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Publications

Journal Article Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. Epublish 115 citations

PubMed: 36763364 DOI: 10.1001/jamanetworkopen.2022.53668

Association of Long-term Exposure to Air Pollution With Late-Life Depression in Older Adults in the US.

JAMA Netw Open 6(2):e2253668

Authors: Xinye Qiu, Liuhua Shi, Laura D Kubzansky, Yaguang Wei, Edgar Castro, Haomin Li, Marc G Weisskopf, Joel D Schwartz

Affiliations

  • Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
  • Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Abstract

Importance

Emerging evidence has suggested harmful associations of air pollutants with neurodegenerative diseases among older adults. However, little is known about outcomes regarding late-life mental disorders, such as geriatric depression.

Objective

To investigate if long-term exposure to air pollution is associated with increased risk of late-life depression diagnosis among older adults in the US.

Design, Setting, and Participants

This population-based longitudinal cohort study consisted of US Medicare enrollees older than 64 years. Data were obtained from the US Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The participants were continuously enrolled in the Fee-for-Service program and both Medicare Part A and Part B. After the 5-year washout period at entry, a total of 8 907 422 unique individuals were covered over the study period of 2005 to 2016, who contributed to 1 526 690 late-onset depression diagnoses. Data analyses were performed between March 2022 and November 2022.

Exposures

The exposures consisted of residential long-term exposure to fine particulate matter (PM2.5), measured in micrograms per cubic meter; nitrogen dioxide (NO2), measured in parts per billion; and ozone (O3), measured in parts per billion.

Main Outcomes and Measures

Late-life depression diagnoses were identified via information from all available Medicare claims (ie, hospital inpatient, skilled nursing facility, home health agency, hospital outpatient, and physician visits). Date of the first occurrence was obtained. Hazard ratios and percentage change in risk were estimated via stratified Cox proportional hazards models accounting for climate coexposures, neighborhood greenness, socioeconomic conditions, health care access, and urbanicity level.

Results

A total of 8 907 422 Medicare enrollees were included in this study with 56.8% being female individuals and 90.2% being White individuals. The mean (SD) age at entry (after washout period) was 73.7 (4.8) years. Each 5-unit increase in long-term mean exposure to PM2.5, NO2, and O3 was associated with an adjusted percentage increase in depression risk of 0.91% (95% CI, 0.02%-1.81%), 0.61% (95% CI, 0.31%- 0.92%), and 2.13% (95% CI, 1.63%-2.64%), respectively, based on a tripollutant model. Effect size heterogeneity was found among subpopulations by comorbidity condition and neighborhood contextual backgrounds.

Conclusions and Relevance

In this cohort study among US Medicare enrollees, harmful associations were observed between long-term exposure to air pollution and increased risk of late-life depression diagnosis.

MeSH

Depression, Air Pollution, Cohort Studies, Air, Clinical Medicine, Environmental Pollution, Diagnosis

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