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Background:

Adult-onset neurodegenerative diseases affect millions and negatively impact health care systems worldwide. Evidence suggests that air pollution may contribute to aggravation of neurodegeneration, but studies have been limited.

Objective:

We examined the potential association between long-term exposure to particulate matter $\le 2.5\mathrm{\mu }\mathrm{m}$ in aerodynamic diameter [fine particulate matter (${\mathrm{PM}}_{2.5}$)] and disease aggravation in Alzheimer’s (AD) and Parkinson’s (PD) diseases and amyotrophic lateral sclerosis (ALS), using first hospitalization as a surrogate of clinical aggravation.

Methods:

We used data from the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS 2000–2014) to construct annual county counts of first hospitalizations with a diagnosis of AD, PD, or ALS (total, urbanicity-, sex-, and age-stratified). We used annual ${\mathrm{PM}}_{2.5}$ concentrations estimated by a prediction model at a $1{\text{-km}}^2$ resolution, which we aggregated to population-weighted county averages to assign exposure to cases based on county of residence. We used outcome-specific mixed quasi-Poisson models with county-specific random intercepts to estimate rate ratios (RRs) for a 1-y ${\mathrm{PM}}_{2.5}$ exposure. We allowed for nonlinear exposure–outcome relationships using penalized splines and accounted for potential confounders.

Results:

We found a positive nonlinear ${\mathrm{PM}}_{2.5}–\text{PD}$ association that plateaued above $11{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$ ($\text{RR}=1.09$, 95% CI: 1.04, 1.14 for a ${\mathrm{PM}}_{2.5}$ increase from 8.1 to $10.4{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$). We also found a linear ${\mathrm{PM}}_{2.5}–\text{ALS}$ positive association ($\text{RR}=1.05$, 95% CI: 1.01, 1.09 per $1\text{-}{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$${\mathrm{PM}}_{2.5}$ increase), and suggestive evidence of an association with AD. We found effect modification by age for PD and ALS with a stronger positive association in patients $<70\text{\hspace{0.17em}years}$ of age but found insufficient evidence of effect modification by sex or urbanization level for any of the outcomes.

Conclusion:

Our findings suggest that annual increase in county-level ${\mathrm{PM}}_{2.5}$ concentrations may contribute to clinical aggravation of PD and ALS. Importantly, the average annual ${\mathrm{PM}}_{2.5}$ concentration in our study was $8.1{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$, below the current American national standards, suggesting the standards may not adequately protect the aging population. https://doi.org/10.1289/EHP7425