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. 2025 Jul 1:984:179745.
doi: 10.1016/j.scitotenv.2025.179745. Epub 2025 May 26.

Non-traditional socio-environmental and geospatial determinants of Alzheimer's disease-related dementia mortality

Skanda Moorthy  1 , Jean-Eudes Dazard  2 , Zhuo Chen  2 , Ruby Charak  3 , Shruthika Palanivel  2 , Salil Deo  4 , Sadeer G Al-Kindi  5 , Sanjay Rajagopalan  6
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Free article

Non-traditional socio-environmental and geospatial determinants of Alzheimer's disease-related dementia mortality

Skanda Moorthy et al. Sci Total Environ. .
Free article

Abstract

Importance: Recent data point to the impact of non-traditional environmental and social factors on Alzheimer's Disease-Related Dementias (ADRD) mortality. Our study aimed to determine the extent to which antecedent air pollution, social vulnerability, and geospatial features in the environment associate with ADRD mortality.

Design: This was a cross-sectional study conducted across the mainland United States. County level Social Vulnerability Index (SVI), particulate matter air pollution (PM2.5) were linked to ADRD mortality. Patient Rule Induction Method (PRIM) was used for delineating and characterizing "bumps" or spikes in mortality. SHapley Additive exPlanations (SHAP) values were used to rank variables by predictivity and association with directional changes in ADRD mortality.

Exposures: PM2.5 data was acquired from 1 × 1 km spatial grids using aerosol optical depth from the Atmospheric Analysis Composition Group at Washington University St. Louis. SVI was acquired from the CDC's ATSDR Data, which is a composite index scale that characterizes socio-environmental vulnerability. Google Street View imagery coupled with deep learning computational techniques was used to extract features of neighborhood level environment characteristics from across the United States.

Results: There was a significant interaction effect between PM2.5 and SVI on ADRD mortality (β = 31.100, p < 0.001). Two clusters of elevated ADRD mortality were identified: counties with high PM2.5 and SVI (HH) and with low PM2.5 and SVI (LL). Analysis of LL subset revealed associations between ADRD mortality and specific SVI subdomains, as well as built environment variables. Geospatial mapping indicated a split in these clusters along northern and southern latitudes, with differences in temperature and sunlight intensity (p < 0.001) rather than urbanization driving the distribution.

Conclusions: Ambient air pollution interacts with SVI to influence ADRD mortality rates. Our findings support a role for non-traditional factors including elements of the built environment, geographical location, and natural environmental exposures contributing to ADRD mortality.

Keywords: Air pollution; Alzheimer's disease; Built environment; Social vulnerability.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sanjay Rajagopalan reports financial support was provided by National Institute of Environmental Health Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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