Long-term effects of PM2.5 components on incident dementia in the northeastern United States

Abstract

•A cohort study by resorting to the Medicare population and PM2.5 components data•Long-term exposure to specific PM2.5 components can accelerate dementia progression•Black carbon and sulfate showed the most stable associations Growing evidence has linked long-term fine particulate matter (PM2.5) exposure to neurological disorders. Less is known about the individual effects of PM2.5 components. A population-based cohort study investigated the association between long-term (1-year average) exposure to PM2.5 components and dementia incidence among the elderly population (age, ≥65 years) in the United States. We used data from the Medicare Chronic Conditions Warehouse and a high-resolution PM2.5 components dataset of the northeastern United States (2000–2017). We identified dementia diagnoses from patients’ hospital and medical insurance records and carried out Cox proportional hazards regression to investigate their association with PM2.5 components. Among ∼2 million participants, 15.1% developed dementia. From the single-pollutant models, hazard ratios per interquartile range increase were 1.10 (95% confidence interval [CI]: 1.09–1.11) for black carbon, 1.08 (95% CI: 1.07, 1.10) for inorganic nitrate, 1.03 (95% CI: 1.02, 1.04) for organic matter, 1.13 (95% CI: 1.11, 1.15) for sulfate, 1.07 (95% CI: 1.06, 1.07) for soil particles, and 1.04 (95% CI: 1.03, 1.05) for sea salt. Increase in exposure to black carbon and sulfate per interquartile range had the strongest associations with dementia incidence. Penalized spline models indicated that dementia incidence increased linearly with elevated black carbon concentrations, whereas the incidence of dementia was only elevated significantly following sulfate concentrations above ∼2 μg/m3. Our study suggests that long-term exposure to PM2.5 components is significantly associated with increased dementia incidence and that different components have different neurotoxicity. Reduction of PM2.5 emissions, especially for main sources of black carbon and sulfate, may reduce the burden of dementia in the aging United States population. Growing evidence has linked long-term fine particulate matter (PM2.5) exposure to neurological disorders. Less is known about the individual effects of PM2.5 components. A population-based cohort study investigated the association between long-term (1-year average) exposure to PM2.5 components and dementia incidence among the elderly population (age, ≥65 years) in the United States. We used data from the Medicare Chronic Conditions Warehouse and a high-resolution PM2.5 components dataset of the northeastern United States (2000–2017). We identified dementia diagnoses from patients’ hospital and medical insurance records and carried out Cox proportional hazards regression to investigate their association with PM2.5 components. Among ∼2 million participants, 15.1% developed dementia. From the single-pollutant models, hazard ratios per interquartile range increase were 1.10 (95% confidence interval [CI]: 1.09–1.11) for black carbon, 1.08 (95% CI: 1.07, 1.10) for inorganic nitrate, 1.03 (95% CI: 1.02, 1.04) for organic matter, 1.13 (95% CI: 1.11, 1.15) for sulfate, 1.07 (95% CI: 1.06, 1.07) for soil particles, and 1.04 (95% CI: 1.03, 1.05) for sea salt. Increase in exposure to black carbon and sulfate per interquartile range had the strongest associations with dementia incidence. Penalized spline models indicated that dementia incidence increased linearly with elevated black carbon concentrations, whereas the incidence of dementia was only elevated significantly following sulfate concentrations above ∼2 μg/m3. Our study suggests that long-term exposure to PM2.5 components is significantly associated with increased dementia incidence and that different components have different neurotoxicity. Reduction of PM2.5 emissions, especially for main sources of black carbon and sulfate, may reduce the burden of dementia in the aging United States population. IntroductionFine particulate matter (PM2.5) is an important air pollutant worldwide and consists of a complex mixture of carbonaceous fractions, water-soluble ions, metals, crustal elements, and other constituents.1Kioumourtzoglou M.A. Austin E. Koutrakis P. et al.PM2.5 and survival among older adults: effect modification by particulate composition.Epidemiology. 2015; 26: 321-327Google Scholar, 2van Donkelaar A. Martin R.V. Li C. Burnett R.T. Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors.Environ. Sci. Technol. 