Associations between air pollution and mental health service use in dementia: a retrospective cohort study

Abstract

BackgroundLittle is known about the role of air pollution in how people with dementia use mental health services.ObjectiveWe examined longitudinal associations between air pollution exposure and mental health service use in people with dementia.MethodsIn 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models.FindingsIn the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2levels were linked with poor functional status, but not cognitive function.ConclusionsResidential air pollution exposure is associated with increased CMHT usage among people with dementia.Clinical implicationsEfforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.