Exposure to air pollution and cognitive impairment risk: a meta-analysis of longitudinal cohort studies with dose-response analysis

Yu, Xiaohui; Zheng, Liwen; Jiang, Wenjie; Zhang, Dongfeng

doi:10.7189/jogh.10.010417

Cited by 26 publications

(27 citation statements)

References 40 publications

(91 reference statements)

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“…Supported by other epidemiological studies, as well as laboratory studies [1,9,10], the results add to already existing evidence for air pollution to increase dementia risk. The estimate is quite high compared to the meta-estimate of a relative risk of 1.08 per 5 g/m 3 increase in PM 2.5 calculated by Yu and colleagues [7]. This is most likely due to the fine spatial resolution in our air pollution model, meaning that we model local contrasts in air pollution concentrations.…”

mentioning

confidence: 67%

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Local Contrasts in Concentration of Ambient Particulate Air Pollution (PM2.5) and Incidence of Alzheimer’s Disease and Dementia: Results from the Betula Cohort in Northern Sweden

Åström

Adolfsson

Segersson

et al. 2021

JAD

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Exposure to fine particulate air pollution (PM2.5) is emerging as a risk factor for Alzheimer’s disease (AD), but existing studies are still limited and heterogeneous. We have previously studied the association between dementia (AD and vascular dementia) and PM2.5 stemming from vehicle exhaust and wood-smoke in the Betula cohort in Northern Sweden. The aim of this commentary is to estimate the association between total PM2.5 and dementia in the Betula cohort, which is more relevant to include in future meta-estimates than the source-specific estimates. The hazard ratio for incident dementia associated with a 1μg/m3 increase in local PM2.5 was 1.38 (95% confidence interval: 0.99 –1.92). The interpretation of our results is that they indicate an association between local contrasts in concentration of PM2.5 at the residential address and incidence of dementia in a low-level setting.

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confidence: 67%

“…We have not yet presented an estimate for the total effect of PM 2.5 on dementia incidence, however. Such an estimate is important to communicate now, as air pollution is beginning to be an established risk factor for AD and meta-analysis of effect estimates are sought for since substantial heterogeneity in published studies still remain [7,8].…”

mentioning

confidence: 99%

Local Contrasts in Concentration of Ambient Particulate Air Pollution (PM2.5) and Incidence of Alzheimer’s Disease and Dementia: Results from the Betula Cohort in Northern Sweden

Åström

Adolfsson

Segersson

et al. 2021

JAD

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“…In the current study we used the CRF for PM 2.5 exposure and cognitive impairment (mainly consisting of Alzheimer’s disease and other dementias), reported by Yu et al 2020 (See Table 1 . ), who calculated a meta-estimate from ten longitudinal cohort studies [ 7 ]. No statistically significant associations between nitrogen dioxide/nitrogen oxides (NO 2 /NO x ) or ozone (O 3 ) and cognitive impairment were found.…”

Section: Methodsmentioning

confidence: 99%

“…Exposure to air pollution increases the risk for cardiovascular and respiratory diseases and for cancer [ 6 ]. During recent years, results from a growing number of studies indicate that air pollution influences not only cardio-respiratory health and cancer but may also increase risk for cognitive decline and risk for development of Alzheimer’s disease (AD) and other dementias [ 7 ]. AD and other dementias currently represent the fifth most common cause of death in the world according to WHO [ 8 ] with a projected future increase as the proportion of the elderly in the population is growing [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…In a review from 2019 the authors conclude that while the evidence from longitudinal cohort studies points toward an association between exposure to PM 2.5 and increased risk of dementia, the exposure measure varies between studies, from local levels, to the urban background to the regional background [ 20 ]. Later, Yu et al 2020 performed a meta-analysis, and estimated a pooled relative risk for dementia of 1.08 for a 5 μg/m 3 increase in PM 2.5 [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Annual dementia incidence and monetary burden attributable to fine particulate matter (PM2.5) exposure in Sweden

et al. 2021

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Background Alzheimer’s disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting monetary estimates are lacking. Methods We used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives. Results The annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM2.5 by 1 μg/m3 was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019. Conclusion This study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.

