A national case-crossover analysis of the short-term effect of PM2.5 on hospitalizations and mortality in subjects with diabetes and neurological disorders

Abstract

Background: Diabetes and neurological disorders are a growing burden among the elderly, and may also make them more susceptible to particulate air matter with aerodynamic diameter less than 2.5 μg (PM2.5). The same biological responses thought to effect cardiovascular disease through air pollution-mediated systemic oxidative stress, inflammation and cerebrovascular dysfunction could also be relevant for diabetes and neurodegenerative diseases.

Methods: We conducted multi-site case-crossover analyses of all-cause deaths and of hospitalizations for diabetes or neurological disorders among Medicare enrollees (>65 years) during the period 1999 to 2010 in 121 US communities. We examined whether 1) short-term exposure to PM2.5 increases the risk of hospitalization for diabetes or neurological disorders, and 2) the association between short-term exposure to PM2.5 and all-cause mortality is modified by having a previous hospitalization of diabetes or neurological disorders.

Results: We found that short term exposure to PM2.5 is significantly associated with an increase in hospitalization risks for diabetes (1.14% increase, 95% CI: 0.56, 1.73 for a 10 μg/m3 increase in the 2 days average), and for Parkinson's disease (3.23%, 1.08, 5.43); we also found an increase in all-cause mortality risks (0.64%, 95% CI: 0.42, 0.85), but we didn't find that hospitalization for diabetes and neurodegenerative diseases modifies the association between short term exposure to PM2.5 and all-cause mortality.

Conclusion: We found that short-term exposure to fine particles increased the risk of hospitalizations for Parkinson's disease and diabetes, and of all-cause mortality. While the association between short term exposure to PM2.5 and mortality was higher among Medicare enrollees that had a previous admission for diabetes and neurological disorders than among Medicare enrollees that did not had a prior admission for these diseases, the effect modification was not statistically significant. We believe that these results provide useful insights regarding the mechanisms by which particles may affect the brain. A better understanding of the mechanisms will enable the development of new strategies to protect individuals at risk and to reduce detrimental effects of air pollution on the nervous system.

Figure 1

Map of the US with the location of the 121 communities; the symbol size represent the population in each community, while the color represent the average PM _2.5 in the community.

Figure 2

Percent increase in total mortality for 10 μg/m³ increase in the two days average PM_2.5 for all Medicare deaths and separately by specific previous cause of admission and by demographics characteristics. The results are combined across the 121 communities.

Figure 3

Percent increase in cause specific primary emergency hospital admissions for 10 μg/m³ increase in the two days average PM_2.5 separately by specific cause of admission and by demographics characteristics. The results are combined across the 121 communities.

Figure 4

Percent increase in cause specific primary emergency hospital admissions for 10 μg/m³ increase in PM_2.5 for lags 0, 1, 2 and moving average from 2 days (01) up to 6 days (05). The results are combined across the 121 communities.