居住在主要道路附近与痴呆症、帕金森病和多发性硬化症的发病率：一项基于人群的队列研究。 - Suppr

Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study.

机构信息

Public Health Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Public Health Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.

出版信息

Lancet. 2017 Feb 18;389(10070):718-726. doi: 10.1016/S0140-6736(16)32399-6. Epub 2017 Jan 5.

BACKGROUND

Emerging evidence suggests that living near major roads might adversely affect cognition. However, little is known about its relationship with the incidence of dementia, Parkinson's disease, and multiple sclerosis. We aimed to investigate the association between residential proximity to major roadways and the incidence of these three neurological diseases in Ontario, Canada.

METHODS

In this population-based cohort study, we assembled two population-based cohorts including all adults aged 20-50 years (about 4·4 million; multiple sclerosis cohort) and all adults aged 55-85 years (about 2·2 million; dementia or Parkinson's disease cohort) who resided in Ontario, Canada on April 1, 2001. Eligible patients were free of these neurological diseases, Ontario residents for 5 years or longer, and Canadian-born. We ascertained the individual's proximity to major roadways based on their residential postal-code address in 1996, 5 years before cohort inception. Incident diagnoses of dementia, Parkinson's disease, and multiple sclerosis were ascertained from provincial health administrative databases with validated algorithms. We assessed the associations between traffic proximity and incident dementia, Parkinson's disease, and multiple sclerosis using Cox proportional hazards models, adjusting for individual and contextual factors such as diabetes, brain injury, and neighbourhood income. We did various sensitivity analyses, such as adjusting for access to neurologists and exposure to selected air pollutants, and restricting to never movers and urban dwellers.

FINDINGS

Between 2001, and 2012, we identified 243 611 incident cases of dementia, 31 577 cases of Parkinson's disease, and 9247 cases of multiple sclerosis. The adjusted hazard ratio (HR) of incident dementia was 1·07 for people living less than 50 m from a major traffic road (95% CI 1·06-1·08), 1·04 (1·02-1·05) for 50-100 m, 1·02 (1·01-1·03) for 101-200 m, and 1·00 (0·99-1·01) for 201-300 m versus further than 300 m (p for trend=0·0349). The associations were robust to sensitivity analyses and seemed stronger among urban residents, especially those who lived in major cities (HR 1·12, 95% CI 1·10-1·14 for people living <50 m from a major traffic road), and who never moved (1·12, 1·10-1·14 for people living <50 m from a major traffic road). No association was found with Parkinson's disease or multiple sclerosis.

INTERPRETATION

In this large population-based cohort, living close to heavy traffic was associated with a higher incidence of dementia, but not with Parkinson's disease or multiple sclerosis.

FUNDING

Health Canada (MOA-4500314182).

背景

新出现的证据表明，居住在主要道路附近可能对认知能力产生不利影响。然而，对于其与痴呆症、帕金森病和多发性硬化症的发病风险之间的关系，人们知之甚少。我们旨在调查安大略省主要道路附近居住与这三种神经疾病发病之间的关系。

方法

在这项基于人群的队列研究中，我们组建了两个基于人群的队列，包括所有年龄在 20-50 岁之间的成年人（约 440 万；多发性硬化症队列）和所有年龄在 55-85 岁之间的成年人（约 220 万；痴呆症或帕金森病队列），他们在 2001 年 4 月 1 日居住在安大略省。合格患者无这些神经系统疾病，在安大略省居住 5 年以上，且为加拿大出生。我们根据患者在 1996 年的居住邮政编码地址确定其与主要道路的接近程度，这是队列开始前的 5 年。痴呆症、帕金森病和多发性硬化症的发病诊断通过使用验证算法的省级卫生行政数据库确定。我们使用 Cox 比例风险模型评估交通接近度与痴呆症、帕金森病和多发性硬化症发病之间的关系，调整了个体和环境因素，如糖尿病、脑损伤和社区收入。我们进行了各种敏感性分析，例如调整了与神经科医生的接触和与选定空气污染物的接触，以及限制为未搬迁者和城市居民。

结果

在 2001 年至 2012 年期间，我们发现了 243611 例痴呆症、31577 例帕金森病和 9247 例多发性硬化症的发病情况。居住在距离主要交通道路不到 50 米的地方与痴呆症发病的调整后的危险比（HR）为 1.07（95%CI 1.06-1.08），距离 50-100 米为 1.04（1.02-1.05），距离 101-200 米为 1.02（1.01-1.03），距离 201-300 米为 1.00（0.99-1.01），距离超过 300 米为 1.00（0.99-1.01）（趋势 p 值=0.0349）。这些关联在敏感性分析中是稳健的，并且在城市居民中似乎更强，尤其是居住在主要城市的居民（居住在距离主要交通道路不到 50 米的人 HR 为 1.12，95%CI 为 1.10-1.14），以及从未搬迁的居民（居住在距离主要交通道路不到 50 米的人 HR 为 1.12，95%CI 为 1.10-1.14）。与帕金森病或多发性硬化症无关联。