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Impact of air pollution and climate change on mental health outcomes: an umbrella review of global evidence

Radua,

De Prisco,

Oliva

et al. 2024

World Psychiatry

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The impact of air pollution and climate change on mental health has recently raised strong concerns. However, a comprehensive overview analyzing the existing evidence while addressing relevant biases is lacking. This umbrella review systematically searched the PubMed/Medline, Scopus and PsycINFO databases (up to June 26, 2023) for any systematic review with meta‐analysis investigating the association of air pollution or climate change with mental health outcomes. We used the R metaumbrella package to calculate and stratify the credibility of the evidence according to criteria (i.e., convincing, highly suggestive, suggestive, or weak) that address several biases, complemented by sensitivity analyses. We included 32 systematic reviews with meta‐analysis that examined 284 individual studies and 237 associations of exposures to air pollution or climate change hazards and mental health outcomes. Most associations (n=195, 82.3%) involved air pollution, while the rest (n=42, 17.7%) regarded climate change hazards (mostly focusing on temperature: n=35, 14.8%). Mental health outcomes in most associations (n=185, 78.1%) involved mental disorders, followed by suicidal behavior (n=29, 12.4%), access to mental health care services (n=9, 3.7%), mental disorders‐related symptomatology (n=8, 3.3%), and multiple categories together (n=6, 2.5%). Twelve associations (5.0%) achieved convincing (class I) or highly suggestive (class II) evidence. Regarding exposures to air pollution, there was convincing (class I) evidence for the association between long‐term exposure to solvents and a higher incidence of dementia or cognitive impairment (odds ratio, OR=1.139), and highly suggestive (class II) evidence for the association between long‐term exposure to some pollutants and higher risk for cognitive disorders (higher incidence of dementia with high vs. low levels of carbon monoxide, CO: OR=1.587; higher incidence of vascular dementia per 1 μg/m3 increase of nitrogen oxides, NOx: hazard ratio, HR=1.004). There was also highly suggestive (class II) evidence for the association between exposure to airborne particulate matter with diameter ≤10 μm (PM10) during the second trimester of pregnancy and the incidence of post‐partum depression (OR=1.023 per 1 μg/m3 increase); and for the association between short‐term exposure to sulfur dioxide (SO2) and schizophrenia relapse (risk ratio, RR=1.005 and 1.004 per 1 μg/m3 increase, respectively 5 and 7 days after exposure). Regarding climate change hazards, there was highly suggestive (class II) evidence for the association between short‐term exposure to increased temperature and suicide‐ or mental disorders‐related mortality (RR=1.024), suicidal behavior (RR=1.012), and hospital access (i.e., hospitalization or emergency department visits) due to suicidal behavior or mental disorders (RR=1.011) or mental disorders only (RR=1.009) (RR values per 1°C increase). There was also highly suggestive (class II) evidence for the association between short‐term exposure to increased apparent temperature (i.e., the temperature equivalent perceived by humans) and suicidal behavior (RR=1.01 per 1°C increase). Finally, there was highly suggestive (class II) evidence for the association between the temporal proximity of cyclone exposure and severity of symptoms of post‐traumatic stress disorder (r=0.275). Although most of the above associations were small in magnitude, they extend to the entire world population, and are therefore likely to have a substantial impact. This umbrella review classifies and quantifies for the first time the global negative impacts that air pollution and climate change can exert on mental health, identifying evidence‐based targets that can inform future research and population health actions.

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Exposure to air pollution and cognitive impairment risk: a meta-analysis of longitudinal cohort studies with dose-response analysis

Cited by 26 publications

References 40 publications

Local Contrasts in Concentration of Ambient Particulate Air Pollution (PM2.5) and Incidence of Alzheimer’s Disease and Dementia: Results from the Betula Cohort in Northern Sweden

Local Contrasts in Concentration of Ambient Particulate Air Pollution (PM2.5) and Incidence of Alzheimer’s Disease and Dementia: Results from the Betula Cohort in Northern Sweden

Annual dementia incidence and monetary burden attributable to fine particulate matter (PM2.5) exposure in Sweden

Impact of air pollution and climate change on mental health outcomes: an umbrella review of global evidence

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