Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study

Shi, Liuhua; Wu, Xiao; Yazdi, Mahdieh Danesh; Braun, Danielle; Awad, Yara Abu; Wei, Yaguang; Liu, Pengfei; Di, Qian; Wang, Yun; Schwartz, Joel; Dominici, Francesca; Kioumourtzoglou, Marianthi-Anna; Zanobetti, Antonella

doi:10.1016/s2542-5196(20)30227-8

Cited by 203 publications

(171 citation statements)

References 33 publications

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“…2016 ). However, a recent nationwide study using information on Medicare enrollees, reported higher estimates in women for both AD and PD ( Shi et al. 2020 ), in agreement with other studies that also reported stronger associations of

exposure with risk ( Liu et al.…”

Section: Discussionsupporting

confidence: 84%

“…Medicare enrollees, reported higher estimates in women for both AD and PD (Shi et al 2020), in agreement with other studies that also reported stronger associations of PM 2:5 exposure with risk (Liu et al 2016) and aggravation (Lee et al 2017) of PD among females relative to males. Conversely, a study in a cohort of female nurses reported a null association between PM 2:5 and PD (Palacios et al 2014).…”

Section: Environmental Health Perspectivessupporting

confidence: 90%

“…This is supported by studies reporting higher rates of hospitalizations among patients with neurodegenerative diseases relative to older adults without neurodegenerative diseases (Alzheimer's Association 2019; Lechtzin et al 2001;Oguh and Videnovic 2012) and increases in number of hospitalizations as the disease progresses, with 50% of hospitalizations occurring in advanced stages of disease (Oguh and Videnovic 2012;Albert et al 1999;Lechtzin et al 2001). Previous studies have also used hospitalization data to evaluate disease aggravation (Lee et al 2019;van Wijngaarden et al 2021;Shi et al 2020;Kioumourtzoglou et al 2016) in neurodegenerative diseases. We had access to SPACRS data starting in 1995; thus, we were able to use data from between 1995 and 1999 to identify potentially prevalent cases and exclude any subjects with a primary or secondary diagnosis prior to 2000 from our analyses.…”

Section: Outcome Definitionmentioning

confidence: 87%

“…Moreover, this study covered a geographical area that included both urban and rural locations and a diverse population with a broad range of ages, allowing us to evaluate age subpopulations and effect modification by age and urbanicity. Other studies using hospitalizations to examine this association in the United States have leveraged the Medicare population, which only includes enrollees >65 years of age (Shi et al 2020;Kioumourtzoglou et al 2016;Lee et al 2019); SPARCS includes information on hospitalizations of all ages. Furthermore, health data for the years 1995-1999 allowed us to exclude any potential prevalent cases.…”

Section: Strengthsmentioning

confidence: 99%

“…Furthermore, some epidemiological studies have identified long-term particle exposure as a risk factor for PD (Liu et al 2016;Fu et al 2019;Shin et al 2018), AD (Fu et al 2019), and ALS (Seelen et al 2017). However, only a limited number of studies have examined the role PM 2:5 exposure may play in disease aggravation in PD (Kioumourtzoglou et al 2016;Lee et al 2017;Shi et al 2020) or AD (Kioumourtzoglou et al 2016;Shi et al 2020) and none in ALS. Moreover, all existing studies have focused on cohorts ≥65 years of age (Medicare enrollees), leaving out a subpopulation of older adults (55-64 years of age) that is also affected by neurodegenerative diseases.…”

Section: Introductionmentioning

confidence: 99%

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Fine Particle Exposure and Clinical Aggravation in Neurodegenerative Diseases in New York State

