Impact of air pollution exposure on the risk of Alzheimer's disease in China: A community-based cohort study

This is an accepted manuscript of an article published by Elsevier in Environmental Research on 03/11/2021, available online: https://doi.org/10.1016/j.envres.2021.112318 The accepted version of the publication may differ from the final published version.Alzheimer's disease (AD) is the most common type of dementia. Impact of air pollution (AP) on the risk of AD is unclear. It is unknown which air pollutants are independently associated with AD and whether fish consumption mitigated the association. We carried out a community-based cohort of 6115 participants aged ���60 years in China to examine the association of PM2.5, PM10, CO, NO2, SO2 and O3 exposure with AD, and differences in the association between people with low and high consumption of fish. The participants were randomly recruited from six counties in Zhejiang province for health survey to document socio-demographic and disease risk factors in 2014, and were followed up to diagnose AD in 2019. A total of 986 cohort members were diagnosed with AD. Based on the daily mean air pollutants monitored in 2013���2015 in the counties, participants were divided into low, middle and high AP exposure groups for subsequent analysis. The multiple adjusted odds ratio (OR) of AD in participants living with the middle and high levels of PM2.5 exposure versus the low exposure were 1.50 (95% CI 0.90���2.50) and 3.92 (2.09���7.37). The increased ORs were also with PM10 (1.74, 0.65���4.64; 3.00, 1.22���7.41) and CO (2.86, 1.32���6.20; 1.19, 0.45���3.18), but not with NO2 (0.63, 0.17���2.27; 0.95, 0.28���3.19), SO2 (0.44, 0.19���1.001; 1.21, 0.56���2.62), and O3 (0.38, 0.20���0.74; 0.50, 0.21���1.21). There were no significant interaction effects of AP with fish consumption on AD. However, participants with low consumption of fish appeared to have higher ORs in PM2.5 exposure (1.80, 1.39���2.33; 5.18, 3.93���6.82) than those high consumption (1.38, 0.78���2.47; 2.89, 1.50���5.59). Our findings of PM2.5, PM10 and CO exposure significantly increased the risk of AD and the potential mitigating effect of fish consumption on the association provide evidence for developing effective strategies for AD reduction and air pollution control.This work was supported by EU MSCA fellowship grant (DEMAIRPO #799247) from European Commission Horizon 2020 Framework Programme through the University of Wolverhampton. The ZJMPHS cohort study was funded by Zhejiang Provincial Public Welfare Technology Application Research Projects of China (LGF19H260003, LGF21H260002) to Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.Published versio