Krzyzanowski Brittany, Mullan Aidan F, Turcano Pierpaolo, Camerucci Emanuele, Bower James H, Savica Rodolfo
Barrow Neurological Institute, Phoenix, Arizona.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
JAMA Netw Open. 2024 Sep 3;7(9):e2433602. doi: 10.1001/jamanetworkopen.2024.33602.
The role of air pollution in risk and progression of Parkinson disease (PD) is unclear.
To assess whether air pollution is associated with increased risk of PD and clinical characteristics of PD.
DESIGN, SETTING, AND PARTICIPANTS: This population-based case-control study included patients with PD and matched controls from the Rochester Epidemiology Project from 1998 to 2015. Data were analyzed from January to June 2024.
Mean annual exposure to particulate matter with a diameter of 2.5 µm or less (PM2.5) from 1998 to 2015 and mean annual exposure to nitrogen dioxide (NO2) from 2000 to 2014.
Outcomes of interest were PD risk, all-cause mortality, presence of tremor-predominant vs akinetic rigid PD, and development of dyskinesia. Models were adjusted for age, sex, race and ethnicity, year of index, and urban vs rural residence.
A total of 346 patients with PD (median [IQR] age 72 [65-80] years; 216 [62.4%] male) were identified and matched on age and sex with 4813 controls (median [IQR] age, 72 [65-79] years, 2946 [61.2%] male). Greater PM2.5 exposure was associated with increased PD risk, and this risk was greatest after restricting to populations within metropolitan cores (odds ratio [OR], 1.23; 95% CI, 1.11-1.35) for the top quintile of PM2.5 exposure compared with the bottom quintile. Greater NO2 exposure was also associated with increased PD risk when comparing the top quintile with the bottom quintile (OR, 1.13; 95% CI, 1.07-1.19). Air pollution was associated with a 36% increased risk of akinetic rigid presentation (OR per each 1-μg/m3 increase in PM2.5, 1.36; 95% CI, 1.02-1.80). In analyses among patients with PD only, higher PM2.5 exposure was associated with greater risk for developing dyskinesia (HR per 1-μg/m3 increase in PM2.5, 1.42; 95% CI, 1.17-1.73), as was increased NO2 exposure (HR per 1 μg/m3 increase in NO2, 1.13; 95% CI, 1.06-1.19). There was no association between PM2.5 and all-cause mortality among patients with PD.
In this case-control study of air pollution and PD, higher levels of PM2.5 and NO2 exposure were associated with increased risk of PD; also, higher levels of PM2.5 exposure were associated with increased risk of developing akinetic rigid PD and dyskinesia compared with patients with PD exposed to lower levels. These findings suggest that reducing air pollution may reduce risk of PD, modify the PD phenotype, and reduce risk of dyskinesia.
空气污染在帕金森病（PD）风险及病情进展中的作用尚不清楚。
评估空气污染是否与PD风险增加及PD临床特征相关。
设计、背景和参与者：这项基于人群的病例对照研究纳入了1998年至2015年罗切斯特流行病学项目中的PD患者及匹配对照。数据于2024年1月至6月进行分析。
1998年至2015年直径小于等于2.5微米的颗粒物（PM2.5）年均暴露量，以及2000年至2014年二氧化氮（NO2）年均暴露量。
关注的结局包括PD风险、全因死亡率、震颤为主型与运动不能-强直型PD的存在情况以及异动症的发生。模型对年龄、性别、种族和族裔、索引年份以及城市与农村居住情况进行了校正。
共识别出346例PD患者（年龄中位数[四分位间距]为72[65 - 80]岁；216例[62.4%]为男性），并按年龄和性别与4813名对照进行匹配（年龄中位数[四分位间距]为72[65 - 79]岁，2946例[61.2%]为男性）。PM2.5暴露增加与PD风险增加相关，在将分析限制于大都市核心区域人群后，这种风险最为显著（暴露量最高五分位数与最低五分位数相比，比值比[OR]为1.23；95%置信区间[CI]为1.11 - 1.35）。比较最高五分位数与最低五分位数时，NO2暴露增加也与PD风险增加相关（OR为1.13；95%CI为1.07 - 1.19）。空气污染与运动不能-强直型表现风险增加36%相关（PM2.5每增加1微克/立方米，OR为1.36；95%CI为1.02 - 1.80）。仅在PD患者的分析中，较高的PM2.5暴露与发生异动症的风险增加相关（PM2.5每增加1微克/立方米，风险比[HR]为1.42；95%CI为1.17 - 1.73），NO2暴露增加也如此（NO2每增加1微克/立方米，HR为1.13；95%CI为1.06 - 1.19）。PD患者中PM2.5与全因死亡率之间无关联。
在这项关于空气污染与PD的病例对照研究中，较高水平的PM2.5和NO2暴露与PD风险增加相关；此外，与暴露于较低水平的PD患者相比，较高水平的PM2.5暴露与发生运动不能-强直型PD和异动症的风险增加相关。这些发现表明，减少空气污染可能降低PD风险、改变PD表型并降低异动症风险。
