risk factor of AD, the apolipoprotein E (APOE) gene, has also been hypothesized to modify the association between PM2.5 and AD. However, little prior research exisits to support these hypotheses. Therefore, this paper aims to investigate the association between traffic-related PM2.5 and AD hallmark pathology, including effect modification by APOE genotype, in an autopsy cohort. Methods Brain tissue donors enrolled in the Emory Goizueta Alzheimer's Disease Research Center (ADRC) who died before 2020 (n=224) were assessed for AD pathology including Braak Stage, Consortium to Establish a Registry for AD (CERAD) score, and the combined AD neuropathologic change (ABC score). Traffic-related PM2.5 concentrations were modeled for the metro-Atlanta area during 2002-2019 with a spatial resolution of 200-250m. One-, 3-, and 5-year average PM2.5 concentrations prior to death were matched to participants home address. We assessed the association between traffic-related PM2.5 and AD hallmark pathology, as well as effect modification by APOE genotype, using adjusted ordinal logistic regression models. Results Traffic-related PM2.5 was significantly associated with CERAD score for the 1-year exposure window (OR: 1.92; 95% CI: 1.12, 3.30), and the 3-year exposure window (OR: 1.87; 95%-CI: 1.01, 3.17). PM2.5 had harmful, but non-significant associations on Braak Stage and ABC score. The strongest associations between PM2.5 and neuropathology markers were among those without APOE ε4 alleles (e.g., for CERAD and 1-year exposure window, OR: 2.31; 95% CI: 1.36, 3.94), though interaction between PM2.5 and APOE genotype was not statistically significant. Conclusions Our study found traffic-related PM2.5 exposure was associated with CERAD score in an autopsy cohort, contributing to epidemiologic evidence that PM2.5 affects Aβ deposition in the brain. This association was particularly strong among donors without APOE ε4 alleles. Future studies should further investigate the biological mechanisms behind this assocation.
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Affiliation(s)
- 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
| | - Donghai Liang
- 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
| | - 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
| | - Marla Gearing
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, Emory University School of Medicine, 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, Emory University School of Medicine, Atlanta, GA, USA
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Anke Huels
- 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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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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Urbano T, Chiari A, Malagoli C, Cherubini A, Bedin R, Costanzini S, Teggi S, Maffeis G, Vinceti M, Filippini T. Particulate matter exposure from motorized traffic and risk of conversion from mild cognitive impairment to dementia: An Italian prospective cohort study. ENVIRONMENTAL RESEARCH 2023; 222:115425. [PMID: 36740156 DOI: 10.1016/j.envres.2023.115425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Based on epidemiologic and laboratory studies, exposure to air pollutants has been linked to many adverse health effects including a higher risk of dementia. In this study, we aimed to evaluate the effect of long-term exposure to outdoor air pollution on risk of conversion to dementia in a cohort of subjects with mild cognitive impairment (MCI). METHODS We recruited 53 Italian subjects newly-diagnosed with MCI. Within a geographical information system, we assessed recent outdoor air pollutant exposure, by modeling air levels of particulate matter with equivalent aerodynamic diameter ≤10 μm (PM10) from motorized traffic at participants' residence. We investigated the relation of PM10 concentrations to subsequent conversion from MCI to any type of dementia. Using a Cox-proportional hazards model combined with a restricted cubic spline model, we computed the hazard ratio (HR) of dementia with its 95% confidence interval (CI) according to increasing PM10 exposure, adjusting for sex, age, and educational attainment. RESULTS During a median follow up of 47.3 months, 34 participants developed dementia, in 26 cases diagnosed as Alzheimer's dementia. In non-linear restricted spline regression analysis, mean and maximum annual PM10 levels positively correlated with cerebrospinal fluid total and phosphorylated tau proteins concentrations, while they were inversely associated with β-amyloid. Concerning the risk of dementia, we found a positive association starting from above 10 μg/m3 for mean PM10 levels and above 35 μg/m3 for maximum PM10 levels. Specific estimates for Alzheimer's dementia were substantially similar. Adding other potential confounders to the multivariable model or removing early cases of dementia onset during the follow-up had little effect on the estimates. CONCLUSIONS Our findings suggest that exposure to outdoor air pollutants, PM10 in particular, may non-linearly increase conversion from MCI to dementia above a certain ambient air concentration.
