{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:51:20Z","timestamp":1793908280015,"version":"4.8.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AG074357"],"award-info":[{"award-number":["R01 AG074357"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["R01 ES034175"],"award-info":[{"award-number":["R01 ES034175"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Air pollution and several common comorbidities\u2014such as hypertension, stroke, and depression\u2014are established risk factors for Alzheimer\u2019s disease (AD). However, whether these comorbidities mediate or amplify the effects of fine particulate matter (PM\n                      <jats:sub>2.5<\/jats:sub>\n                      ) on AD remains unclear. We aimed to investigate whether these conditions modify or mediate the association between PM\n                      <jats:sub>2.5<\/jats:sub>\n                      exposure and incident AD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We conducted a nationwide cohort study including 27.8 million US Medicare beneficiaries aged 65 years and older from 2000 to 2018. Exposure to PM\n                      <jats:sub>2.5<\/jats:sub>\n                      was assessed using high-resolution air pollution datasets. Cox proportional hazards models were applied to estimate the associations between exposure to PM\n                      <jats:sub>2.5<\/jats:sub>\n                      , incident AD, and comorbidities. The potential for comorbidities to modify and mediate the association between PM\n                      <jats:sub>2.5<\/jats:sub>\n                      and AD was evaluated by stratified analyses and mediation analysis. We identified approximately 3.0 million incident AD cases. PM\n                      <jats:sub>2.5<\/jats:sub>\n                      exposure (5-year moving average prior to AD onset) was associated with increased risk of AD in the overall population (hazard ratio [HR]) per interquartile range [IQR, 3.8 \u00b5g\/m\n                      <jats:sup>3<\/jats:sup>\n                      ] increase: 1.085 (95% CI: 1.078, 1.091]. This association was slightly stronger in individuals with stroke (HR per IQR increase: 1.105; 95% CI: 1.096, 1.114), but there was little effect modification for hypertension and depression. PM\n                      <jats:sub>2.5<\/jats:sub>\n                      exposure was also significantly associated with higher risks of hypertension, depression, and stroke, all of which were also linked to increased AD risk. However, mediation effects were minimal, with 1.6% of the association between PM\n                      <jats:sub>2.5<\/jats:sub>\n                      and incident AD mediated by hypertension, 4.2% by stroke, and 2.1% by depression. Study limitations include use of administrative claims data and potential exposure misclassification from area-level PM\n                      <jats:sub>2.5<\/jats:sub>\n                      estimates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Our findings suggest that PM\n                      <jats:sub>2.5<\/jats:sub>\n                      exposure was associated with increased AD risk, primarily through direct rather than comorbidity-mediated pathways. Stroke may modestly increase susceptibility. These findings highlight the need for air quality interventions as part of dementia prevention strategies in aging populations, especially those facing overlapping environmental and clinical vulnerabilities.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004912","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:21:15Z","timestamp":1771352475000},"page":"e1004912","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The role of comorbidities in the associations between air pollution and Alzheimer\u2019s disease: A national cohort study in the American Medicare 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