The effect of China's Clean Air Act on cognitive function in older adults: a population-based, quasi-experimental study.
The effect of China's Clean Air Act on cognitive function in older adults: a population-based, quasi-experimental study.
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中国《清洁空气法案》对老年人认知功能的影响：一项基于人群的准实验研究
DOI：
10.1016/s2666-7568(22)00004-6
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Zeng Y
中科院分区：
文献类型：
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作者：
Yao Y;Lv X;Qiu C;Li J;Wu X;Zhang H;Yue D;Liu K;Eshak ES;Lorenz T;Anstey KJ;Livingston G;Xue T;Zhang J;Wang H;Zeng Y
空气污染可能会加速认知老化;目前尚不清楚大规模干预措施，如中国的清洁空气法（CCAA），是否可以缓解认知恶化。我们的目的是评估CCAA对老年人认知功能变化的影响。在这项基于人群的准实验研究中，我们对2014年和2018年中国健康长寿纵向调查（CLHLS）期间收集的数据进行了差异分析。研究设计使用了反事实分析功能，将CLHLS参与者分为两组。干预组包括居住在省政府设定的从2014年起每年至少减少5%的颗粒物（PM）目标地区的参与者，而对照组由居住在没有PM减少目标地区的个人组成。使用简易精神状态检查（MMSE）测量整体认知功能。我们使用固定效应模型来研究CCAA实施前后MMSE评分变化的组间差异。我们将MMSE评分的纵向变化与直径小于2.5 μm的PM（PM2.5）浓度和其他管制污染物浓度的变化相关联。我们使用替代模型和敏感性分析来评估主要模型结果的稳健性。2812人参加了2014年和2018年的调查（2014年平均年龄81.0岁[SD 9.3]; 1408 [50.1%]女性和1404 [49.9%]男性）。干预组2251例（80.0%），对照组561例（20.0%）。在控制潜在混杂因素后，2014 - 2018年干预组MMSE评分下降幅度明显小于对照组：平均组间差异为2.45分（95%CI 1.32 - 3.57）。PM2.5四分位数间增加与MMSE评分显著下降0.83分（95%CI 0.24 - 1.42）相关;同样，SO2增加也与MMSE评分显著下降0.80分（0.32 - 1.29）相关。实施严格的清洁空气政策可能会减轻老年人与空气污染相关的认知老化风险。国家自然科学基金、国家重点研发计划、国家博士后科学基金资助项目、杜克/杜克大学与新加坡国立大学合作试点项目、中国老龄研究院与北京大学-百度基金、能源基金、中央高校基础研究基金等。
Air pollution might accelerate cognitive ageing; it is unclear whether large-scale interventions, such as China’s Clean Air Act (CCAA), can mitigate cognitive deterioration. We aimed to evaluate the effect of CCAA on changes in cognitive function in older adults. In this population-based, quasi-experimental study, we did a difference-in-differences analysis of the data collected during the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The study design used a counterfactual analysis feature by dividing CLHLS participants into two groups. The intervention group included participants who lived in areas where the provincial government set a target of reducing particulate matter (PM) by at least 5% annually from 2014 onward, whereas the control group consisted of individuals who lived in areas without a PM reduction target. Global cognitive function was measured using the Mini-Mental State Examination (MMSE). We used fixed-effects models to examine the between-group differences in MMSE score changes before and after CCAA implementation. We associated longitudinal changes in MMSE scores with changes in concentrations of PM with a diameter of less than 2·5 μm (PM2·5) concentration and other regulated pollutants. We used alternative models and sensitivity analyses to evaluate the robustness of the results from the main models. 2812 individuals participated in the 2014 and 2018 surveys (mean age 81·0 years [SD 9·3] in 2014; 1408 [50·1%] female and 1404 [49·9%] male). 2251 (80·0%) were included in the intervention group and 561 (20·0%) in the control group. After controlling for potential confounders, the intervention group had a significantly smaller decline in MMSE scores from 2014 to 2018 compared with the control group: the mean between-group difference was 2·45 points (95% CI 1·32–3·57). Interquartile increases in PM2·5 were associated with a significant MMSE score decline of 0·83 points (95% CI 0·24–1·42); similarly, increases in SO2 were also associated with a significant MMSE score decline of 0·80 points (0·32–1·29). Implementing stringent clean air policies might mitigate the risk of air pollutant-associated cognitive ageing in older people. National Natural Sciences Foundation of China, National Key R&D Program of China, China Postdoctoral Science Foundation funded project, the Duke/Duke-National University of Singapore Collaboration Pilot Project, the National Institute on Aging and Peking University-Baidu Fund, Energy Foundation, and the Fundamental Research Funds for the Central Universities.