Long-term cumulative associations of annual air pollution exposure and hospitalization with Parkinson’s Disease
Scott W. Delaney, Lauren Mock, Veronica A. Wang, Brad A. Racette, Gary W. Miller, Marianthi-Anna Kioumourtzoglou, Antonella Zanobetti, Danielle Braun, Daniel MorkBackground:
Parkinson’s Disease (PD) prevention and treatment are complicated because biological processes underlying PD may begin several years before diagnosis. Previous studies suggest that increased exposure to fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) air pollution increases PD morbidity.
Methods:
We analyzed data from 10,366,083 Medicare fee-for-service beneficiaries (age 65+) in the contiguous United States from 2000 to 2016. We defined “hospitalization with PD” as a beneficiary’s first hospitalization claim with diagnosis codes indicating PD. We linked 10-year exposure histories for PM 2.5 , NO 2 , and summer ozone (O 3 ). In a discrete-time survival analysis, we fitted distributed lag models and estimated the lagged associations between air pollution and the odds of first hospitalization with PD.
Results:
Increased PM 2.5 and NO 2 exposure at least 4 years before hospitalization was associated with increased odds of hospitalization with PD. Accounting for nonlinearities in exposure-response and 10 years of continuous exposure to PM 2.5 at the 90th versus the 0.5th percentile (i.e., 11.8 μg/m 3 vs. 3.0 μg/m 3 ), the odds ratio for hospitalization with PD was 1.634 (95% CI: 1.489, 1.792). Similarly, for 10 years of continuous exposure to NO 2 at the 90th versus the 0.5th percentile (i.e., 31.7 ppb vs. 3.7 ppb), the odds ratio for hospitalization with PD was 1.474 (95% CI: 1.379, 1.575). Evidence of a relationship between O 3 exposure and odds for hospitalization with PD was more limited.
Conclusions:
Air pollution at least 4 years before hospitalization may increase the odds of hospitalization with PD. Reducing air pollution exposure may have long-term effects on PD prevention.