Air Pollution and Alzheimer's Disease and Related Dementias: A National Study

空气污染与阿尔茨海默病及相关痴呆症：一项全国研究

• 批准号: 10669144
• 负责人: Nelson K Steenland
• 金额: $ 70.05万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669144
• 关键词: Acceleration; Acidity; Address; Aerosols; Affect; Air Pollutants; Air Pollution; Alzheimer disease detection; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ammonia; Bayesian Method; Biological; Biological Availability; Caring; Cause of Death; Chemicals; Chronic; Coupled; Data; Data Set; Databases; Dementia; Diagnosis; Disease; Economics; Elderly; Environmental Epidemiology; Environmental Exposure; Environmental Policy; Epidemiology; Event; Exposure to; Gases; Goals; Health; Health protection; Home Care Services; Hospitalization; Impaired cognition; Incidence; Individual; Inpatients; Knowledge; Learning; Link; Liquid substance; Long-Term Effects; Longitudinal cohort; Measurement; Measures; Medicare; Medicare claim; Metals; Modeling; Modification; Morbidity - disease rate; Nitrogen Dioxide; Noise; Outcome; Outpatients; Oxidative Stress; Ozone; Pathogenesis; Pathway interactions; Patients; Persons; Phase; Play; Policies; Pollution; Positioning Attribute; Public Health; Publishing; Race; Records; Regulation; Reporting; Research; Resolution; Risk Factors; Role; Sensitivity and Specificity; Skilled Nursing Facilities; Source; Statistical Methods; Survival Analysis; Thermodynamics; Time; Toxic effect; Toxicology; Trace metal; Uncertainty; United States; United States National Academy of Sciences; Update; Visit; Water; Work; World Health Organization; ambient air pollution; beneficiary; cognitive function; cohort; data warehouse; dementia risk; fine particles; flexibility; high risk; human old age (65+); machine learning method; modifiable risk; neuroinflammation; novel; pollutant; prevent; response; sex; social; systemic inflammatory response

Dementia is a major public health challenge with substantial economic and social burden, affecting more than 47 million people worldwide. Alzheimer's disease (AD) constitutes about two-thirds of dementia cases and is the sixth leading cause of death in the United States, and the only diagnosis among the top 10 that cannot be cured. There is a pressing need to support Alzheimer's disease and related dementias (AD/ADRD) patients by identifying novel and modifiable risk factors that may reduce morbidity. Emerging evidence suggests that air pollution – in particular fine particulate matter (PM2.5) – plays an important role in AD/ADRD pathogenesis. However, little is known about the relative contributions of different air pollutants (PM2.5, NO2, ozone), nor about PM2.5 components. To facilitate the targeting of pollution control efforts, the National Academy of Sciences (NAS) and the World Health Organization (WHO) have placed a high priority on determining which air pollutants and/or which components of PM2.5 are most toxic. In addition, one major gap in the emerging epidemiologic evidence on air pollution and AD/ADRD morbidity is that many previous studies have relied on hospitalizations as the measure of morbidity. Yet, hospitalization is not the typical course for AD/ADRD diagnosis and initial treatment. Instead, if it does occur for patients, hospitalization happens during the more advanced stages of the disease and usually for treating complications of the disease. Thus, hospitalization records do not accurately reflect disease incidence, and thus underestimate case numbers. Therefore, we propose a study that will leverage the massive datasets of high-resolution environmental exposure data and Medicare claims (including doctor visits where most AD/ADRD diagnoses would occur) across the contiguous US to better understand the influence of air pollution on AD/ADRD morbidity among US elderly, and identify potential vulnerable subpopulations, with the ultimate goal of informing environmental policy. We will (1) generate and validate a comprehensive, high- resolution, multiple-species, air pollution dataset across the contiguous US for 2000-2021, including criteria air pollutants (PM2.5 mass, NO2, and ozone), PM2.5 components (including trace metals), as well as aerosol water and fine particle pH that may influence metal dissolution; (2) estimate the chronic effects of criteria pollutants (PM2.5, NO2, and ozone) on AD/ADRD risks using the nationwide Medicare Chronic Conditions Warehouse (CCW) database, which includes Medicare inpatient and outpatient claims, doctor visits, skilled nursing facility, and home health-care claims for AD/ADRD among ~100 million Medicare beneficiaries; (3) assess the relative contributions of PM2.5 components and potential effect modification by aerosol water/pH on AD/ADRD risks using the nationwide Medicare cohort; and (4) conduct sensitivity analyses by correcting for exposure measurement error and outcome misclassification. Our proposed research will fill major knowledge gaps in the epidemiology of environmental exposures and AD/ADRD morbidity, and inform policy for targeted source-specific regulations and facilitate actionable measures that can prevent or mitigate the AD health burden due to air pollution.