2019; 53: 2595-2611Google Scholar, 3Li J. Garshick E. Hart J.E. et al.Estimation of ambient PM2.5 in Iraq and Kuwait from 2001 to 2018 using machine learning and remote sensing.Environ. Int. 2021; 151: 106445Google Scholar Exposure to PM2.5 has been associated with adverse health effects, including cardiovascular disease, respiratory disease, lung cancer, and premature mortality.4Brauer M. Freedman G. Frostad J. et al.Ambient air pollution exposure estimation for the global burden of disease 2013.Environ. Sci. Technol. 2016; 50: 79-88Google Scholar, 5Di Q. Wang Y. Zanobetti A. et al.Air pollution and mortality in the Medicare population.N. Engl. J. Med. 2017; 376: 2513-2522Google Scholar, 6Schwartz J.D. Di Q. Requia W.J. et al.A direct estimate of the impact of PM2.5, NO2, and O3 exposure on life expectancy using propensity scores.Epidemiology. 2021; 32: 469-476Google Scholar, 7Danesh Yazdi M. Wang Y. Di Q. et al.Long-term association of air pollution and hospital admissions among Medicare participants using a doubly robust additive model.Circulation. 2021; 143: 1584-1596Google Scholar, 8Yu P. Guo S. Xu R. et al.Cohort studies of long-term exposure to outdoor particulate matter and risks of cancer: a systematic review and meta-analysis.Innovation. 2021; 2: 100143https://doi.org/10.1016/j.xinn.2021.100143Google Scholar Several studies also suggest that long-term PM2.5 exposure is a risk factor for neurodegenerative diseases.9Peters R. Ee N. Peters J. et al.Air pollution and dementia: a systematic review.J. Alzheimers Dis. 2019; 70: S145-S163Google Scholar, 10Peeples L. News Feature: how air pollution threatens brain health.Proc. Natl. Acad. Sci. U S A. 2020; 117: 13856-13860Google Scholar, 11Shi L. Wu X. Danesh Yazdi M. et al.Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.Lancet Planet. Health. 2020; 4: e557-e565Google ScholarDementia is one of the most prevalent neurodegenerative diseases and a major public health concern. It affects more than 47 million people worldwide, resulting in substantial health and financial burdens.12Livingston G. Huntley J. Sommerlad A. et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Google Scholar The prevalence of dementia has increased significantly in recent years.13Vos T. Lim S.S. Abbafati C. et al.Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease 2020; 396: Scholar risk for dementia that can by the population is a suggest that PM2.5 has the to dementia and L. C. et al.Long-term air pollution exposure is associated with an of the particulate and of and in and Scholar, A. et outdoor air pollution and brain health Scholar, et particulate matter and brain and affects of and in disease 2020; Scholar evidence that PM2.5 can accelerate diseases et al.A study to effects of long-term of particulate matter on in the 2015; of evidence suggests that particulate air pollution to including longitudinal studies in the United States and the L. Wu X. Danesh Yazdi M. et al.Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.Lancet Planet. Health. 2020; 4: e557-e565Google M. A study of the between disease and of and air pollution in Scholar, M.A. J.D. et al.Long-term PM2.5 exposure and neurological hospital admissions in the United 2016; Scholar, Y. et air pollution increased the risk of disease in a Int. 2016; Scholar, J. et air pollution and disease in a 2016; Scholar, C. R. et association between and hospital admissions to dementia in 2017; Scholar, et air pollution exposure disease in a population-based 2017; Scholar, S. Burnett R.T. et of ambient air pollution on disease in 2001 to a population-based cohort J. Scholar, R. M. et disease and long-term exposure to outdoor air a study in The Int. 2019; Scholar, Y. et exposure and in neurodegenerative diseases in 2021; Scholar, J. Li N. Wang X. et of particulate matter with dementia and in a 2021; 2: Scholar, M. J. Wang Y. et al.Long-term effect of fine particulate matter on with 2019; Scholar The of studies associations between PM2.5 and dementia. A systematic review and also that exposure to PM2.5 is associated with a risk of dementia per increase in PM2.5 P. Guo X. The association between PM2.5 exposure and neurological a systematic review and 2019; Scholar studies have on records a of incidence. A recent study by et L. Li et al.A cohort study of long-term air pollution exposure and dementia in older in the United 2021; Scholar on Medicare data in the United States including also evidence that long-term exposure to PM2.5 may increase the incidence of studies have on the effects of PM2.5 a complex the effects of PM2.5 may by chemical components. PM2.5 organic matter inorganic inorganic sulfate black carbon soil and sea from specific have different and resulting in health for Scholar, Wang C. et al.Ambient