{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:51:17Z","timestamp":1790495477766,"version":"4.1.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000008","name":"Health Canada","doi-asserted-by":"publisher","award":["MOA-4500314182"],"award-info":[{"award-number":["MOA-4500314182"]}],"id":[{"id":"10.13039\/501100000008","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Public Health Ontario"},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000226","name":"MOHLTC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Alzheimer\u2019s Disease Resource Center"},{"DOI":"10.13039\/100007911","name":"University of California San Diego","doi-asserted-by":"crossref","award":["P30AG059299"],"award-info":[{"award-number":["P30AG059299"]}],"id":[{"id":"10.13039\/100007911","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence suggests a link between air pollution and dementia. Cardiovascular disease (CVD) may be a potential determinant of dementia. This motivated us to quantify the contribution of CVD to the association between air pollution and dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort of Canadian-born residents of Ontario, who participated in the 1996\u20132003 Canadian Community Health Surveys, was followed through 2013 or until dementia diagnosis. Exposure to nitrogen dioxide (NO2) and fine particulate matter (PM2.5) was estimated with a 3-year average and 5-year lag before dementia diagnosis. Incident CVD was evaluated as a mediator. We used multi-level Cox proportional and Aalen additive hazard regression models, adjusting for individual- and neighbourhood-level risk factors to estimate associations with NO2 and PM2.5. We estimated the total, direct and indirect effects of air pollution on dementia through cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 34 391 older adults. At baseline, the mean age of this cohort was 59\u2009years. The risk of dementia was moderately higher among those more exposed to NO2 (hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.99\u20131.19; and 100 additional cases per 100\u00a0000 [standard error (SE) &amp;lt;100x10-5]) and PM2.5 [(HR 1.29, 95% CI 0.99\u20131.64; 200 additional cases per 100\u00a0000] [SE 100x10-5]) after adjusting for covariates; however, these estimates are imprecise. A greater proportion of the relationship between PM2.5 and dementia was mediated through CVD than NO2 for both scales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results suggest some of the association between air pollution and dementia is mediated through CVD, indicating that improving cardiovascular health may prevent dementia in areas with higher exposure to air pollution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyz154","type":"journal-article","created":{"date-parts":[[2019,7,9]],"date-time":"2019-07-09T07:09:06Z","timestamp":1562656146000},"page":"36-44","source":"Crossref","is-referenced-by-count":68,"title":["The role of cardiovascular disease in the relationship between air pollution and incident dementia: a population-based cohort study"],"prefix":"10.1093","volume":"49","author":[{"given":"Sindana D","family":"Ilango","sequence":"first","affiliation":[{"name":"Graduate School of Public Health, San Diego State University, San Diego, CA, USA"},{"name":"Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Chen","sequence":"first","affiliation":[{"name":"Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada"},{"name":"Public Health Ontario, Toronto, ON, Canada"},{"name":"ICES, Toronto, ON, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perry","family":"Hystad","sequence":"first","affiliation":[{"name":"College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"van Donkelaar","sequence":"first","affiliation":[{"name":"Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C","family":"Kwong","sequence":"first","affiliation":[{"name":"Public Health Ontario, Toronto, ON, Canada"},{"name":"ICES, Toronto, ON, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada"},{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada"},{"name":"Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Tu","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada"},{"name":"Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall V","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada"},{"name":"Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Benmarhnia","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA"},{"name":"Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,25]]},"reference":[{"key":"2020040317153313500_dyz154-B1","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/S0140-6736(17)30505-6","article-title":"Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015","volume":"389","author":"Cohen","year":"2017","journal-title":"Lancet"},{"key":"2020040317153313500_dyz154-B2","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.envpol.2007.06.012","article-title":"Human health effects of air pollution","volume":"151","author":"Kampa","year":"2008","journal-title":"Environ Pollut"},{"key":"2020040317153313500_dyz154-B3","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.tins.2009.05.009","article-title":"Air pollution: mechanisms of neuroinflammation and CNS disease","volume":"32","author":"Block","year":"2009","journal-title":"Trends