Air Pollution, Climate Conditions and Risk of Hospital Admissions for Psychotic Disorders in U.S. Residents

• Authors: Liuhua Shi, Emory University; Xinye Qiu, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Yaguang Wei, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Marc Weisskopf, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Avron Spiro, Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Liuhua Shi, Emory University, Atlanta, GA, USA; Edgar Castro, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Brent Coull, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Petros Koutrakis, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Joel Schwartz, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
• Journal Title: ENVIRONMENTAL RESEARCH
• Volume: Volume 216, Number Pt 2
• Publisher: Elsevier | 2023-01-01
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.envres.2022.114636
• Subjects: Health Sciences, Epidemiology; Environmental Sciences; Health Sciences, Medicine and Surgery
• Keywords: air pollution; temperature; precipitation; psychosis

Abstract

Background: The physical environmental risk factors for psychotic disorders are poorly understood. This study aimed to examine the associations between exposure to ambient air pollution, climate measures and risk of hospitalization for psychotic disorders and uncover potential disparities by demographic, community factors. Methods: Using Health Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs), we applied zero-inflated negative binomial regression to obtain relative risks of hospitalization due to psychotic disorders associated with increases in residential exposure to ambient air pollution (fine particulate matter, PM2.5; nitrogen dioxide, NO2), temperature and cumulative precipitation. The analysis covered all-age residents in eight U.S. states over the period of 2002 – 2016. We additionally investigated modification by age, sex and area-level poverty, percent of blacks and Hispanics. Results: Over the study period and among the covered areas, we identified 1,211,100 admissions due to psychotic disorders. For each interquartile (IQR) increase in exposure to PM2.5 and NO2, we observed a relative risk (RR) of 1.11 (95% confidence interval (CI) = 1.09, 1.13) and 1.27 (95% CI = 1.24, 1.31), respectively. For each 1 °C increase of temperature, the RR was 1.03 (95% CI = 1.03, 1.04). Males were more affected by NO2. Older age residents (>= 30 yrs.) were more sensitive to PM2.5 and temperature. Population living in economically disadvantaged areas were more affected by air pollution. Conclusions: The study suggests that living in areas with higher levels of air pollutants and ambient temperature could contribute to additional risk of inpatient care for individuals with psychotic disorders.