Environmental epidemiology (Philadelphia, Pa.) · 2025
Combined and synergistic effects of heat and fine particulate matter on hospitalization among patients with Alzheimer's disease and related dementias.
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Spoto Federica, Zanobetti Antonella, Delaney Scott W, Gill Thomas M, Bell Michelle L, Dominici Francesca, Braun Danielle, Mork Daniel
Аннотация
BACKGROUND: Patients with Alzheimer's disease and related dementias (ADRD) are vulnerable to environmental stressors such as extreme heat and air pollution, yet their combined health effects remain poorly understood.
METHODS: We assessed the joint impact of extreme heat and fine particulate matter exposure (PM2.5) on the risk of all-cause hospitalization among an ADRD cohort of Medicare beneficiaries aged ≥65 years. Using a time-stratified case-crossover design, we analyzed data from beneficiaries with prior ADRD-related hospitalizations across the contiguous US in 2000-2016. Daily heat index and PM2.5 concentrations were linked to residential ZIP codes, and conditional logistic regression models were applied to estimate same-day associations during the warm season (May-September), including interaction terms to explore potential synergistic effects.
RESULTS: We found a linear association between heat and hospitalization, with an odds ratio (OR) of 1.017 (95% confidence interval [CI] = 1.004, 1.031) on extreme heat days (99th percentile) versus median. The PM2.5-hospitalization relationship was nonlinear, with stronger effects at lower concentrations (10 vs. 5 µg/m3 OR = 1.010; 95% CI = 1.005, 1.015). When accounting for changes in PM2.5, the OR on extreme heat days versus the median was 1.016 (95% CI = 1.001, 1.032).
CONCLUSION: These findings underscore the need to consider both environmental stressors when assessing health risks in ADRD populations.
METHODS: We assessed the joint impact of extreme heat and fine particulate matter exposure (PM2.5) on the risk of all-cause hospitalization among an ADRD cohort of Medicare beneficiaries aged ≥65 years. Using a time-stratified case-crossover design, we analyzed data from beneficiaries with prior ADRD-related hospitalizations across the contiguous US in 2000-2016. Daily heat index and PM2.5 concentrations were linked to residential ZIP codes, and conditional logistic regression models were applied to estimate same-day associations during the warm season (May-September), including interaction terms to explore potential synergistic effects.
RESULTS: We found a linear association between heat and hospitalization, with an odds ratio (OR) of 1.017 (95% confidence interval [CI] = 1.004, 1.031) on extreme heat days (99th percentile) versus median. The PM2.5-hospitalization relationship was nonlinear, with stronger effects at lower concentrations (10 vs. 5 µg/m3 OR = 1.010; 95% CI = 1.005, 1.015). When accounting for changes in PM2.5, the OR on extreme heat days versus the median was 1.016 (95% CI = 1.001, 1.032).
CONCLUSION: These findings underscore the need to consider both environmental stressors when assessing health risks in ADRD populations.