Neurosci"},{"key":"2020040317153313500_dyz154-B4","author":"Prince","year":"2013"},{"key":"2020040317153313500_dyz154-B5","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.neuro.2016.06.004","article-title":"Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research","volume":"56","author":"Power","year":"2016","journal-title":"Neurotoxicology"},{"key":"2020040317153313500_dyz154-B6","doi-asserted-by":"crossref","first-page":"e103078","DOI":"10.1371\/journal.pone.0103078","article-title":"Increased risk of dementia in patients exposed to nitrogen dioxide and carbon monoxide: a population-based retrospective cohort study","volume":"9","author":"Chang","year":"2014","journal-title":"PLoS One"},{"key":"2020040317153313500_dyz154-B7","first-page":"220","article-title":"Association between air pollutants and dementia risk in the elderly","volume":"1","author":"Wu","year":"2015","journal-title":"Alzheimer\u2019s Dement"},{"key":"2020040317153313500_dyz154-B8","doi-asserted-by":"crossref","first-page":"573","DOI":"10.3233\/JAD-140855","article-title":"Ozone, particulate matter, and newly diagnosed Alzheimer\u2019s disease: a population-based cohort study in Taiwan","volume":"44","author":"Jung","year":"2015","journal-title":"J Alzheimers Dis"},{"key":"2020040317153313500_dyz154-B9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1289\/ehp.1408973","article-title":"Long-term PM2.5exposure and neurological hospital admissions in the northeastern United States","volume":"124","author":"Kioumourtzoglou","year":"2016","journal-title":"Environ Health Perspect"},{"key":"2020040317153313500_dyz154-B10","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1289\/ehp.1408322","article-title":"Traffic-related air pollution and dementia incidence in Northern Sweden: a longitudinal study","volume":"124","author":"Oudin","year":"2016","journal-title":"Environ Health Perspect"},{"key":"2020040317153313500_dyz154-B11","doi-asserted-by":"crossref","first-page":"e1022","DOI":"10.1038\/tp.2016.280","article-title":"Particulate air pollutants, APOE alleles and their contributions to cognitive impairment in older women and to amyloidogenesis in experimental models","volume":"7","author":"Cacciottolo","year":"2017","journal-title":"Transl Psychiatry"},{"key":"2020040317153313500_dyz154-B12","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.envint.2017.08.020","article-title":"Exposure to ambient air pollution and the incidence of dementia: a population-based cohort study","volume":"108","author":"Chen","year":"2017","journal-title":"Environ Int"},{"key":"2020040317153313500_dyz154-B13","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/S0140-6736(16)32399-6","article-title":"Living near major roads and the incidence of dementia, Parkinson\u2019s disease, and multiple sclerosis: a population-based cohort study","volume":"389","author":"Chen","year":"2017","journal-title":"Lancet"},{"key":"2020040317153313500_dyz154-B14","doi-asserted-by":"crossref","first-page":"e022404.","DOI":"10.1136\/bmjopen-2018-022404","article-title":"Are noise and air pollution related to the incidence of dementia? A cohort study in London, England","volume":"8","author":"Carey","year":"2018","journal-title":"BMJ Open"},{"key":"2020040317153313500_dyz154-B15","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/geronb\/gbu064","article-title":"Fine particulate matter air pollution and cognitive function among U.S. older adults","volume":"70","author":"Ailshire","year":"2015","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"2020040317153313500_dyz154-B16","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1093\/aje\/kwu155","article-title":"Fine particulate matter air pollution and cognitive function among older US adults","volume":"180","author":"Ailshire","year":"2014","journal-title":"Am J Epidemiol"},{"key":"2020040317153313500_dyz154-B17","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1001\/archinternmed.2011.683","article-title":"Exposure to particulate air pollution and cognitive decline in older women","volume":"172","author":"Weuve","year":"2012","journal-title":"Arch Intern Med"},{"key":"2020040317153313500_dyz154-B18","doi-asserted-by":"crossref","first-page":"1361.","DOI":"10.1289\/ehp.1509824","article-title":"Long-term air pollution and traffic noise exposures and mild cognitive impairment in older adults: a cross-sectional analysis of the Heinz Nixdorf recall study","volume":"124","author":"Tzivian","year":"2016","journal-title":"Environ Health Perspect"},{"key":"2020040317153313500_dyz154-B19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.neuro.2013.09.004","article-title":"Components of air pollution and cognitive function in middle-aged and older adults in Los Angeles","volume":"40","author":"Gatto","year":"2014","journal-title":"Neurotoxicology"},{"key":"2020040317153313500_dyz154-B20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-018-30568-6","article-title":"Cross-sectional and longitudinal analyses of outdoor air pollution exposure and cognitive function in UK Biobank","volume":"8","author":"Cullen","year":"2018","journal-title":"Sci Rep"},{"key":"2020040317153313500_dyz154-B21","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s40572-017-0142-3","article-title":"Outdoor ambient air pollution and neurodegenerative