痴呆症是实质性经济和社会伯恩（Burnen）的主要公共卫生挑战 全球4700万人。阿尔茨海默氏病（AD）约占痴呆病例的三分之二，是 美国第六大死亡原因，也是无法治愈的前十名中唯一的诊断。 迫切需要支持阿尔茨海默氏病和相关痴呆症（AD/ADRD）患者 识别可能降低发病率的新型和可修改的危险因素。新兴证据表明空气 污染 - 特别是细微的物质（PM2.5） - 在AD/ADRD发病机理中起重要作用。 但是，关于不同空气污染物（PM2.5，NO2，臭氧）的相对贡献知之甚少 PM2.5组件。为了促进污染控制工作的目标，美国国家科学院（NAS） 世界卫生组织（WHO）在确定哪些空气污染物和/或 PM2.5的哪些成分最有毒。此外，新兴流行病学证据中的一个主要差距 关于空气污染和AD/ADRD的发病率是，许多先前的研究都在住院方面放松了 衡量发病率。但是，住院并不是AD/ADRD诊断和初始治疗的典型课程。 取而代 通常用于治疗疾病的并发症。那就是住院记录无法准确反映 疾病事件，因此低估了病例数。因此，我们提出了一项研究，以利用 高分辨率环境暴露数据和医疗保险索赔的大量数据集（包括医生访问） 在整个连续的情况下，大多数广告/ADRD诊断都会发生在哪里，以更好地了解 我们之间对AD/ADRD发病率的空气污染，并确定潜在的脆弱亚群，并与 告知环境政策的最终目标。我们将（1）生成和验证一个全面的，高的 分辨率，多种物种，2000 - 2021年连续美国的空气污染数据集，包括标准空气 污染物（PM2.5质量，NO2和臭氧），PM2.5组件（包括微量金属）以及气溶胶水 可能影响金属溶解的细粒子pH； （2）估计标准污染物的慢性影响 （PM2.5，NO2和臭氧）使用全国Medicare慢性条件仓库冒着广告/ADRD风险 （CCW）数据库，其中包括医疗保险住院和门诊索赔，医生访问，熟练的护士设施， 在约1亿Medicare受益人中对AD/ADRD的家庭保健索赔； （3）评估亲戚 PM2.5组件的贡献和通过气​​溶胶水/pH对AD/ADRD风险进行的潜在效应修饰的贡献 全国Medicare队列； （4）通过校正暴露测量来进行灵敏度分析 错误和结果错误分类。我们提出的研究将填补流行病学的主要知识空白 环境暴露和AD/ADRD发病率，并为针对特定来源的法规提供了政策 并促进可行的措施，以防止或减轻由于空气污染而导致的AD健康燃烧。

项目成果

A Meta-Analysis of Alzheimer's Disease Incidence and Prevalence Comparing African-Americans and Caucasians.

• DOI: 10.3233/jad-150778
• 发表时间: 2016
• 期刊: Journal of Alzheimer's disease : JAD
• 作者: Steenland K;Goldstein FC;Levey A;Wharton W
• 通讯作者: Wharton W

The effect of race and co-morbidities on Alzheimer's disease based on Medicare data.

基于医疗保险数据的种族和合并症对阿尔茨海默病的影响。

• DOI: 10.1002/alz.12838
• 发表时间: 2023
• 期刊: Alzheimer's & dementia : the journal of the Alzheimer's Association
• 作者: Steenland,Kyle;Tan,Youran;Wingo,Thomas;Shi,Liuhua;Xiao,Siyao;Wharton,Whitney
• 通讯作者: Wharton,Whitney