The impact of airborne particles and ozone on cognition, mobility, and health care spending at older ages: Evidence from a nationally-representative longitudinal cohort

空气中的颗粒物和臭氧对老年人认知、行动能力和医疗保健支出的影响：来自全国代表性纵向队列的证据

• 批准号: 9980899
• 负责人: Sara Adar
• 金额: $ 57.74万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980899
• 关键词: Accounting; Adult; Age; Air; Air Pollutants; Air Pollution; Alzheimer' s disease related dementia; Blood; Brain; Chronic Disease; Clinical; Cognition; Cognitive; County; Data; Dementia; Discipline of Nursing; Disease; Economic Burden; Elderly; Environmental Risk Factor; Exposure to; Goals; Health Care Costs; Health Expenditures; Health Promotion; Health and Retirement Study; Healthcare; Heart Diseases; Impairment; Independent Living; Individual; Inflammation; Insurance; Investigation; Lead; Longitudinal cohort; Lung diseases; Medicare/Medicaid; Minor; Modeling; Morbidity - disease rate; Occupational Exposure; Older Population; Organ; Oxidative Stress; Ozone; Particulate Matter; Pathology; Pharmaceutical Preparations; Policy Maker; Population; Premature Mortality; Prevalence; Prevention; Process; Public Health; Quality of life; Research; Research Personnel; Resources; Respondent; Risk; Risk Factors; Role; Self Care; Services; Smoking; Source; Stream; Testing; Time; Work; ambient air pollution; base; body system; caregiving; coarse particles; cognitive function; cohort; cost; dementia risk; disability; health economics; healthy lifestyle; in-home care; interest; member; novel; ozone exposure; particle; physically handicapped; population health; pre-clinical; prevent; prospective; relating to nervous system; spatiotemporal; vascular injury; years lived with disability

Declines in cognitive function and mobility are common in older adults, arising from the collective impacts of subclinical pathologies and chronic disease across multiple organ systems. As these declines progress from minor functional limitations to more severe stages of Alzheimer’s disease and related dementias and physical disabilities, there can be substantial impairments to self-care activities and independent living. This leads to poorer quality of life as well as significantly increased health care costs for long-term services and support. Unfortunately, individual-level prevention efforts have been largely ineffective in reducing the population prevalence of disability and only modestly successful for Alzheimer’s disease and related dementias. Our central hypothesis is that particulate matter (PM) and ozone (O3) air pollution are likely, but largely unexplored, environmental risk factors that could be controlled on the population-level to minimize cognitive and mobility declines in older adults. This hypothesis is based on evidence that air pollutants enter the blood stream, translocate into the brain, and initiate systemic pathophysiological processes that lead to subclinical, preclinical, and then, chronic disease in multiple organs. This accumulation of subclinical and clinical disease ultimately results in an increased risk of cognitive and mobility impairments, Alzheimer’s disease and related dementias and physical disabilities, and health care costs due to lost independence. To test our hypothesis, we will newly predict exposures to ambient PM and O3 for each Health and Retirement Study (HRS) respondent using state-of-the-art national exposure models while also accounting for non-ambient sources of exposure. The HRS is a nationally-representative cohort of over 37,500 older adults followed for more than 20 years with detailed biennial data on cognitive function, Alzheimer’s disease and related dementias, mobility, disability, and health care expenditures. Specifically, we aim to: 1) Prospectively examine associations of long-term exposures to fine (PM2.5) and coarse particulate matter (PM10-2.5) and O3 in ambient air with cognitive and mobility declines in older adults, 2) Directly estimate associations between long-term exposures to PM2.5, PM10-2.5, and O3 in ambient air and health care costs due to lost independence in older adults, 3) Quantify the cognitive and mobility-related health and economic burdens attributable to long-term exposures to ambient PM2.5, PM10-2.5, and O3 among all older adults in the US, and 4) Create and disseminate open-access resources of ambient PM2.5, PM10-2.5, and O3 exposures for the HRS and estimates of county-level and national health and health care cost burdens due to PM and O3’s impacts on cognition, Alzheimer’s disease and related dementias, mobility and physical disabilities for the entire US. This research is expected to have a large public health impact by providing evidence to policy makers and stakeholders at the local, state, and national levels about a novel, environmental risk factor that could be modified at the population-level to promote health in older ages.

认知功能和行动能力的下降在老年人中很常见，这是由多个器官系统的亚临床病理和慢性病的集体影响引起的。随着这些疾病从轻微的功能限制发展到阿尔茨海默病和相关的痴呆症和身体残疾的更严重阶段，自我护理活动和独立生活可能会受到严重损害。这导致了较差的生活质量，并大大增加了长期服务和支持的保健费用。不幸的是，个人一级的预防努力在降低人口残疾患病率方面基本无效，对阿尔茨海默病和相关痴呆症的预防只取得了一定的成功。我们的中心假设是，颗粒物(PM)和臭氧(03)空气污染可能是但在很大程度上未被探索的环境风险因素，可以在人口层面上进行控制，以将老年人的认知和行动能力下降降至最低。这一假说的基础是有证据表明，空气污染物进入血流，转移到大脑，并启动全身病理生理过程，导致亚临床、临床前，然后是多个器官的慢性疾病。这种亚临床和临床疾病的积累最终导致认知和行动能力障碍、阿尔茨海默病和相关的痴呆症和身体残疾的风险增加，以及由于丧失独立性而产生的医疗费用。为了验证我们的假设，我们将使用最先进的国家暴露模型，同时考虑非环境暴露源，对每个健康和退休研究(HRS)受访者的环境PM和臭氧暴露进行新的预测。HRS是一个由37,500多名老年人组成的具有全国代表性的队列，对其进行了20多年的跟踪调查，提供了关于认知功能、阿尔茨海默病和相关痴呆、行动能力、残疾和医疗支出的详细每两年一次的数据。具体地说，我们的目标是：1)前瞻性地研究长期暴露于环境空气中细颗粒物(PM2.5)和粗颗粒物(PM10-2.5)和臭氧与老年人认知和行动能力下降的关系；2)直接估计长期暴露于环境空气中PM2.5、PM10-2.5和臭氧与老年人因丧失独立性而产生的医疗费用之间的关系；3)量化长期暴露于环境PM2.5、PM10-2.5和臭氧在美国所有老年人中可归因于认知和行动相关的健康和经济负担。4)创建和传播环境PM2.5、PM10-2.5和臭氧暴露的开放获取资源，以及估计整个美国因PM和03‘S对认知、阿尔茨海默病和相关痴呆、行动不便和身体残疾的影响而造成的县级和全国医疗保健成本负担。这项研究预计将对公共健康产生重大影响，向地方、州和国家各级的政策制定者和利益相关者提供证据，证明一种新的环境风险因素可以在人口层面进行修改，以促进老年人的健康。