diseases: the neuroinflammation hypothesis","volume":"4","author":"Jayaraj","year":"2017","journal-title":"Curr Environ Health Rep"},{"key":"2020040317153313500_dyz154-B22","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1093\/aje\/kwu153","article-title":"Invited commentary: how exposure to air pollution may shape dementia risk, and what epidemiology can say about it","volume":"180","author":"Weuve","year":"2014","journal-title":"Am J Epidemiol"},{"key":"2020040317153313500_dyz154-B23","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1161\/CIR.0b013e3181dbece1","article-title":"Particulate matter air pollution and cardiovascular disease","volume":"121","author":"Brook","year":"2010","journal-title":"Circulation"},{"key":"2020040317153313500_dyz154-B24","doi-asserted-by":"crossref","first-page":"43.","DOI":"10.1186\/1476-069X-12-43","article-title":"Long-term air pollution exposure and cardio- respiratory mortality: a review","volume":"12","author":"Hoek","year":"2013","journal-title":"Environ Health"},{"key":"2020040317153313500_dyz154-B25","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.ejim.2013.04.001","article-title":"Air particulate matter and cardiovascular disease: A narrative review","volume":"24","author":"Martinelli","year":"2013","journal-title":"Eur J Intern Med"},{"key":"2020040317153313500_dyz154-B26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/01.CIR.0000108927.80044.7F","article-title":"Cardiovascular mortality and long-term exposure to particulate air pollution","volume":"109","author":"Pope","year":"2004","journal-title":"Circulation"},{"key":"2020040317153313500_dyz154-B27","first-page":"367","article-title":"Alzheimer\u2019s disease facts and figures includes a special report on the financial and personal benefits of early diagnosis","volume":"14","year":"2018","journal-title":"Alzheimers Dement"},{"key":"2020040317153313500_dyz154-B28","doi-asserted-by":"crossref","first-page":"e114431","DOI":"10.1371\/journal.pone.0114431","article-title":"Cardiovascular disease risk models and longitudinal changes in cognition: a systematic review","volume":"9","author":"Harrison","year":"2014","journal-title":"PLoS One"},{"key":"2020040317153313500_dyz154-B29","author":"Thomas Scheike","year":"2019"},{"key":"2020040317153313500_dyz154-B30","first-page":"9","article-title":"Canadian community health survey - methodological overview","volume":"13","author":"B\u00e9land","year":"2002","journal-title":"Health Rep"},{"key":"2020040317153313500_dyz154-B31","first-page":"337","article-title":"Identification of physician-diagnosed Alzheimer\u2019s disease and related dementias in population-based administrative data: a validation study using family physicians\u2019 electronic medical records","volume":"54","author":"Liisa Jaakkimainen","year":"2016","journal-title":"J Affect Disord"},{"key":"2020040317153313500_dyz154-B32","doi-asserted-by":"crossref","first-page":"E765","DOI":"10.1503\/cmaj.111958","article-title":"Trends in the incidence and outcomes of heart failure in Ontario, Canada: 1997 to 2007","volume":"184","author":"Yeung","year":"2012","journal-title":"CMAJ"},{"key":"2020040317153313500_dyz154-B33","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1146\/annurev-publhealth-032315-021402","article-title":"Mediation analysis: a practitioner\u2019s guide","volume":"37","author":"VanderWeele","year":"2016","journal-title":"Annu Rev Public Health"},{"key":"2020040317153313500_dyz154-B34","volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","author":"VanderWeele","year":"2015"},{"key":"2020040317153313500_dyz154-B35","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/EDE.0b013e31821c680c","article-title":"Direct and indirect effects in a survival context","volume":"22","author":"Lange","year":"2011","journal-title":"Epidemiology"},{"key":"2020040317153313500_dyz154-B36","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4615-7397-5_1","volume-title":"A Model for Nonparametric Regression Analysis of Counting Processes","author":"Aalen","year":"1980"},{"key":"2020040317153313500_dyz154-B37","author":"Therneau","year":"2018"},{"key":"2020040317153313500_dyz154-B38","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.envres.2016.01.018","article-title":"Exposure to air pollution and cognitive functioning across the life course: a systematic literature review","volume":"147","author":"Clifford","year":"2016","journal-title":"Environ Res"}],"container-title":["International Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ije\/article-pdf\/49\/1\/36\/32995627\/dyz154.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ije\/article-pdf\/49\/1\/36\/32995627\/dyz154.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T17:24:21Z","timestamp":1585934661000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ije\/article\/49\/1\/36\/5538733"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,25]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,7,25]]},"published-print":{"date-parts":[[2020,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ije\/dyz154","relation":{},"ISSN":["0300-5771","1464-3685"],"issn-type":[{"value":"0300-5771","type":"print"},{"value":"1464-3685","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,2]]},"published":{"date-parts":[[2019,7,25]]}}}