{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:38:40Z","timestamp":1786977520616,"version":"build-2736575974"},"reference-count":62,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The escalating burden of gastrointestinal (GI) and liver diseases poses a critical public health challenge, with emerging evidence implicating air pollution as a modifiable risk factor. However, the mechanistic pathways, particularly the mediating role of depression in the pollution\u2010disease nexus, remain underexplored. This study investigates the longitudinal associations between ambient air pollution exposure and GI\/liver diseases in a nationwide cohort, with a focus on quantifying depression's mediating effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS, 2011\u20132020;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918,755), we evaluated the impact of long\u2010term exposure to PM\n                      <jats:sub>1<\/jats:sub>\n                      , PM\n                      <jats:sub>2.5<\/jats:sub>\n                      , PM\n                      <jats:sub>10<\/jats:sub>\n                      , SO\n                      <jats:sub>2<\/jats:sub>\n                      , CO, NO\n                      <jats:sub>2<\/jats:sub>\n                      , and O\n                      <jats:sub>3<\/jats:sub>\n                      on incident GI\/liver diseases. Multivariable\u2010adjusted Cox proportional hazards models incorporated demographic, socioeconomic (region, education, retirement status), and lifestyle (smoking, drinking) covariates. Mediation analysis assessed the proportion of total effects mediated by depression (CESD\u201010 scores).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Chronic exposure to PM\n                      <jats:sub>1<\/jats:sub>\n                      (HR\u2009=\u20091.33, 95% CI: 1.30\u20131.37), PM\n                      <jats:sub>2.5<\/jats:sub>\n                      (HR\u2009=\u20091.30, 1.26\u20131.33), PM\n                      <jats:sub>10<\/jats:sub>\n                      (HR\u2009=\u20091.29, 1.25\u20131.32), SO\n                      <jats:sub>2<\/jats:sub>\n                      (HR\u2009=\u20091.64, 1.60\u20131.69), CO (HR\u2009=\u20091.47, 1.43\u20131.51), and NO\n                      <jats:sub>2<\/jats:sub>\n                      (HR\u2009=\u20091.27, 1.23\u20131.30) per interquartile range increase was significantly associated with elevated disease risk, whereas O\n                      <jats:sub>3<\/jats:sub>\n                      exhibited protective effects (HR\u2009=\u20090.77, 0.74\u20130.79). Depression mediated 4.0%\u201311.3% of pollution effects, with the highest mediation observed for O\n                      <jats:sub>3<\/jats:sub>\n                      (11.3%) and lowest for SO\n                      <jats:sub>2<\/jats:sub>\n                      (4.0%). Stratified analyses revealed heightened vulnerability in rural residents, individuals with lower education, and Northeastern populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study pioneers the identification of depression as a mediator linking air pollution to GI\/liver diseases in a nationally representative cohort. The findings advocate for integrative policies targeting air quality improvement and mental health interventions to alleviate the dual burden of environmental and psychological morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.70878","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T05:29:54Z","timestamp":1776403794000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Depression Mediates the Association Between Ambient Air Pollution and Gastrointestinal\/Liver Diseases: A Prospective Cohort Study"],"prefix":"10.1002","volume":"32","author":[{"given":"Yanqi","family":"Kou","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Affiliated Hospital of Guangdong Medical University, Guangdong Medical University  Zhanjiang Guangdong 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