PM2.5 and exposure and their Int. 2021; 151: Scholar, P. X. Li Q. et of and particulate in 2020; Scholar the individual effects of PM2.5 components on dementia is an to the effect of exposure to PM2.5 components on dementia to PM2.5 components for the and sources the most Wang C. et al.Ambient PM2.5 and exposure and their Int. 2021; 151: on the study by et L. Li et al.A cohort study of long-term air pollution exposure and dementia in older in the United 2021; Scholar by a population-based cohort study of the Medicare dataset and a high-resolution PM2.5 components dataset from The data on and in the northeastern United exposure estimates identified a of dementia using Medicare including with the of a PM2.5 exposure was to on The effects of long-term exposure to major PM2.5 components and on dementia were investigated using Cox proportional hazards population and air pollution dementia cohort with a of had about million with a of the of the people the cohort between and were were and more than were above the the population 15.1% developed dementia. The information for the dementia cohort is in for the dementia of from population of of medical in a and the northeastern United States had an PM2.5 of μg/m3. The concentrations of PM2.5 components were and The interquartile of and were and The between PM2.5 and PM2.5 in The of the in The of PM2.5 is in The PM2.5 concentrations were in of the United including and and concentrations were in and the of and and the of was also with the other had and of were in concentrations the of and effect the single-pollutant long-term exposure to PM2.5 and PM2.5 major components had a association with dementia A increase in was associated with an increase in with a hazard of 1.10 (95% confidence interval [CI]: for PM2.5 1.10 (95% CI: for 1.08 (95% CI: 1.07, 1.10) for 1.03 (95% CI: 1.02, 1.04) for 1.13 (95% CI: 1.11, 1.15) for 1.07 (95% CI: 1.06, 1.07) for and 1.04 (95% CI: 1.03, 1.05) for models, the associations with long-term exposure to CI: CI: CI: 1.03, CI: 1.02, and CI: 1.03, 1.05) were for showed a association with dementia CI: the for in single-pollutant We that had for and whereas had for for and among identified than for identified other than had associations between dementia and and than older than whereas older than had associations between dementia and and of dementia associated with increase in PM2.5 major (95% in a of dementia associated with increase in the PM2.5 major components by study in single-pollutant the between of PM2.5 and dementia from single-pollutant models A was with and with of were with and concentrations, and the for and for The showed associations between dementia and the significantly concentrations, with a about μg/m3. The for was to with concentrations by a from single-pollutant models for black carbon, nitrate, organic matter, sulfate, soil particles, and sea salt. The spline regression models the concentrations of PM2.5 from the to of the single-pollutant models for PM2.5 in The were with models, with associations for and associations for the other components on dementia. The of the cohort to the of main analysis from The from models in The from models for and with from single-pollutant for a association was concentrations for other PM2.5 components. We that exposure increase the risk of dementia by a a cohort study from the northeastern United that long-term exposure to and elevated the risk of dementia among the elderly population (age, has been to associated with dementia only the single-pollutant was and a association was PM2.5 other major components of PM2.5 were and models, of and were associated with the dementia from of and review of black carbon and carbon in and the United 2016; Scholar It is associated with including pollution and J. et al.Global air and health of and black carbon Scholar We a association between and dementia. studies the associations between and neurodegenerative have associations between and of brain in and in the A. et of black carbon with among in a cohort J. et air pollution and in a cohort of older Scholar A for the of is that from sources can and may the and the et exposure and of Scholar can also on and to et exposure and of in the is a complex mixture of and organic of organic carbon and of of and review and of the Scholar of and is the major of from of organic is also a major of S. M. Guo Q. et sources and of organic in Sci. Technol. Scholar organic by of with studies have in and the effects of on the L. Y. et al.Long-term exposure to fine particulate and cardiovascular diseases in 2021; Scholar have been studies that exposure to to disorders in neurodegenerative in R. et of exposure to air on the of