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Author Notes:

H.H. Chang, 1518 Clifton Rd., NE, Atlanta, GA 30322. E-mail: howard.chang@emory.edu

The data used to produce this publication were acquired from the: California Office of Statewide Health Planning and Development (years 2005–2016); the Missouri Department of Health and Senior Services (years 2005–2018); the North Carolina Hospital (inpatient, ambulatory surgery/outpatient, emergency room) Discharge Database (Truven Health Analytics, years 2011–2017) from the Cecil G. Sheps Center for Health Services Research and the North Carolina Division of Health Service Regulation; the Center for Health Statistics & Informatics of the New Jersey Department of Health, Trenton, NJ (years 2005–2016); and the Statewide Planning and Research Cooperative System of the New York State Department of Health (years 2005–2016). The contents of this publication including data analysis, interpretation, conclusions derived, and the views expressed herein are solely those of the authors and do not represent the conclusions or official views of data sources listed above. The data sources, their employees, officers, and agents make no representation, warranty or guarantee as to the accuracy, completeness, currency, or suitability of the information provided here.

The authors declare that they have no conflicts of interest with regard to the content of this report.



  • Air pollution
  • Alzheimer’s disease
  • Dementia
  • Emergency department visits
  • Health effect
  • Hospitalization

Short-term associations between ambient air pollution and emergency department visits for Alzheimer's disease and related dementias


Journal Title:

Environmental Epidemiology


Volume 7, Number 1


, Pages e237-e237

Type of Work:

Article | Final Publisher PDF


Background: Dementia is a seriously disabling illness with substantial economic and social burdens. Alzheimer's disease and its related dementias (AD/ADRD) constitute about two-thirds of dementias. AD/ADRD patients have a high prevalence of comorbid conditions that are known to be exacerbated by exposure to ambient air pollution. Existing studies mostly focused on the long-term association between air pollution and AD/ADRD morbidity, while very few have investigated short-term associations. This study aims to estimate short-term associations between AD/ADRD emergency department (ED) visits and three common air pollutants: fine particulate matter (PM2.5), nitrogen dioxide (NO2), and warm-season ozone. Methods: For the period 2005 to 2015, we analyzed over 7.5 million AD/ADRD ED visits in five US states (California, Missouri, North Carolina, New Jersey, and New York) using a time-stratified case-crossover design with conditional logistic regression. Daily estimated PM2.5, NO2,and warm-season ozone concentrations at 1 km spatial resolution were aggregated to the ZIP code level as exposure. Results: The most consistent positive association was found for NO2. Across five states, a 17.1 ppb increase in NO2concentration over a 4-day period was associated with a 0.61% (95% confidence interval = 0.27%, 0.95%) increase in AD/ADRD ED visits. For PM2.5, a positive association with AD/ADRD ED visits was found only in New York (0.64%, 95% confidence interval = 0.26%, 1.01% per 6.3 µg/m3). Associations with warm-season ozone levels were null. Conclusions: Our results suggest AD/ADRD patients are vulnerable to short-term health effects of ambient air pollution and strategies to lower exposure may reduce morbidity.

Copyright information:

© 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.

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