Short-term associations between ambient air pollution and emergency department visits for Alzheimer's disease and related dementias

Abstract

Dementia is a seriously disabling illness with substantial economic and social burdens. Alzheimer's disease and its related dementias (AD/ADRD) constitute about two-thirds of dementias. AD/ADRD patients have a high prevalence of comorbid conditions that are known to be exacerbated by exposure to ambient air pollution. Existing studies mostly focused on the long-term association between air pollution and AD/ADRD morbidity, while very few have investigated short-term associations. This study aims to estimate short-term associations between AD/ADRD emergency department (ED) visits and three common air pollutants: fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and warm-season ozone.

Methods: For the period 2005 to 2015, we analyzed over 7.5 million AD/ADRD ED visits in five US states (California, Missouri, North Carolina, New Jersey, and New York) using a time-stratified case-crossover design with conditional logistic regression. Daily estimated PM_2.5, NO_2, and warm-season ozone concentrations at 1 km spatial resolution were aggregated to the ZIP code level as exposure.

Results: The most consistent positive association was found for NO₂. Across five states, a 17.1 ppb increase in NO₂ concentration over a 4-day period was associated with a 0.61% (95% confidence interval = 0.27%, 0.95%) increase in AD/ADRD ED visits. For PM_2.5, a positive association with AD/ADRD ED visits was found only in New York (0.64%, 95% confidence interval = 0.26%, 1.01% per 6.3 µg/m³). Associations with warm-season ozone levels were null.

Conclusions: Our results suggest AD/ADRD patients are vulnerable to short-term health effects of ambient air pollution and strategies to lower exposure may reduce morbidity.

Keywords: Air pollution; Alzheimer’s disease; Dementia; Emergency department visits; Health effect; Hospitalization.