細懸浮微粒與失智症和帕金森氏症惡化之相關性－以嘉義地區為例

Effects of ambient fine particulate matter on the exacerbation of dementia and Parkinson's disease in Chiayi City

10.6288/TJPH.202310_42(5).112078

黃淑倫(Su-Lun Hwang)；林裕清(Yu-Ching Lin)；林玠模(Chieh-Mo Lin)；紀妙青(Miao-Ching Chi)

細懸浮微粒 ； 帕金森氏症 ； 急診就醫 ； 都市化 ； fine particulate matter ； Parkinson's disease ； emergency department visits ； urbanization

台灣公共衛生雜誌

42卷5期（2023 / 10 / 30）

554 - 563

繁體中文;英文

目標：本研究探討大氣細懸浮微粒（fine particulate matter, PM_(2.5)）短期暴露對失智症與帕金森氏症（Parkinson's disease, PD）惡化影響。方法：分析「長庚醫學研究資料庫」選取嘉義縣市失智症與PD急診就醫個案（2015-2019年），連結環保署空品測站資料。以時間分層病例交叉研究法探討大氣PM_(2.5)對失智症與PD惡化影響。結果：PM_(2.5)每增加10 mg/m^3，PD急診就醫風險增加39%（Lag0），且呈現累積效應（Lag0-1至Lag0-3的勝算比[Odds ratio, OR]分別為1.29、1.31、1.36）。女性，PD急診就醫風險增加53%（Lag0），且呈現延遲（Lag1，OR = 1.31）與累積效應（Lag0-1至Lag0-5，OR分別為1.45、1.51、1.61、1.58、1.60）。特定鄉鎮（高齡化、農業與偏遠），PD急診就醫風險增加46% （Lag0）；一般鄉鎮，PD急診就醫風險則呈現延遲（Lag2，OR = 1.49）與累積效應（Lag0-2與Lag0-3，OR分別為1.63、1.90）。急診就醫年齡（> 75歲），PD急診就醫風險增加32% （Lag0）；≤75歲，PD急診就醫風險呈現累積效應（Lag0-3至Lag0-5，OR分別為2.13、2.28、2.40）。失智症則無顯著增加現象。結論：大氣PM_(2.5)短期暴露可能提高PD急診就醫風險。

Objectives: This study investigated the effects of short-term exposure to ambient fine particulate matter (PM_(2.5)) on the worsening of dementia and Parkinson's disease (PD). Methods: Data regarding emergency department visits (EDVs) for dementia and PD and air pollutant levels in Chiayi City from 2015 to 2019 were obtained from the Chang Gung Research Database and Taiwan's Environmental Protection Administration, respectively. A time-stratified case-crossover design was adopted to estimate the risks of EDVs for dementia and PD patients associated with short-term exposure to PM_(2.5). Results: Increased exposure to PM_(2.5) was associated with a 39% increase in EDVs for PD patients following a 10 mg/m^3 increase at Lag 0. Moreover, cumulative effects were observed, with odds ratios (ORs) of 1.29, 1.31, and 1.36 for Lag 0-1 to Lag 0-3, respectively. Among women, PD-related EDVs increased by 53% at Lag 0, and delayed and cumulative effects were evident, with ORs of 1.31, 1.45, 1.51, 1.61, 1.58, and 1.60 for Lag 1, Lag 0-1 to Lag 0-5, respectively. In specific towns (aged, agricultural, and rural), a 46% increase in EDVs was noted for PD at Lag 0. In general towns, PM_(2.5) exhibited delayed and cumulative effects, with ORs of 1.49, 1.63, and 1.90 for Lag 2, Lag 0-2 to Lag 0-3, respectively. Among individuals aged ≥75 years, PM_(2.5) had cumulative effects, with ORs of 2.13, 2.28, and 2.40 for Lag 0-3 to Lag 0-5, respectively. However, no significant association was observed between PM_(2.5) exposure and an increase in EDVs for dementia patients. Conclusions: Short-term PM_(2.5) exposure increased the risk of PD exacerbation and demonstrated delayed effects.

