■空气污染是公认的与慢性病相关的危险因素,包括呼吸和心血管疾病,这可能会在以后的生活中导致身体和认知障碍。虽然这些功能的丧失,单独或组合,降低个人独立生活的可能性,人们对空气污染与这一关键结果的联系知之甚少。
■调查空气污染与晚年独立性丧失之间的关联。
■这项队列研究是作为认知健康和衰老的环境预测因子研究的一部分进行的,并使用了1998年至2016年健康和退休研究的数据。与会者包括这位国家代表的受访者,以人群为基础的队列,他们年龄大于50岁,并且以前没有报告过失独.分析于2023年8月31日至10月15日进行。
■10年平均污染物浓度(直径小于2.5μm的颗粒物[PM2.5]或直径在2.5μm至10μm之间的颗粒物[PM10-2.5],二氧化氮[NO2],和臭氧[O3])是使用时空模型以及9个排放源的PM2.5水平在受访者地址进行估算的。
■独立性丧失被定义为由于健康和记忆问题或搬到疗养院而接受至少一项日常生活活动或日常生活工具活动的新护理。用广义估计方程回归对潜在混杂因素进行调整来估计关联。
■在25314名50岁以上的受访者中(平均[SD]基线年龄,61.1[9.4]岁;11208名男性[44.3%]),在10.2(5.5)年的平均(SD)随访期间,有9985名个体(39.4%)失去了独立性。较高的平均浓度暴露水平与总PM2.5水平失去独立性的风险增加相关(10年平均每1-IQR的风险比[RR],1.05;95%CI,1.01-1.10),道路交通PM2.5水平(10年平均每1-IQR的RR,1.09;95%CI,1.03-1.16)和非道路交通(每10年平均1-IQR的RR,1.13;95%CI,1.03-1.24),和NO2水平(10年平均每1-IQR的RR,1.05;95%CI,1.01-1.08)。与其他来源相比,交通产生的污染物与独立性丧失最一致和最强烈地相关;只有道路交通相关的PM2.5水平在调整其他来源的PM2.5后仍与风险增加相关(10年平均浓度每1-IQR增加的RR,1.10;95%CI,1.00-1.21)。其他污染物-结果关联为零,除了O3水平,与较低的独立性丧失风险相关(在10年平均浓度中,每1-IQR增加的RR,0.94;95%CI,0.92-0.97)。
■这项研究发现,长期暴露于空气污染与以后生活中失去独立性的需要帮助有关,交通相关来源产生的污染风险特别大且持续增加。这些发现表明,控制空气污染可能与转移或延迟需要护理和长期独立生活的能力有关。
UNASSIGNED: Air pollution is a recognized risk factor associated with chronic diseases, including respiratory and cardiovascular conditions, which can lead to physical and cognitive impairments in later life. Although these losses of function, individually or in combination, reduce individuals\' likelihood of living independently, little is known about the association of air pollution with this critical outcome.
UNASSIGNED: To investigate associations between air pollution and loss of independence in later life.
UNASSIGNED: This cohort study was conducted as part of the Environmental Predictors Of Cognitive Health and Aging study and used 1998 to 2016 data from the Health and Retirement Study. Participants included respondents from this nationally representative, population-based cohort who were older than 50 years and had not previously reported a loss of independence. Analyses were performed from August 31 to October 15, 2023.
UNASSIGNED: Mean 10-year pollutant concentrations (particulate matter less than 2.5 μm in diameter [PM2.5] or ranging from 2.5 μm to 10 μm in diameter [PM10-2.5], nitrogen dioxide [NO2], and ozone [O3]) were estimated at respondent addresses using spatiotemporal models along with PM2.5 levels from 9 emission sources.
UNASSIGNED: Loss of independence was defined as newly receiving care for at least 1 activity of daily living or instrumental activity of daily living due to health and memory problems or moving to a nursing home. Associations were estimated with generalized estimating equation regression adjusting for potential confounders.
UNASSIGNED: Among 25 314 respondents older than 50 years (mean [SD] baseline age, 61.1 [9.4] years; 11 208 male [44.3%]), 9985 individuals (39.4%) experienced lost independence during a mean (SD) follow-up of 10.2 (5.5) years. Higher exposure levels of mean concentration were associated with increased risks of lost independence for total PM2.5 levels (risk ratio [RR] per 1-IQR of 10-year mean, 1.05; 95% CI, 1.01-1.10), PM2.5 levels from road traffic (RR per 1-IQR of 10-year mean, 1.09; 95% CI, 1.03-1.16) and nonroad traffic (RR per 1-IQR of 10-year mean, 1.13; 95% CI, 1.03-1.24), and NO2 levels (RR per 1-IQR of 10-year mean, 1.05; 95% CI, 1.01-1.08). Compared with other sources, traffic-generated pollutants were most consistently and robustly associated with loss of independence; only road traffic-related PM2.5 levels remained associated with increased risk after adjustment for PM2.5 from other sources (RR per 1-IQR increase in 10-year mean concentration, 1.10; 95% CI, 1.00-1.21). Other pollutant-outcome associations were null, except for O3 levels, which were associated with lower risks of lost independence (RR per 1-IQR increase in 10-year mean concentration, 0.94; 95% CI, 0.92-0.97).
UNASSIGNED: This study found that long-term exposure to air pollution was associated with the need for help for lost independence in later life, with especially large and consistent increases in risk for pollution generated by traffic-related sources. These findings suggest that controlling air pollution could be associated with diversion or delay of the need for care and prolonged ability to live independently.