Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
Department of Psychological Medicine, IoPPN, King's College London, London, UK.
BMJ Ment Health. 2023 Jul;26(1). doi: 10.1136/bmjment-2023-300762.
Little is known about the role of air pollution in how people with dementia use mental health services.
We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia.
In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO) and particulate matter (PM and PM) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models.
In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO levels were linked with poor functional status, but not cognitive function.
Residential air pollution exposure is associated with increased CMHT usage among people with dementia.
Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
人们对空气污染在痴呆症患者使用精神卫生服务方面的作用知之甚少。
我们研究了空气污染暴露与痴呆症患者精神卫生服务使用之间的纵向关联。
在伦敦南部的 5024 名 65 岁或以上患有痴呆症的人群中，将大气中二氧化氮（NO）和颗粒物（PM 和 PM）的高分辨率估计值与居住地址相关联。使用负二项回归模型检查空气污染与社区心理健康团队（CMHT）事件（记录了 9 年）之间的关联。使用简易精神状态检查（MMSE）测量认知功能，使用国民健康结果量表（HoNOS65+）测量健康和社会功能。使用线性回归模型评估空气污染与 MMSE 和 HoNOS65+评分之间的关联。
在随访的第一年，所有空气污染物的暴露量增加与 CMHT 使用量呈剂量反应关系。当我们将最高空气污染四分位（四分位 4：Q4）与最低四分位（Q1）进行比较时，这些关联最强（例如，NO：调整后的发病率比（aIRR）1.27，95%CI 1.11 至 1.45，p<0.001）。PM 与 CMHT 事件之间的剂量反应模式在 5 年和 9 年时仍然存在。关联在血管性痴呆患者中最强。NO 水平与功能状态较差相关，但与认知功能无关。
居住空气污染暴露与痴呆症患者 CMHT 使用量增加有关。
在城市环境中努力减少污染物暴露可能会减少痴呆症患者对精神卫生服务的使用，从而为已经相当紧张的精神科服务腾出资源。