1. Benner, M,Steiner, V,Pierce, LL(2018).Family caregivers’reports of hospitalizations and emergency department visits in community-dwelling individuals with dementia.Dementia,17,585-595.
2. Breckenridge, CB,Berry, C,Chang, ET,Sielken, RL., Jr.,Mandel, JS(2016).Association between Parkinson’s disease and cigarette smoking, rural living, well-water consumption, farming and pesticide use: systematic review and meta-analysis.PLoS One,11,e0151841.
3. Chen, C,Li, H,Niu, Y(2019).Impact of short-term exposure to fine particulate matter air pollution on urinary metabolome: a randomized, double-blind, crossover trial.Environ Int,130,104878.
4. Fu, P,Guo, X,Cheung, FMH,Yung, KKL(2019).The association between PM2.5 exposure and neurological disorders: a systematic review and meta-analysis.Sci Total Environ,655,1240-1248.
5. Janes, H,Sheppard, L,Lumley, T(2005).Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias.Epidemiology,16,717-726.
6. Kasdagli, MI,Franco, P,Gordo, C,Marques da Costa, E,Lopes, A(2023).Marques da Costa E, Lopes A. Short-term exposure to particulate matter and effects on emergency hospital admissions for Alzheimer’s disease and Parkinson’s disease: an ecological study from an aged European metropolis.Air Qual Atmosphere Health,16,1619-1631.
7. Katsouyanni, K,Dimakopoulou, K,Samoli, E(2019).Air pollution and Parkinson’s disease: a systematic review and meta-analysis up to 2018.Int J Hyg Environ Health,222,402-409.
8. Kioumourtzoglou, MA,Spiegelman, D,Szpiro, AA(2014).Exposure measurement error in PM2.5 health effects studies: a pooled analysis of eight personal exposure validation studies.Environ Health,13,2.
9. Lee, H,Myung, W,Kim, DK,Kim, CT,Kim, H(2017).Short-term air pollution exposure aggravates Parkinson’s disease in a population-based cohort.Sci Rep,7,44741.
10. Lee, M,Schwartz, J,Wang, Y,Dominici, F(2019).Long-term effect of fine particulate matter on hospitalization with dementia.Environ Pollut,254,112926.
11. Mielke, MM,Vemuri, P,Rocca, WA(2014).Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences.Clin Epidemiol,6,37-48.
12. Nilsen, J,Chen, S,Irwin, RW,Iwamoto, S,Brinton, RD(2006).Estrogen protects neuronal cells from amyloid betainduced apoptosis via regulation of mitochondrial proteins and function.BMC Neurosci,7,74.
13. Oudin, A,Segersson, D,Adolfsson, R,Forsberg, B(2018).Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden.PLoS One,13,e0198283.
14. Patel, R,Kompoliti, K(2023).Sex and gender differences in Parkinson’s disease.Neurol Clin,41,371-379.
15. Pun, VC,Kazemiparkouhi, F,Manjourides, J,Suh, HH(2017).Long-term PM2.5 exposure and respiratory, cancer, and cardiovascular mortality in older US adults.Am J Epidemiol,186,961-969.
16. Shephard, F,Greville-Heygate, O,Liddell, S,Emes, R,Chakrabarti, L(2016).Analysis of Mitochondrial haemoglobin in Parkinson ’s diseasebrain.Mitochondrion,29,45-52.
17. Tsai, TL,Lin, YT,Hwang, BF(2019).Fine particulate matter is a potential determinant of Alzheimer’s disease: a systemic review and meta-analysis.Environ Res,177,108638.
18. Vines, SK,Farrington, CP(2001).Within-subject exposure dependency in case-crossover studies.Stat Med,20,3039-3049.
19. Wang, BR,Shi, JQ,Ge, NN(2018).PM2.5 exposure aggravates oligomeric amyloid beta-induced neuronal injury and promotes NLRP3 inflammasome activation in an in vitro model of Alzheimer’s disease.J Neuroinflammation,15,132.
20. Wang, Q,Santizo, R,Baughman, VL,Pelligrino, DA,Iadecola, C(1999).Estrogen provides neuroprotection in transient forebrain ischemia through perfusion independent mechanisms in rats.Stroke,30,630-637.
21. Wang, Y,Li, C,Zhang, X(2021).Exposure to PM2.5aggravates Parkinson’s disease via inhibition of autophagy and mitophagy pathway.Toxicology,456,152770.
22. Wirdefeldt, K,Adami, HO,Cole, P,Trichopoulos, D,Mandel, J(2011).Epidemiology and etiology of Parkinson’s disease: a review of the evidence.Eur J Epidemiol,26 Suppl,S1-S58.
23. Yan, YH,Chen, TB,Yang, CP(2022).Long-term exposure to particulate matter was associated with increased dementia risk using both traditional approaches and novel machine learning methods.Sci Rep,12,17130.
24. Yitshak-Sade, M,Nethery, R,Schwartz, JD(2021).PM2.5 and hospital admissions among Medicare enrollees with chronic debilitating brain disorders.Sci Total Environ,755,142524.
25. Zanobetti, A,Dominici, F,Wang, Y,Schwartz, JD(2014).A national case-crossover analysis of the short-term effect of PM2.5 on hospitalizations and mortality in subjects with diabetes and neurological disorders.Environ Health,13,38.
26. Zhang, H,Shi, L,Ebelt, ST(2023).Short-term associations between ambient air pollution and emergency department visits for Alzheimer’s disease and related dementias.Environ Epidemiol,7,e237.
27. 台灣失智症協會：認識失智症。http://www.tada2002.org.tw/About/IsntDementia。引用2023/06/26。Taiwan Alzheimer Disease Association. Understanding dementia. Available at: http://www.tada2002.org.tw/About/IsntDementia. Accessed June 26, 2023. [In Chinese]
28. 劉介宇, CY,洪永泰, YT,莊義利, YL(2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊，4，1-22。
29. 衛生福利部：111年國人死因統計結果。https://dep.mohw.gov.tw/dos/lp-5069-113-xCat-y111.html。引用2023/06/26。Ministry of Health and Welfare, R.O.C. (Taiwan). 2022 cause of death statistics. Available at: https://dep.mohw.gov.tw/dos/lp-5069-113-xCat-y111.html. Accessed June 26, 2023. [In Chinese]