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Affiliation(s)
- Teresa Urbano
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Chiari
- Neurology Unit, University Hospital of Modena, Modena, Italy
| | - Carlotta Malagoli
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Roberta Bedin
- Neurology Unit, University Hospital of Modena, Modena, Italy; Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sofia Costanzini
- DIEF - Department of Engineering 'Enzo Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - Sergio Teggi
- DIEF - Department of Engineering 'Enzo Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Averett N. Breaking New Ground: Space Agencies and Epidemiologists Partner Up on Particulates. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:32001. [PMID: 36961446 PMCID: PMC10038136 DOI: 10.1289/ehp12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/18/2022] [Indexed: 06/18/2023]
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Wyatt LH, Cleland SE, Wei L, Paul N, Patil A, Ward-Caviness C, Henderson SB, Rappold AG. Long-term exposure to ambient O 3 and PM 2.5 is associated with reduced cognitive performance in young adults: A retrospective longitudinal repeated measures study in adults aged 18-90 years. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 320:121085. [PMID: 36642175 DOI: 10.1016/j.envpol.2023.121085] [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: 10/27/2021] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
A growing body of evidence indicates that exposure to air pollution affects cognitive performance; however, few studies have assessed this in the context of repeated measures within a large group of individuals or in a population with a large age range. In this study, we evaluated the associations between long-term exposure to fine particulate matter (PM2.5) and ozone (O3) in large cohort of adults aged 18-90 years. The study cohort included 29,091 Lumosity users in the contiguous US who completed 20 repetitions of the Lost in Migration game between 2017 and 2018. Game scores reflect the ability to filter information and avoid distracting information. Long-term air pollution data included ambient PM2.5 and O3 averaged for the 365-day period before each gameplay date. Generalized linear models were used to examine the associations between long-term PM2.5 and O3 and game score percentile. Co-pollutant models were adjusted for meteorology, time trend, age, gender, device, education, local socioeconomic factors, and urbanicity. Results represent the change in attention game score percentile per 1 μg/m3 increase in PM2.5 or 0.01 ppm increase in O3. In the entire cohort, a -0.10 (95% CI: -0.16, -0.04) change in score percentile was associated with PM2.5, while no significant association was observed with O3. Modification of these associations by age was observed for both PM2.5 and O3, with stronger associations observed in younger users. In users aged 18-29, a -0.25 (-0.45, -0.05) change in score percentile was associated with PM2.5, while no associations were observed in other age groups. With O3, there was a -2.92 (-4.63, -1.19) and -2.81 (-4.29, -1.25) change in score percentile for users aged 18-29 and 30-39, respectively. We observed that elevated long-term PM2.5 and O3 were associated with decreased focus scores in young adults, but follow-up research is necessary to further illuminate these associations.
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Affiliation(s)
- Lauren H Wyatt
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Stephanie E Cleland
- Oak Ridge Institute for Science and Education at the Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Linda Wei
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Naman Paul
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amrita Patil
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Cavin Ward-Caviness
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | | | - Ana G Rappold
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA.
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Gharbi-Meliani A, Husson F, Vandendriessche H, Eleonore Bayen F, Yaffe K, Bachoud-Lévi AC, de Langavant LC. Identification of High Likelihood of Dementia in Population-Based Surveys using Unsupervised Clustering: a Longitudinal Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286078. [PMID: 36865284 PMCID: PMC9980227 DOI: 10.1101/2023.02.17.23286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background Dementia is defined by cognitive decline that affects functional status. Longitudinal ageing surveys often lack a clinical diagnosis of dementia though measure cognitive and function over time. We used unsupervised machine learning and longitudinal data to identify transition to probable dementia. Methods Multiple Factor Analysis was applied to longitudinal function and cognitive data of 15,278 baseline participants (aged 50 years and more) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) (waves 1, 2 and 4-7, between 2004 and 2017). Hierarchical Clustering on Principal Components discriminated three clusters at each wave. We estimated probable or "Likely Dementia" prevalence by sex and age, and assessed whether dementia risk factors increased the risk of being assigned probable dementia status using multistate models. Next, we compared the "Likely Dementia" cluster with self-reported dementia status and replicated our findings in the English Longitudinal Study of Ageing (ELSA) cohort (waves 1-9, between 2002 and 2019, 7,840 participants at baseline). Findings Our algorithm identified a higher number of probable dementia cases compared with self-reported cases and showed good discriminative power across all waves (AUC ranged from 0.754 [0.722-0.787] to 0.830 [0.800-0.861]). "Likely Dementia" status was more prevalent in older people, displayed a 2:1 female/male ratio and was associated with nine factors that increased risk of transition to dementia: low education, hearing loss, hypertension, drinking, smoking, depression, social isolation, physical inactivity, diabetes, and obesity. Results were replicated in ELSA cohort with good accuracy. Interpretation Machine learning clustering can be used to study dementia determinants and outcomes in longitudinal population ageing surveys in which dementia clinical diagnosis is lacking.
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Affiliation(s)
- Amin Gharbi-Meliani
- Equipe neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Département d'études cognitives, Ecole normale supérieure, Université PSL, Université Paris-Est Créteil, AP-HP Hôpital Henri Mondor-Albert Chenevier, Centre de référence Maladie de Huntington et Service de Neurologie, INSERM, 75005 Paris [ou 94000 Créteil], France
| | - François Husson
- Institut Agro, Univ Rennes1, CNRS, IRMAR, 35000, Rennes, France
| | - Henri Vandendriessche
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d'études cognitives, Ecole normale supérieure, Université PSL, INSERM, 75005 Paris, France
| | - France Eleonore Bayen
- Global Brain Health Institute, University of California, San Francisco, CA, United States; Sorbonne Université, Hôpital Pitié-Salpêtrière-Assistance Publique Hôpitaux de Paris, Département de Rééducation Neurologique, Paris, France
| | - Kristine Yaffe
- Global Brain Health Institute, University of California, San Francisco, CA, United States; Departments of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco
| | - Anne-Catherine Bachoud-Lévi
- Equipe neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Département d'études cognitives, Ecole normale supérieure, Université PSL, Université Paris-Est Créteil, AP-HP Hôpital Henri Mondor-Albert Chenevier, Centre de référence Maladie de Huntington et Service de Neurologie, INSERM, 75005 Paris [ou 94000 Créteil], France
| | - Laurent Cleret de Langavant
- Equipe neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Département d'études cognitives, Ecole normale supérieure, Université PSL, Université Paris-Est Créteil, AP-HP Hôpital Henri Mondor-Albert Chenevier, Centre de référence Maladie de Huntington et Service de Neurologie, INSERM, 75005 Paris [ou 94000 Créteil], France; Global Brain Health Institute, University of California, San Francisco, CA, United States
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