Associations between air pollution and mental health service use in dementia: a retrospective cohort study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background Little is known about the role of air pollution in how people with dementia use mental health services.
Objective We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia.
Methods In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models.
Findings In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function.
Conclusions Residential air pollution exposure is associated with increased CMHT usage among people with dementia.
Clinical implications Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
Objective We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia.
Methods In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models.
Findings In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function.
Conclusions Residential air pollution exposure is associated with increased CMHT usage among people with dementia.
Clinical implications Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
Date Issued
2023-08-01
Date Acceptance
2023-06-11
Citation
BMJ Mental Health, 2023, 26 (1)
ISSN
2755-9734
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Mental Health
Volume
26
Issue
1
Copyright Statement
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. Published by BMJ.
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:001071882100001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
Adult psychiatry
Delirium & cognitive disorders
DISEASE
ENVIRONMENTAL-FACTORS
EXPOSURE
HOSPITAL ADMISSIONS
Life Sciences & Biomedicine
PEOPLE
PREDICTORS
Psychiatry
PSYCHIATRY
Science & Technology
SENSITIVITY
Publication Status
Published
Coverage Spatial
England
Article Number
e300762
Date Publish Online
2023-08-07