Depression Mediates the Association Between Ambient Air Pollution and Gastrointestinal/Liver Diseases: A Prospective Cohort Study.

BACKGROUND

The escalating burden of gastrointestinal (GI) and liver diseases poses a critical public health challenge, with emerging evidence implicating air pollution as a modifiable risk factor. However, the mechanistic pathways, particularly the mediating role of depression in the pollution-disease nexus, remain underexplored. This study investigates the longitudinal associations between ambient air pollution exposure and GI/liver diseases in a nationwide cohort, with a focus on quantifying depression's mediating effects.

METHODS

Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020; n = 18,755), we evaluated the impact of long-term exposure to PM1, PM2.5, PM10, SO2, CO, NO2, and O3 on incident GI/liver diseases. Multivariable-adjusted Cox proportional hazards models incorporated demographic, socioeconomic (region, education, retirement status), and lifestyle (smoking, drinking) covariates. Mediation analysis assessed the proportion of total effects mediated by depression (CESD-10 scores).

RESULTS

Chronic exposure to PM1 (HR = 1.33, 95% CI: 1.30-1.37), PM2.5 (HR = 1.30, 1.26-1.33), PM10 (HR = 1.29, 1.25-1.32), SO2 (HR = 1.64, 1.60-1.69), CO (HR = 1.47, 1.43-1.51), and NO2 (HR = 1.27, 1.23-1.30) per interquartile range increase was significantly associated with elevated disease risk, whereas O3 exhibited protective effects (HR = 0.77, 0.74-0.79). Depression mediated 4.0%-11.3% of pollution effects, with the highest mediation observed for O3 (11.3%) and lowest for SO2 (4.0%). Stratified analyses revealed heightened vulnerability in rural residents, individuals with lower education, and Northeastern populations.

CONCLUSIONS

This study pioneers the identification of depression as a mediator linking air pollution to GI/liver diseases in a nationally representative cohort. The findings advocate for integrative policies targeting air quality improvement and mental health interventions to alleviate the dual burden of environmental and psychological morbidity.