Nunez

Boehme

Weisskopf

et al. 2021

Environ Health Perspect

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BACKGROUND: Adult-onset neurodegenerative diseases affect millions and negatively impact health care systems worldwide. Evidence suggests that air pollution may contribute to aggravation of neurodegeneration, but studies have been limited. OBJECTIVE: We examined the potential association between long-term exposure to particulate matter ≤2:5 lm in aerodynamic diameter [fine particulate matter (PM 2:5)] and disease aggravation in Alzheimer's (AD) and Parkinson's (PD) diseases and amyotrophic lateral sclerosis (ALS), using first hospitalization as a surrogate of clinical aggravation. METHODS: We used data from the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS 2000-2014) to construct annual county counts of first hospitalizations with a diagnosis of AD, PD, or ALS (total, urbanicity-, sex-, and age-stratified). We used annual PM 2:5 concentrations estimated by a prediction model at a 1-km 2 resolution, which we aggregated to population-weighted county averages to assign exposure to cases based on county of residence. We used outcome-specific mixed quasi-Poisson models with county-specific random intercepts to estimate rate ratios (RRs) for a 1-y PM 2:5 exposure. We allowed for nonlinear exposure-outcome relationships using penalized splines and accounted for potential confounders. RESULTS: We found a positive nonlinear PM 2:5-PD association that plateaued above 11 lg=m 3 (RR = 1:09, 95% CI: 1.04, 1.14 for a PM 2:5 increase from 8.1 to 10:4 lg=m 3). We also found a linear PM 2:5-ALS positive association (RR = 1:05, 95% CI: 1.01, 1.09 per 1-lg=m 3 PM 2:5 increase), and suggestive evidence of an association with AD. We found effect modification by age for PD and ALS with a stronger positive association in patients <70 years of age but found insufficient evidence of effect modification by sex or urbanization level for any of the outcomes. CONCLUSION: Our findings suggest that annual increase in county-level PM 2:5 concentrations may contribute to clinical aggravation of PD and ALS. Importantly, the average annual PM 2:5 concentration in our study was 8:1 lg=m 3 , below the current American national standards, suggesting the standards may not adequately protect the aging population.

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exposure with risk ( Liu et al.…”

Section: Discussionsupporting

confidence: 84%

Section: Environmental Health Perspectivessupporting

confidence: 90%

Section: Outcome Definitionmentioning

confidence: 87%

Section: Strengthsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fine Particle Exposure and Clinical Aggravation in Neurodegenerative Diseases in New York State

Nunez

Boehme

Weisskopf

et al. 2021

Environ Health Perspect

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Associations of Greenness, Parks, and Blue Space With Neurodegenerative Disease Hospitalizations Among Older US Adults

et al. 2022

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ImportanceExposure to natural environments has been associated with health outcomes related to neurological diseases. However, the few studies that have examined associations of natural environments with neurological diseases report mixed findings.ObjectiveTo evaluate associations of natural environments with hospital admissions for Alzheimer disease and related dementias (ADRD) and Parkinson disease (PD) among older adults in the US.Design, Setting, and ParticipantsThis open cohort study included fee-for-service Medicare beneficiaries aged 65 years or older who lived in the contiguous US from January 1, 2000, to December 31, 2016. Beneficiaries entered the cohort on January 1, 2000, or January 1 of the year after enrollment. Data from US Medicare enrollment and Medicare Provider Analysis and Review files, which contain information about individual-level covariates and all hospital admissions for Medicare fee-for-service beneficiaries, were analyzed between January 2021 and September 2022.ExposuresDifferences in IQRs for zip code–level greenness (normalized difference vegetation index [NDVI]), percentage park cover, and percentage blue space cover (surface water; ≥1.0% vs &lt;1.0%).Main Outcomes and MeasuresThe main outcome was first hospitalizations with a primary or secondary discharge diagnosis of ADRD or PD. To examine associations of exposures to natural environments with ADRD and PD hospitalization, we used Cox-equivalent Poisson models.ResultsWe included 61 662 472 and 61 673 367 Medicare beneficiaries in the ADRD and PD cohorts, respectively. For both cohorts, 55.2% of beneficiaries were women. Most beneficiaries in both cohorts were White (84.4%), were not eligible for Medicaid (87.6%), and were aged 65 to 74 years (76.6%) at study entry. We observed 7 737 609 and 1 168 940 first ADRD and PD hospitalizations, respectively. After adjustment for potential individual- and area-level confounders (eg, Medicaid eligibility and zip code–level median household income), NDVI was negatively associated with ADRD hospitalization (hazard ratio [HR], 0.95 [95% CI, 0.94-0.96], per IQR increase). We found no evidence of an association of percentage park and blue space cover with ADRD hospitalization. In contrast, NDVI (HR, 0.94 [95% CI, 0.93-0.95], per IQR increase), percentage park cover (HR, 0.97 [95% CI, 0.97-0.98], per IQR increase), and blue space cover (HR, 0.97 [95% CI, 0.96-0.98], ≥1.0% vs &lt;1.0%) were associated with a decrease in PD hospitalizations. Patterns of effect modification by demographics differed between exposures.Conclusions and RelevanceThe findings of this cohort study suggest that some natural environments are associated with a decreased risk of ADRD and PD hospitalization.