brain matter, and in 2015; Wu M. Wang C. et exposure to neurodegenerative in 2015; Scholar an adverse effect of on dementia with the single-pollutant and a association was PM2.5 other components of PM2.5 were in the to the of the for most of the the association was The for other PM2.5 components reduce the associations of and of the effect for components in the models from their in the single-pollutant et S. Donkelaar A. et al.A method to estimate the mortality risk of long-term exposure to fine particulate matter and 2016; Scholar also a association between and mortality in the single-pollutant for PM2.5 and other components. also to among The effects of to is a inorganic in the major and of for the A. Scholar is to the major of and in is to the main of M. X. Y. et in pollution and Natl. Acad. Sci. U S A. 2019; Scholar We a association between and dementia. A was in concentrations, and the stable concentrations above μg/m3. the adverse effects of on neurodegenerative disorders have been has been linked to is known to a major in dementia and neurodegenerative Wang G. et and of to in air the J. Med. Scholar is evidence that air pollution the risk of neurodegenerative M. A study of the between disease and of and air pollution in Y. et air pollution increased the risk of disease in a Int. 2016; J. et air pollution and disease in a 2016; is also a inorganic in the in the of a mixture of sulfate, to et E. et hospital admissions and long-term exposure to ambient fine air 2021; Scholar a association between and for neurodegenerative disorders with a risk of (95% CI: per the only a between and dementia a was concentrations for other major components. effect by sulfate the in the by an in the that of of particulate matter, only a of lung The a of chemical of T. Guo L. et ambient particles, metals, and a between sulfate and Sci. Technol. 2017; of and of crustal and and and We a association between and dementia. It has been that of in the and can the M. E. and Med. from sea is of also other chemical that in other studies have investigated the between and neurodegenerative disorders. It has been that is associated with cardiovascular disease, L. Y. et al.Long-term exposure to fine particulate and cardiovascular diseases in 2021; Scholar The effect of on dementia is of on study has the of is the cohort study associations between PM2.5 exposure and dementia. PM2.5 dementia effects from the and only a studies have investigated specific PM2.5 components. study evidence for the association between PM2.5 components and may have for PM2.5 studies have on in used more Medicare including Medicare and and health dementia in study can disease incidence. The of a also to more Cox proportional hazards models a to for and more robust for the and individual including study also has for the exposure were to information of of Medicare only the exposure data on exposure is with out the of and may the of dementia. studies the and were and that were the may the between in the cohort models and single-pollutant models with PM2.5 have of the among PM2.5 components. the mixture analysis L. for the health effects of machine Health. Scholar the investigated PM2.5 components to more than of the PM2.5 whereas other elements, of the of exposure data for individual et and in chemical composition in the United States for health effects Scholar the effect of other components on dementia for the for other components a components to PM2.5 of in study evidence that long-term exposure to PM2.5 components accelerate dementia the of PM2.5 chemical components to increased dementia incidence may and showed the most stable associations with dementia whereas the of PM2.5, has the PM2.5 pollution has an important public health We PM2.5 the effect of specific PM2.5 components on neurodegenerative especially for and also to for to more of PM2.5 components in the and cohort study on and on The Medicare and Medicare Chronic Conditions Warehouse were used to study population (age, from the for the Medicare and the Medicare Medicare by of of and of and were in study was to of dementia. The of dementia an that Medicare hospital and and health insurance including and and The the of the with a dementia Medicare in The Medicare for dementia is on G. M. The of data in T. et of Medicare an the of dementia Alzheimers Dis. Scholar Medicare to a cohort of Medicare in northeastern and disease cohort that were in the Medicare and in Medicare A and from and was a of was dementia have also used a dementia L. Li et al.A cohort study of long-term air pollution exposure and dementia in older in the United 2021; et in older with dementia the 53: Scholar increase the that the individual have dementia to Medicare were the cohort on the of the following the of and were the of an of in Medicare the of study is by and the the data The Medicare dataset was and in the with and PM2.5 and major components were using PM2.5 composition models for The can Donkelaar A. Martin R.V. Li C. Burnett R.T. Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors.Environ. Sci. Technol. 2019; 53: 2595-2611Google Scholar PM2.5 concentrations were by of chemical and PM2.5 were individual chemical components to and using from of the and the the and the of PM2.5 concentrations by were from the with a of PM2.5 was used for PM2.5 the regression by Donkelaar et Donkelaar A. Martin R.V. Li C. Burnett R.T. Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors.Environ. Sci. Technol. 2019; 53: 2595-2611Google Scholar to of and and to of the in to Donkelaar A. Martin R.V. Li C. Burnett R.T. Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors.Environ. Sci. Technol. 2019; 53: 2595-2611Google Donkelaar A. Li C. et al.Global estimates and long-term of fine particulate matter concentrations Sci. Technol. 2020; Scholar PM2.5 concentrations and the The of PM2.5 were to PM2.5 to with the with an of for for for for for and for was using a of the of using Donkelaar A. Martin R.V. Li C. Burnett R.T. Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors.Environ. Sci. Technol. 2019; 53: 2595-2611Google Scholar the PM2.5 and chemical components of in northeastern and between and of long-term Our exposure estimates were on the of the and the We used PM2.5 and components the had that PM2.5 in the have estimate effects on dementia than exposure an of an dementia by L. Li et al.A cohort study of long-term air pollution exposure and dementia in older in the United 2021; and were to for The including and were from the Medicare risk and health The of population above of the population population of people older than from and of were from the and American risk and and health of and medical were from the and the and Cox proportional hazards models with were used to the association between exposure to PM2.5 components and dementia among the The models were for the risk and health models were for the to more robust confidence for effect models for a review with J. Sci. Scholar in estimates to by of from models were with per increase in the of PM2.5 that for the single-pollutant models on and for between PM2.5 components and spline J. Scholar by including a spline for in the L. Wu X. Danesh Yazdi M. et al.Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.Lancet Planet. Health. 2020; 4: e557-e565Google Scholar The spline was in the models one a single-pollutant models to the in the for The models for the main L. Wu X. Danesh Yazdi M. et al.Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.Lancet Planet. Health. 2020; 4: e557-e565Google the of main for the PM2.5 in single-pollutant a cohort analysis for the to for a to in spline models and investigated the were for the analysis were on the with the analysis with was by IntroductionFine particulate matter (PM2.5) is an important air pollutant worldwide and consists of a complex mixture of carbonaceous fractions, water-soluble ions, metals, crustal elements, and other constituents.1Kioumourtzoglou M.A. Austin E. Koutrakis P. et al.PM2.5 and survival among older adults: effect modification by particulate composition.Epidemiology. 2015; 26: 321-327Google Scholar, 2van Donkelaar A. Martin R.V. Li C. Burnett R.T. Regional estimates of chemical composition of fine particulate matter using a combined geoscience-statistical method with information from satellites, models, and monitors.Environ. Sci. Technol. 2019; 53: 2595-2611Google Scholar, 3Li J. Garshick E. Hart J.E. et al.Estimation of ambient PM2.5 in Iraq and Kuwait from 2001 to 2018 using machine learning and remote sensing.Environ. Int. 2021; 151: 106445Google Scholar Exposure to PM2.5 has been associated with adverse health effects, including cardiovascular disease, respiratory disease, lung cancer, and premature mortality.4Brauer M. Freedman G. Frostad J. et al.Ambient air pollution exposure estimation for the global burden of disease 2013.Environ. Sci. Technol. 2016; 50: 79-88Google Scholar, 5Di Q. Wang Y. Zanobetti A. et al.Air pollution and mortality in the Medicare population.N. Engl. J. Med. 2017; 376: 2513-2522Google Scholar, 6Schwartz J.D. Di Q. Requia W.J. et al.A direct estimate of the impact of PM2.5, NO2, and O3 exposure on life expectancy using propensity scores.Epidemiology. 2021; 32: 469-476Google Scholar, 7Danesh Yazdi M. Wang Y. Di Q. et al.Long-term association of air pollution and hospital admissions among Medicare participants using a doubly robust additive model.Circulation. 