Long-term effects of PM(2·5) on neurological disorders in the American Medicare population: a longitudinal cohort study.
Long-term effects of PM(2·5) on neurological disorders in the American Medicare population: a longitudinal cohort study.
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DOI：
10.1016/s2542-5196(20)30227-8
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Zanobetti A
中科院分区：
文献类型：
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作者：
Shi L;Wu X;Danesh Yazdi M;Braun D;Abu Awad Y;Wei Y;Liu P;Di Q;Wang Y;Schwartz J;Dominici F;Kioumourtzoglou MA;Zanobetti A
越来越多的证据表明细颗粒物 (PM2·5) 与过早死亡、心血管疾病和呼吸道疾病有关。然而，人们对PM2·5对神经系统疾病的影响知之甚少。我们的目的是调查长期暴露于 PM2·5 对帕金森病或阿尔茨海默病以及相关痴呆症发展的影响。我们进行了一项纵向队列研究，构建了一个以人口为基础的全国性开放队列，其中包括美国本土（2000-16 年）所有按服务收费的医疗保险受益人（年龄≥65 岁），无一例外。我们根据高分辨率模型的年平均预测来指定 PM2·5 邮政编码（即邮政编码）浓度。为了适应我们非常大的数据集，我们应用具有并行计算的 Cox 等效泊松模型来估计帕金森病或阿尔茨海默病和相关痴呆症首次入院的风险比 (HR)，并调整健康模型中的潜在混杂因素。从 2000 年 1 月 1 日到 2016 年 12 月 31 日，我们根据初级和二级诊断账单代码，在 63 038 019 名年龄在 65 岁或以上的个体中，识别出 1·0 百万帕金森病病例和 3·4 百万阿尔茨海默病及相关痴呆病例。年 PM2·5 浓度每增加 5 μg/m3，因帕金森病首次入院的 HR 为 1·13 (95% CI 1·12–1·14)，因阿尔茨海默病和相关痴呆症首次入院的 HR 为 1·13 (1·12–1·14)。对于这两种结果，有强有力的证据表明 PM2·5 浓度低于 16 μg/m3（PM2·5 分布的第 95 个百分位）呈线性，随后与越来越大的置信带保持稳定的关联。我们提供的证据表明，在美国，接触年平均 PM2·5 与帕金森病、阿尔茨海默病和相关痴呆症首次入院的风险增加显着相关。对于老龄化的美国人口来说，改善空气质量以将 PM2·5 浓度降低到低于现行国家标准可以通过减轻神经系统疾病的负担来产生巨大的健康益处。
Accumulating evidence links fine particulate matter (PM2·5) to premature mortality, cardiovascular disease, and respiratory disease. However, less is known about the influence of PM2·5 on neurological disorders. We aimed to investigate the effect of long-term PM2·5 exposure on development of Parkinson’s disease or Alzheimer’s disease and related dementias. 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 PM2·5 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. 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 μg/m3 increase in annual PM2·5 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 PM2·5 concentrations less than 16 μg/m3 (95th percentile of the PM2·5 distribution), followed by a plateaued association with increasingly larger confidence bands. We provide evidence that exposure to annual mean PM2·5 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 PM2·5 concentrations to less than current national standards could yield substantial health benefits by reducing the burden of neurological disorders.