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Air Pollution and Parkinson Disease in a Population-Based Study

Krzyzanowski,

Mullan,

Turcano

et al. 2024

JAMA Netw Open

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ImportanceThe role of air pollution in risk and progression of Parkinson disease (PD) is unclear.ObjectiveTo assess whether air pollution is associated with increased risk of PD and clinical characteristics of PD.Design, Setting, and ParticipantsThis population-based case-control study included patients with PD and matched controls from the Rochester Epidemiology Project from 1998 to 2015. Data were analyzed from January to June 2024.ExposuresMean annual exposure to particulate matter with a diameter of 2.5 µm or less (PM2.5) from 1998 to 2015 and mean annual exposure to nitrogen dioxide (NO2) from 2000 to 2014.Main Outcomes and MeasuresOutcomes of interest were PD risk, all-cause mortality, presence of tremor-predominant vs akinetic rigid PD, and development of dyskinesia. Models were adjusted for age, sex, race and ethnicity, year of index, and urban vs rural residence.ResultsA total of 346 patients with PD (median [IQR] age 72 [65-80] years; 216 [62.4%] male) were identified and matched on age and sex with 4813 controls (median [IQR] age, 72 [65-79] years, 2946 [61.2%] male). Greater PM2.5 exposure was associated with increased PD risk, and this risk was greatest after restricting to populations within metropolitan cores (odds ratio [OR], 1.23; 95% CI, 1.11-1.35) for the top quintile of PM2.5 exposure compared with the bottom quintile. Greater NO2 exposure was also associated with increased PD risk when comparing the top quintile with the bottom quintile (OR, 1.13; 95% CI, 1.07-1.19). Air pollution was associated with a 36% increased risk of akinetic rigid presentation (OR per each 1-μg/m3 increase in PM2.5, 1.36; 95% CI, 1.02-1.80). In analyses among patients with PD only, higher PM2.5 exposure was associated with greater risk for developing dyskinesia (HR per 1-μg/m3 increase in PM2.5, 1.42; 95% CI, 1.17-1.73), as was increased NO2 exposure (HR per 1 μg/m3 increase in NO2, 1.13; 95% CI, 1.06-1.19). There was no association between PM2.5 and all-cause mortality among patients with PD.Conclusions and RelevanceIn this case-control study of air pollution and PD, higher levels of PM2.5 and NO2 exposure were associated with increased risk of PD; also, higher levels of PM2.5 exposure were associated with increased risk of developing akinetic rigid PD and dyskinesia compared with patients with PD exposed to lower levels. These findings suggest that reducing air pollution may reduce risk of PD, modify the PD phenotype, and reduce risk of dyskinesia.

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Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study

Cited by 203 publications

References 33 publications

Fine Particle Exposure and Clinical Aggravation in Neurodegenerative Diseases in New York State

Fine Particle Exposure and Clinical Aggravation in Neurodegenerative Diseases in New York State

Associations of Greenness, Parks, and Blue Space With Neurodegenerative Disease Hospitalizations Among Older US Adults

Air Pollution and Parkinson Disease in a Population-Based Study

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