Triggering of Neurodegenerative Hospital Admissions and Emergency Room Visits by Fine Particle Concentrations in Six Urban Centers in New York State: The New York State Accountability Study

Abstract

Emerging evidence has linked exposure to ambient fine particle (PM2.5) concentrations with an increased incidence of neurodegenerative conditions such as dementia, Alzheimer’s disease (AD), and Parkinson’s disease (PD). Previous studies have not examined the association between ambient PM2.5 concentrations and exacerbations of symptoms, which would further add to the public health burden of these chronic neurodegenerative conditions. Using the Statewide Planning and Research Cooperative System (SPARCS) database, we retrieved all hospital admissions (inpatient) and emergency room visits (outpatient) with a primary diagnosis of one of three neurodegenerative disease subtypes for NYS residents living within 15 miles from PM2.5 monitoring sites in Buffalo, Rochester, Albany, Queens, Bronx, and Manhattan from 2005-2016. Using quasi-Poisson regression models adjusting for temperature, relative humidity, and secular trends in hospitalization rates, we examined the association between daily inpatient and outpatient neurodegenerative hospitalizations and ambient PM2.5 concentrations estimated for short-term and long-term time windows: concurrent exposure as well as lagged by 14, 30, 180, and 365 days. A total of 63,287 inpatient admissions and 14,288 outpatient visits for the three neurodegenerative conditions occurred during the study period. Interquartile range (IQR) increases in PM2.5 concentration were not associated with increased rates of inpatient AD and dementia hospitalizations. However, increased rates of PD hospital admissions were associated with increased PM2.5 concentrations in the previous 14 days (rate ratio (RR) = 1.04; 95% confidence interval (CI) = 1.00-1.09), and 30 days (RR=1.06; 95% CI=1.00-1.12). For outpatient visits, an increased rate of AD was associated with increased PM2.5 in the past 365 days (RR=1.77; 95% CI = 1.03-3.03). Thus, ambient PM2.5 exposure may be associated with exacerbations of symptoms among patients with neurodegenerative disease.