Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China
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Nevill, Alan M.
Brunner, Eric John
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AbstractIt remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM<sub>2.5</sub> associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM<sub>2.5</sub> exposure at ≥ 64.5 μg/m<sup>3</sup> versus <63.5 μg/m<sup>3</sup> and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM<sub>2.5</sub> (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM<sub>10</sub> (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.
CitationTang, J., Chen, A., He, F. et al. (2023) Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China. Environmental Research, 223, 115048.
PubMed ID36529331 (pubmed)
DescriptionThis is an accepted manuscript of an article published by Elsevier on 20/02/2023, available online: https://doi.org/10.1016/j.envres.2022.115048 The accepted version of the publication may differ from the final published version.
SponsorsThe study was funded by an EU grant from Horizon 2020 MSCA – DEMAIRPO #799247. The baseline and follow-up data collection of the Anhui cohort study were funded by the Royal Society of UK, and the BUPA Foundation (Grants Nos. 45NOV06, and TBF-M09-05). The ZJMPHS cohort study was funded by Zhejiang Provincial Public Welfare Technology Application Research Projects of China (LGF19H260003, LGF21H260002).
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/
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