Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA; Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
Environ Pollut. 2019 Nov;254(Pt A):112926. doi: 10.1016/j.envpol.2019.07.094. Epub 2019 Jul 19.
New evidence suggests that particulate matter less than 2.5 μm in diameter (PM) is associated with late-onset dementia (LOD). However, epidemiological studies for the entire population are lacking.
We analyzed approximately 94 million follow-up records from fee-for-service Medicare records for 13 million Medicare beneficiaries residing in the southeastern United States (U.S.) from 2000 to 2013. We used spatially and temporally continuous PM exposure data. To account for time-varying PM levels, we applied an Andersen-Gill counting process proportional hazard model; we stratified our analyses by subtype of dementia and level of urbanization of residence.
During a median follow-up of 6 years, 1,409,599 hospitalizations with dementia occurred. The adjusted hazard ratio (HR) of hospitalization with dementia was 1.049 (95% confidence interval [CI], 1.048 to 1.051) per 1 μg/m increase in annual PM. The hazard ratio for vascular dementia was higher (HR, 1.086; 95% CI, 1.082 to 1.090). In large, the magnitude of the effect grew as the level of urbanization increased (HR, 1.036; 95% CI, 1.031 to 1.041 in rural areas versus HR, 1.052; 95% CI, 1.050 to 1.054 in metropolitan areas).
Long-term exposure to higher PM was associated with increased hospitalizations with dementia.
新证据表明，直径小于 2.5μm 的颗粒物（PM）与迟发性痴呆（LOD）有关。然而，针对全人群的流行病学研究尚缺乏。
我们分析了 2000 年至 2013 年期间，美国东南部约 1300 万医疗保险受益人的约 9400 万项随访记录。我们使用了时空连续的 PM 暴露数据。为了说明 PM 水平随时间的变化，我们应用了 Andersen-Gill 计数过程比例风险模型；我们根据痴呆亚型和居住地城市化程度对分析进行了分层。
在中位数为 6 年的随访期间，发生了 1409599 例与痴呆相关的住院治疗。每年 PM 每增加 1μg/m，痴呆住院的调整后危害比（HR）为 1.049（95%置信区间[CI]，1.048 至 1.051）。血管性痴呆的 HR 更高（HR，1.086；95% CI，1.082 至 1.090）。总的来说，随着城市化水平的提高，这种影响的幅度也随之增大（HR，1.036；95% CI，农村地区为 1.031 至 1.041，大都市地区为 1.052；95% CI，1.050 至 1.054）。
长期暴露于较高水平的 PM 与痴呆住院人数增加有关。
