Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Sci Total Environ. 2021 Feb 10;755(Pt 2):142524. doi: 10.1016/j.scitotenv.2020.142524. Epub 2020 Oct 3.
Although long-term exposure to particulate matter<2.5 μm (PM) has been linked to chronic debilitating brain disorders (CDBD), the role of short-term exposure in health care demand, and increased susceptibility for PM-related health conditions, among Medicare enrollees with CDBD has received little attention. We used a causal modeling approach to assess the effect of short-term high PM exposure on all-cause admissions, and prevalent cause-specific admissions among Medicare enrollees with CDBD (Parkinson's disease-PD, Alzheimer's disease-AD and other dementia).
We constructed daily zipcode counts of hospital admissions of Medicare beneficiaries older than 65 across the United-States (2000-2014). We obtained daily PM estimates from a satellite-based model. A propensity score matching approach was applied to match high-pollution (PM > 17.4 μg/m) to low-pollution zip code-days with similar background characteristics. Then, we estimated the percent change in admissions attributable to high pollution. We repeated the models restricting the analysis to zipcode-days with PM below of 35 μg/m.
We observed significant increases in all-cause hospital admissions (2.53% in PD and 2.49% in AD/dementia) attributable to high PM exposure. The largest observed effect for common causes was for pneumonia and urinary tract infection. All the effects were larger in CDBD compared to the general Medicare population, and similarly strong at levels of exposure considered safe by the EPA.
We found Medicare beneficiaries with CDBD to be at higher risk of being admitted to the hospital following acute exposure to PM levels well below the National Ambient Air Quality Standard defined as safe by the EPA.
尽管长期暴露于<2.5μm 的颗粒物（PM）与慢性使人虚弱的大脑疾病（CDBD）有关，但短期暴露对医疗保险参保者的医疗需求和 PM 相关健康状况的易感性的影响在 CDBD 患者中却很少受到关注。我们使用因果建模方法来评估短期高 PM 暴露对医疗保险参保者所有原因入院和 CDBD（帕金森病-PD、阿尔茨海默病-AD 和其他痴呆症）的特定原因入院的影响。
我们构建了美国（2000-2014 年）所有年龄在 65 岁以上的医疗保险受益人的每日邮政编码住院人数。我们从卫星模型中获得每日 PM 估计值。采用倾向评分匹配方法将高污染（PM>17.4μg/m）与低污染邮政编码日进行匹配，这些低污染邮政编码日具有相似的背景特征。然后，我们估计了归因于高污染的入院百分比变化。我们还在 PM 低于 35μg/m 的邮政编码日中重复了模型分析。
我们观察到归因于高 PM 暴露的所有原因住院人数显著增加（PD 为 2.53%，AD/痴呆症为 2.49%）。最常见的原因是肺炎和尿路感染。与一般医疗保险人群相比，CDBD 患者观察到的所有影响更大，而且在 EPA 认为安全的暴露水平下，这些影响同样强烈。
我们发现 CDBD 的医疗保险参保者在暴露于远低于 EPA 定义为安全的国家环境空气质量标准的 PM 水平后，有更高的住院风险。
