Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
JAMA Netw Open. 2023 Feb 1;6(2):e2253668. doi: 10.1001/jamanetworkopen.2022.53668.
Emerging evidence has suggested harmful associations of air pollutants with neurodegenerative diseases among older adults. However, little is known about outcomes regarding late-life mental disorders, such as geriatric depression.
To investigate if long-term exposure to air pollution is associated with increased risk of late-life depression diagnosis among older adults in the US.
DESIGN, SETTING, AND PARTICIPANTS: This population-based longitudinal cohort study consisted of US Medicare enrollees older than 64 years. Data were obtained from the US Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The participants were continuously enrolled in the Fee-for-Service program and both Medicare Part A and Part B. After the 5-year washout period at entry, a total of 8 907 422 unique individuals were covered over the study period of 2005 to 2016, who contributed to 1 526 690 late-onset depression diagnoses. Data analyses were performed between March 2022 and November 2022.
The exposures consisted of residential long-term exposure to fine particulate matter (PM2.5), measured in micrograms per cubic meter; nitrogen dioxide (NO2), measured in parts per billion; and ozone (O3), measured in parts per billion.
Late-life depression diagnoses were identified via information from all available Medicare claims (ie, hospital inpatient, skilled nursing facility, home health agency, hospital outpatient, and physician visits). Date of the first occurrence was obtained. Hazard ratios and percentage change in risk were estimated via stratified Cox proportional hazards models accounting for climate coexposures, neighborhood greenness, socioeconomic conditions, health care access, and urbanicity level.
A total of 8 907 422 Medicare enrollees were included in this study with 56.8% being female individuals and 90.2% being White individuals. The mean (SD) age at entry (after washout period) was 73.7 (4.8) years. Each 5-unit increase in long-term mean exposure to PM2.5, NO2, and O3 was associated with an adjusted percentage increase in depression risk of 0.91% (95% CI, 0.02%-1.81%), 0.61% (95% CI, 0.31%- 0.92%), and 2.13% (95% CI, 1.63%-2.64%), respectively, based on a tripollutant model. Effect size heterogeneity was found among subpopulations by comorbidity condition and neighborhood contextual backgrounds.
In this cohort study among US Medicare enrollees, harmful associations were observed between long-term exposure to air pollution and increased risk of late-life depression diagnosis.
新出现的证据表明，空气污染物与老年人的神经退行性疾病之间存在有害关联。然而，对于老年期精神障碍（如老年抑郁症）的结果知之甚少。
研究在美国老年人中，长期暴露于空气污染是否与晚年抑郁症诊断风险增加有关。
设计、设置和参与者：本基于人群的纵向队列研究包括美国 64 岁以上的医疗保险参保者。数据来自美国医疗保险和医疗补助服务中心慢性疾病仓库。参与者连续参加了收费服务计划以及医疗保险 A 部分和 B 部分。在进入后的 5 年洗脱期后，共有 8907422 名独特的个体在 2005 年至 2016 年的研究期间被覆盖，他们贡献了 1526690 例迟发性抑郁症诊断。数据分析于 2022 年 3 月至 2022 年 11 月进行。
暴露包括居住的长期细颗粒物（PM2.5）暴露，以每立方米微克计；二氧化氮（NO2），以十亿分之几计；和臭氧（O3），以十亿分之几计。
通过所有可用的医疗保险索赔（即医院住院、熟练护理设施、家庭保健机构、医院门诊和医生就诊）信息来确定晚年抑郁症的诊断。获得首次发生的日期。通过分层 Cox 比例风险模型估计风险的危害比和百分比变化，该模型考虑了气候共暴露、邻里绿化、社会经济状况、医疗保健机会和城市水平。
这项研究共纳入了 8907422 名医疗保险参保者，其中 56.8%为女性，90.2%为白人。进入时的平均（标准差）年龄（洗脱期后）为 73.7（4.8）岁。长期平均暴露于 PM2.5、NO2 和 O3 每增加 5 个单位，调整后的抑郁症风险增加 0.91%（95%CI，0.02%-1.81%）、0.61%（95%CI，0.31%-0.92%）和 2.13%（95%CI，1.63%-2.64%），这是基于三污染物模型得出的。在基于合并症条件和邻里背景的亚人群中发现了效应大小异质性。
在这项针对美国医疗保险参保者的队列研究中，观察到长期暴露于空气污染与晚年抑郁症诊断风险增加之间存在有害关联。
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