2021; 143: 1584-1596Google Scholar, 8Yu P. Guo S. Xu R. et al.Cohort studies of long-term exposure to outdoor particulate matter and risks of cancer: a systematic review and meta-analysis.Innovation. 2021; 2: 100143https://doi.org/10.1016/j.xinn.2021.100143Google Scholar Several studies also suggest that long-term PM2.5 exposure is a risk factor for neurodegenerative diseases.9Peters R. Ee N. Peters J. et al.Air pollution and dementia: a systematic review.J. Alzheimers Dis. 2019; 70: S145-S163Google Scholar, 10Peeples L. News Feature: how air pollution threatens brain health.Proc. Natl. Acad. Sci. U S A. 2020; 117: 13856-13860Google Scholar, 11Shi L. Wu X. Danesh Yazdi M. et al.Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.Lancet Planet. Health. 2020; 4: e557-e565Google ScholarDementia is one of the most prevalent neurodegenerative diseases and a major public health concern. It affects more than 47 million people worldwide, resulting in substantial health and financial burdens.12Livingston G. Huntley J. Sommerlad A. et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Google Scholar The prevalence of dementia has increased significantly in recent years.13Vos T. Lim S.S. Abbafati C. et al.Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease 2020; 396: Scholar risk for dementia that can by the population is a suggest that PM2.5 has the to dementia and L. C. et al.Long-term air pollution exposure is associated with an of the particulate and of and in and Scholar, A. et outdoor air pollution and brain health Scholar, et particulate matter and brain and affects of and in disease 2020; Scholar evidence that PM2.5 can accelerate diseases et al.A study to effects of long-term of particulate matter on in the 2015; of evidence suggests that particulate air pollution to including longitudinal studies in the United States and the L. Wu X. Danesh Yazdi M. et al.Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.Lancet Planet. Health. 2020; 4: e557-e565Google M. A study of the between disease and of and air pollution in Scholar, M.A. J.D. et al.Long-term PM2.5 exposure and neurological hospital admissions in the United 2016; Scholar, Y. et air pollution increased the risk of disease in a Int. 2016; Scholar, J. et air pollution and disease in a 2016; Scholar, C. R. et association between and hospital admissions to dementia in 2017; Scholar, et air pollution exposure disease in a population-based 2017; Scholar, S. Burnett R.T. et of ambient air pollution on disease in 2001 to a population-based cohort J. Scholar, R. M. et disease and long-term exposure to outdoor air a study in The Int. 2019; Scholar, Y. et exposure and in neurodegenerative diseases in 2021; Scholar, J. Li N. Wang X. et of particulate matter with dementia and in a 2021; 2: Scholar, M. J. Wang Y. et al.Long-term effect of fine particulate matter on with 2019; Scholar The of studies associations between PM2.5 and dementia. A systematic review and also that exposure to PM2.5 is associated with a risk of dementia per increase in PM2.5 P. Guo X. The association between PM2.5 exposure and neurological a systematic review and 2019; Scholar studies have on records a of incidence. A recent study by et L. Li et al.A cohort study of long-term air pollution exposure and dementia in older in the United 2021; Scholar on Medicare data in the United States including also evidence that long-term exposure to PM2.5 may increase the incidence of studies have on the effects of PM2.5 a complex the effects of PM2.5 may by chemical components. PM2.5 organic matter inorganic inorganic sulfate black carbon soil and sea from specific have different and resulting in health for Scholar, Wang C. et al.Ambient PM2.5 and exposure and their Int. 2021; 151: Scholar, P. X. Li Q. et of and particulate in 2020; Scholar the individual effects of PM2.5 components on dementia is an to the effect of exposure to PM2.5 components on dementia to PM2.5 components for the and sources the most Wang C. et al.Ambient PM2.5 and exposure and their Int. 2021; 151: on the study by et L. Li et al.A cohort study of long-term air pollution exposure and dementia in older in the United 2021; Scholar by a population-based cohort study of the Medicare dataset and a high-resolution PM2.5 components dataset from The data on and in the northeastern United exposure estimates identified a of dementia using Medicare including with the of a PM2.5 exposure was to on The effects of long-term exposure to major PM2.5 components and on dementia were investigated using Cox proportional hazards

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