A national cohort study (2000-2018) of long-term air pollution exposure and incident dementia in older adults in the United States

Air pollution may increase risk of Alzheimer's disease and related dementias (ADRD) in the U.S., but the extent of this relationship is unclear. Here, we constructed two national U.S. population-based cohorts of those aged >= 65 from the Medicare Chronic Conditions Warehouse (2000-2018), combined with high-resolution air pollution datasets, to investigate the association of long-term exposure to ambient fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O-3) with dementia and AD incidence, respectively. We identified similar to 2.0 million incident dementia cases (N = 12,233,371; dementia cohort) and similar to 0.8 million incident AD cases (N = 12,456,447; AD cohort). Per interquartile range (IQR) increase in the 5-year average PM2.5 (3.2 mu g/m(3)), NO2 (11.6 ppb), and warm-season O-3 (5.3 ppb) over the past 5 years prior to diagnosis, the hazard ratios (HRs) were 1.060 (95% confidence interval [CI]: 1.054, 1.066), 1.019 (95% CI: 1.012, 1.026), and 0.990 (95% CI: 0.987, 0.993) for incident dementias, and 1.078 (95% CI: 1.070, 1.086), 1.031 (95% CI: 1.023, 1.039), and 0.982 (95%CI: 0.977, 0.986) for incident AD, respectively, for the three pollutants. For both outcomes, concentration-response relationships for PM2.5 and NO2 were approximately linear. Our study suggests that exposures to PM2.5 and NO2 are associated with incidence of dementia and AD.

Automated summary

The study suggests that long-term exposure to PM2.5 and NO2 is associated with the incidence of dementia and Alzheimer's disease in older adults.