Dataset Information

Long-term effects of PM_2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.

ABSTRACT: Background: Accumulating evidence links fine particulate matter (PM_2·5) to premature mortality, cardiovascular disease, and respiratory disease. However, less is known about the influence of PM_2·5 on neurological disorders. We aimed to investigate the effect of long-term PM_2·5 exposure on development of Parkinson's disease or Alzheimer's disease and related dementias.

Methods: We did a longitudinal cohort study in which we constructed a population-based nationwide open cohort including all fee-for-service Medicare beneficiaries (aged ?65 years) in the contiguous United States (2000-16) with no exclusions. We assigned PM_2·5 postal code (ie, ZIP code) concentrations based on mean annual predictions from a high-resolution model. To accommodate our very large dataset, we applied Cox-equivalent Poisson models with parallel computing to estimate hazard ratios (HRs) for first hospital admission for Parkinson's disease or Alzheimer's disease and related dementias, adjusting for potential confounders in the health models.

Findings: Between Jan 1, 2000, and Dec 31, 2016, of 63?038?019 individuals who were aged 65 years or older during the study period, we identified 1·0 million cases of Parkinson's disease and 3·4 million cases of Alzheimer's disease and related dementias based on primary and secondary diagnosis billing codes. For each 5 ?g/m³ increase in annual PM_2·5 concentrations, the HR was 1·13 (95% CI 1·12-1·14) for first hospital admission for Parkinson's disease and 1·13 (1·12-1·14) for first hospital admission for Alzheimer's disease and related dementias. For both outcomes, there was strong evidence of linearity at PM_2·5 concentrations less than 16 ?g/m³ (95th percentile of the PM_2·5 distribution), followed by a plateaued association with increasingly larger confidence bands.

Interpretation: We provide evidence that exposure to annual mean PM_2·5 in the USA is significantly associated with an increased hazard of first hospital admission with Parkinson's disease and Alzheimer's disease and related dementias. For the ageing American population, improving air quality to reduce PM_2·5 concentrations to less than current national standards could yield substantial health benefits by reducing the burden of neurological disorders.

Funding: The Health Effects Institute, The National Institute of Environmental Health Sciences, The National Institute on Aging, and the HERCULES Center.

SUBMITTER: Shi L

PROVIDER: S-EPMC7720425 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Long-term effects of PM<sub>2·5</sub> on neurological disorders in the American Medicare population: a longitudinal cohort study.

Shi Liuhua L Wu Xiao X Danesh Yazdi Mahdieh M Braun Danielle D Abu Awad Yara Y Wei Yaguang Y Liu Pengfei P Di Qian Q Wang Yun Y Schwartz Joel J Dominici Francesca F Kioumourtzoglou Marianthi-Anna MA Zanobetti Antonella A

The Lancet. Planetary health 20201019 12

<h4>Background</h4>Accumulating evidence links fine particulate matter (PM<sub>2·5</sub>) to premature mortality, cardiovascular disease, and respiratory disease. However, less is known about the influence of PM<sub>2·5</sub> on neurological disorders. We aimed to investigate the effect of long-term PM<sub>2·5</sub> exposure on development of Parkinson's disease or Alzheimer's disease and related dementias.<h4>Methods</h4>We did a longitudinal cohort study in which we constructed a population-ba ...[more]

PMID: 33091388

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Project description:ObjectivesPart A: To pilot the use of a register to identify and monitor patients with complex needs arising from long-term neurological conditions. Part B: To determine the extent to which patients' needs for health and social services are met following discharge to the community after inpatient rehabilitation; to identify which factors predict unmet needs and to explore the relationship between service provision and outcomes at 12 months.DesignA multicentre, prospective, cohort study surveying participants at 1, 6 and 12 months using postal/online questionnaires and telephone interview.SettingConsecutive discharges to the community from all nine tertiary, specialist, inpatient neurorehabilitation services in London over 18 months in 2010-2011.ParticipantsOf 576 admissions 428 patients were recruited at discharge: 256 responded at 4 weeks, 212 at 6 months and 190 at 12 months.MeasuresNeurological Impairment Scale, The Needs and Provision Complexity Scale, The Northwick Park Dependency Scale, Community Integration Questionnaire, Zarit Burden Inventory.Resultsn=322 (75%) expressed willingness to be registered, but in practice less than half responded to questionnaires at 6 and 12 months (49% and 44%, respectively), despite extensive efforts to contact them, with no significant differences between responders and non-responders. Significant unmet needs were identified within the first year following discharge, particularly in rehabilitation, social work support and provision of specialist equipment. Dependency for basic care and motor and cognitive impairment predicted services received, together accounting for 40% of the variance. Contra to expectation, patients whose rehabilitation needs were met were more dependent and less well integrated at 12 months post discharge than those with unmet needs.ConclusionsRegistration is acceptable to most patients, but questionnaires/telephone interviews may not be the most efficient way to reach them. When community resources are limited, service provision tends to be focused on the most dependent patients.RegistrationThe study was registered with the NIHR Comprehensive Local Research Network: ID number 7503.

Project description:BackgroundThe epidemiological evidence on relationships between long-term exposure to particulate matter and hypertension and blood pressure has been inconclusive. Limited evidence was available for particulate matter with an aerodynamic diameter???1??m (PM1) in rural areas of developing countries.ObjectiveThis study aimed to investigate the associations between long-term exposure to PM1 and hypertension and blood pressure among rural Chinese population.MethodsThis study included 39,259 participants who had completed the baseline survey from Henan Rural Cohort. Participants' exposure to PM1 was assessed by a satellite-based spatiotemporal model. The binary logistic regression model was used to examine the association between long-term PM1 exposure and hypertension, and multivariable linear regression model was used to investigate the associations between long-term PM1 exposure and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP). Moreover, we examined potential effect modifications by demographic, lifestyle and diet factors.ResultsThe mean concentration of PM1 for all participants during the 3-year before baseline survey was 59.98??g/m3. Each 1??g/m3 increase in PM1 concentration was significantly associated with an increase of 4.3% [Odds ratio(OR)?=?1.043, 95% confidence interval(CI): 1.033, 1.053] in odds for hypertension, an increase of 0.401?mm?Hg (95% CI, 0.335, 0.467), 0.328?mm?Hg (95% CI, 0.288, 0.369), 0.353?mm?Hg (95% CI, 0.307, 0.399) and 0.073?mm?Hg (95% CI, 0.030, 0.116) in SBP, DBP, MAP and PP, respectively. Further stratified analyses showed that the effect of PM1 on hypertension and blood pressure could be modified by sex, lifestyle and diet.ConclusionsThis study suggests that long-term exposure to ambient PM1 increases the risk of hypertension and is associated with elevations in blood pressure in rural Chinese adults, especially in male and those with unhealthy habits.

Dataset Information

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

Publications

Long-term effects of PM<sub>2·5</sub> on neurological disorders in the American Medicare population: a longitudinal cohort study.

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Long-term effects of PM_2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.