Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Tornblad Institute, Biskopsgatan 7, 223v62, Lund, Sweden.
Environ Health. 2021 May 27;20(1):65. doi: 10.1186/s12940-021-00750-x.
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 (PM) air pollution and resulting monetary estimates are lacking.
We used data on average population-weighted exposure to ambient PM 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 PM 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.
The annual number of dementia cases attributable to PM 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 PM by 1 μg/m 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.
This study estimated that 5% of annual dementia cases could be attributed to PM 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.
根据世界卫生组织的数据，阿尔茨海默病（AD）和其他痴呆症目前是世界上第五大常见死因，随着老年人口在总人口中比例的增加，预计未来这一数字还会上升。空气污染已成为 AD 的一个合理危险因素，但缺乏估计因细颗粒物（PM）空气污染暴露而导致的痴呆病例数及其相关货币估算的研究。
我们使用了瑞典 30 岁以上人群的环境 PM 平均人群加权暴露数据。为了估算瑞典 60 岁以上人群因空气污染导致的痴呆症的年病例数，我们使用了最新的 PM 暴露与痴呆症发病率之间的浓度反应函数（CRF），该函数基于 10 项针对 60 岁以上人群的纵向队列研究。为了估算归因病例的货币负担，我们通过包括因质量调整生命年（QALY）损失导致的无形成本，计算了与痴呆症相关的直接和间接终生成本以及总费用。我们使用瑞典两种不同的 QALY 货币估值来从两个不同的支付方角度估算因生活质量下降而导致的货币价值。
PM 暴露导致的痴呆症年病例数估计为 820 例，占瑞典年痴呆症病例数的 5%。每个痴呆症病例的直接和间接终生平均成本估计为 213000 欧元。估计 PM 减少 1μg/m 将导致每年痴呆症发病率减少 101 例，估计 2019 年瑞典 GDP 的 0.01%范围内会产生货币收益。
本研究估计，每年 5%的痴呆症病例可能归因于 PM 暴露，由此产生的货币负担相当可观。这些发现表明，在公共卫生政策决策中需要考虑与痴呆症发病率相关的空气传播有毒污染物。
