Exposure to ambient air pollution and the incidence of dementia: A population-based cohort study
Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of polluta...
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| Published in | Environment international Vol. 108; pp. 271 - 277 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier Ltd
01.11.2017
Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0160-4120 1873-6750 1873-6750 |
| DOI | 10.1016/j.envint.2017.08.020 |
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| Abstract | Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.
The study population comprised all Ontario residents who, on 1 April 2001, were 55–85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.
We identified 257,816 incident cases of dementia in 2001–2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03–1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08–1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.
In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.
•A population-based cohort of ~2.1 million adult residents in Ontario, Canada.•Exposure to ambient nitrogen dioxide and fine particulate matter was associated higher incidence of dementia.•15,813 cases of dementia (or 6.1% of total cases) were attributable to elevated air pollution exposure in this cohort.•Air pollution levels in Ontario are among the lowest in the world. |
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| AbstractList | Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.
The study population comprised all Ontario residents who, on 1 April 2001, were 55–85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.
We identified 257,816 incident cases of dementia in 2001–2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03–1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08–1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.
In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.
•A population-based cohort of ~2.1 million adult residents in Ontario, Canada.•Exposure to ambient nitrogen dioxide and fine particulate matter was associated higher incidence of dementia.•15,813 cases of dementia (or 6.1% of total cases) were attributable to elevated air pollution exposure in this cohort.•Air pollution levels in Ontario are among the lowest in the world. Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.The study population comprised all Ontario residents who, on 1 April 2001, were 55–85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.We identified 257,816 incident cases of dementia in 2001–2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03–1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08–1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence. Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia. The study population comprised all Ontario residents who, on 1 April 2001, were 55-85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM ), nitrogen dioxide (NO ), and ozone (O ), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected. We identified 257,816 incident cases of dementia in 2001-2013. We found a positive association between PM and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03-1.05) for every interquartile-range increase in exposure to PM . Similarly, NO was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08-1.12). No association was found for O . These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM and NO , based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort. In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence. Introduction: Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia. Methods: The study population comprised all Ontario residents who, on 1 April 2001, were 55–85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected. Results: We identified 257,816 incident cases of dementia in 2001–2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03–1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08–1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort. Discussion: In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence. Keywords: Fine particulate matter, Nitrogen dioxides, Ozone, Dementia, Cohort Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.INTRODUCTIONEmerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.The study population comprised all Ontario residents who, on 1 April 2001, were 55-85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.METHODSThe study population comprised all Ontario residents who, on 1 April 2001, were 55-85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.We identified 257,816 incident cases of dementia in 2001-2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03-1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08-1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.RESULTSWe identified 257,816 incident cases of dementia in 2001-2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03-1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08-1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.DISCUSSIONIn this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence. |
| Author | Kwong, Jeffrey C. Burnett, Richard T. Chen, Hong Hystad, Perry Tu, Karen Brook, Jeffrey R. Murray, Brian J. Kopp, Alexander Copes, Ray van Donkelaar, Aaron Goldberg, Mark S. Martin, Randall V. Wilton, Andrew S. |
| Author_xml | – sequence: 1 givenname: Hong surname: Chen fullname: Chen, Hong email: hong.chen@oahpp.ca organization: Public Health Ontario, Toronto, ON, Canada – sequence: 2 givenname: Jeffrey C. surname: Kwong fullname: Kwong, Jeffrey C. organization: Public Health Ontario, Toronto, ON, Canada – sequence: 3 givenname: Ray surname: Copes fullname: Copes, Ray organization: Public Health Ontario, Toronto, ON, Canada – sequence: 4 givenname: Perry surname: Hystad fullname: Hystad, Perry organization: College of Public Health and Human Sciences, Oregon State University, Corvallis, USA – sequence: 5 givenname: Aaron surname: van Donkelaar fullname: van Donkelaar, Aaron organization: Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada – sequence: 6 givenname: Karen surname: Tu fullname: Tu, Karen organization: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada – sequence: 7 givenname: Jeffrey R. surname: Brook fullname: Brook, Jeffrey R. organization: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada – sequence: 8 givenname: Mark S. surname: Goldberg fullname: Goldberg, Mark S. organization: Department of Medicine, McGill University, Montreal, QC, Canada – sequence: 9 givenname: Randall V. surname: Martin fullname: Martin, Randall V. organization: Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada – sequence: 10 givenname: Brian J. surname: Murray fullname: Murray, Brian J. organization: Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada – sequence: 11 givenname: Andrew S. surname: Wilton fullname: Wilton, Andrew S. organization: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada – sequence: 12 givenname: Alexander surname: Kopp fullname: Kopp, Alexander organization: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada – sequence: 13 givenname: Richard T. surname: Burnett fullname: Burnett, Richard T. organization: Population Studies Division, Health Canada, Ottawa, ON, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28917207$$D View this record in MEDLINE/PubMed |
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| Snippet | Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the... Introduction: Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially... |
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| SubjectTerms | Aged Aged, 80 and over Air Pollutants - analysis Air Pollutants - toxicity air pollution Air Pollution - analysis algorithms brain Cohort Cohort Studies confidence interval Dementia Dementia - epidemiology Dementia - etiology diabetes Environmental Exposure Female Fine particulate matter Humans Incidence income land use Male Middle Aged nitrogen dioxide Nitrogen Dioxide - analysis Nitrogen dioxides Ontario Ontario - epidemiology Ozone Ozone - analysis Particulate Matter - analysis particulates pollutants regression analysis satellites |
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| Title | Exposure to ambient air pollution and the incidence of dementia: A population-based cohort study |
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