{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:08:56Z","timestamp":1789038536026,"version":"build-2803163510"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG061189"],"award-info":[{"award-number":["R01AG061189"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["U54MD000507"],"award-info":[{"award-number":["U54MD000507"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01AG061189"],"award-info":[{"award-number":["R01AG061189"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["U54MD000507"],"award-info":[{"award-number":["U54MD000507"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: American Indians are disproportionately affected by air pollution, an important risk factor for dementia. However, few studies have investigated the effects of air pollution on the risk of dementia among American Indians. (2) Methods: This retrospective cohort study included a total of 26,871 American Indians who were 55+ years old in 2007, with an average follow-up of 3.67 years. County-level average air pollution data were downloaded from land-use regression models. All-cause dementia was identified using ICD-9 diagnostic codes from the Indian Health Service\u2019s (IHS) National Data Warehouse and related administrative databases. Cox models were employed to examine the association of air pollution with dementia incidence, adjusting for co-exposures and potential confounders. (3) Results: The average PM2.5 levels in the IHS counties were lower than those in all US counties, while the mean O3 levels in the IHS counties were higher than the US counties. Multivariable Cox regressions revealed a positive association between dementia and county-level O3 with a hazard ratio of 1.24 (95% CI: 1.02\u20131.50) per 1 ppb standardized O3. PM2.5 and NO2 were not associated with dementia risk after adjusting for all covariates. (4) Conclusions: O3 is associated with a higher risk of dementia among American Indians.<\/jats:p>","DOI":"10.3390\/ijerph21020128","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T03:59:42Z","timestamp":1706155182000},"page":"128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Potential Effects of Long-Term Exposure to Air Pollution on Dementia: A Longitudinal Analysis in American Indians Aged 55 Years and Older"],"prefix":"10.3390","volume":"21","author":[{"given":"Yachen","family":"Zhu","sequence":"first","affiliation":[{"name":"Program in Public Health, University of California, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxi","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Bartell","sequence":"additional","affiliation":[{"name":"Program in Public Health, University of California, Irvine, CA 92697, USA"},{"name":"Department of Environmental and Occupational Health, University of California, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8168-8593","authenticated-orcid":false,"given":"Maria M.","family":"Corrada","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, Irvine, CA 92697, USA"},{"name":"Department of Neurology, School of Medicine, University of California, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spero M.","family":"Manson","sequence":"additional","affiliation":[{"name":"Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"O\u2019Connell","sequence":"additional","affiliation":[{"name":"Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luohua","family":"Jiang","sequence":"additional","affiliation":[{"name":"Program in Public Health, University of California, Irvine, CA 92697, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California, Irvine, CA 92697, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1056\/NEJM199312093292401","article-title":"An association between air pollution and mortality in six US cities","volume":"329","author":"Dockery","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"eabf4491","DOI":"10.1126\/sciadv.abf4491","article-title":"PM2.5 polluters disproportionately and systemically affect people of color in the United States","volume":"7","author":"Tessum","year":"2021","journal-title":"Sci. Adv."},{"key":"ref_3","unstructured":"(2023, February 23). The Disproportionate Impacts of Oil and Gas Air Pollution on Tribal Air Quality. Available online: https:\/\/www.catf.us\/wp-content\/uploads\/2018\/05\/Tribal_Communities_At_Risk.pdf."},{"key":"ref_4","unstructured":"(2023, February 23). Basic Information about Oil and Natural Gas Air Pollution Standards, Available online: https:\/\/www.epa.gov\/controlling-air-pollution-oil-and-natural-gas-operations\/basic-information-about-oil-and-natural."},{"key":"ref_5","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":"ref_6","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1177\/1747493018772800","article-title":"A review of epidemiological research on stroke and dementia and exposure to air pollution","volume":"13","author":"Reis","year":"2018","journal-title":"Int. J. Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S145","DOI":"10.3233\/JAD-180631","article-title":"Air pollution and dementia: A systematic review","volume":"70","author":"Peters","year":"2019","journal-title":"J. Alzheimer\u2019s Dis."},{"key":"ref_8","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":"ref_9","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":"ref_10","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":"ref_11","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jamaneurol.2019.4914","article-title":"Association between cardiovascular disease and long-term exposure to air pollution with the risk of dementia","volume":"77","author":"Grande","year":"2020","journal-title":"JAMA Neurol."},{"key":"ref_12","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. Alzheimer\u2019s Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"087001","DOI":"10.1289\/EHP9018","article-title":"Fine particulate matter and dementia incidence in the adult changes in thought study","volume":"129","author":"Shaffer","year":"2021","journal-title":"Environ. Health Perspect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6754","DOI":"10.1038\/s41467-021-27049-2","article-title":"A national cohort study (2000\u20132018) of long-term air pollution exposure and incident dementia in older adults in the United States","volume":"12","author":"Shi","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1097\/EDE.0000000000000144","article-title":"Traffic-related air pollution in relation to cognitive function in older adults","volume":"25","author":"Tonne","year":"2014","journal-title":"Epidemiology"},{"key":"ref_16","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":"ref_17","doi-asserted-by":"crossref","unstructured":"Chang, K.-H., Chang, M.-Y., Muo, C.-H., Wu, T.-N., Chen, C.-Y., and Kao, C.-H. (2014). Increased risk of dementia in patients exposed to nitrogen dioxide and carbon monoxide: A population-based retrospective cohort study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0103078"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12789","DOI":"10.1038\/s41598-017-13048-1","article-title":"Is long-term exposure to air pollution associated with episodic memory? A longitudinal study from Northern Sweden","volume":"7","author":"Oudin","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12940-019-0511-5","article-title":"Long-term exposure to air pollution and hospitalization for dementia in the Rome longitudinal study","volume":"18","author":"Cerza","year":"2019","journal-title":"Environ. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3233\/JAD-170658","article-title":"Association of low-level ozone with cognitive decline in older adults","volume":"61","author":"Cleary","year":"2018","journal-title":"J. Alzheimer\u2019s Dis."},{"key":"ref_21","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. Diagn. Assess. Dis. Monit."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Loop, M.S., Kent, S.T., Al-Hamdan, M.Z., Crosson, W.L., Estes, S.M., Estes Jr, M.G., Quattrochi, D.A., Hemmings, S.N., Wadley, V.G., and McClure, L.A. (2013). Fine particulate matter and incident cognitive impairment in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0075001"},{"key":"ref_23","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":"ref_24","doi-asserted-by":"crossref","unstructured":"Oudin, A., Segersson, D., Adolfsson, R., and Forsberg, B. (2018). Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198283"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2107833119","DOI":"10.1073\/pnas.2107833119","article-title":"Association of improved air quality with lower dementia risk in older women","volume":"119","author":"Wang","year":"2022","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2105\/AJPH.94.1.53","article-title":"Health service access, use, and insurance coverage among American Indians\/Alaska Natives and Whites: What role does the Indian Health Service play?","volume":"94","author":"Zuckerman","year":"2004","journal-title":"Am. J. Public Health"},{"key":"ref_27","first-page":"1011","article-title":"United States indigenous populations and dementia: Is there a case for culture-based psychosocial interventions?","volume":"57","author":"Browne","year":"2017","journal-title":"Gerontologist"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.amepre.2005.07.023","article-title":"Cardiovascular health among American Indians and Alaska Natives: Successes, challenges, and potentials","volume":"29","author":"Galloway","year":"2005","journal-title":"Am. J. Prev. Med."},{"key":"ref_29","unstructured":"(2023, February 23). IHS Profile Based on 2015\u20132020 Data-Numbers Are Approximate, Available online: https:\/\/www.ihs.gov\/newsroom\/factsheets\/ihsprofile\/."},{"key":"ref_30","unstructured":"(2023, February 23). Research Policy Update a First Look at the 2020 Census American Indian\/Alaska Native Redistricting Data. Available online: https:\/\/bpb-us-w2.wpmucdn.com\/sites.wustl.edu\/dist\/a\/1072\/files\/2021\/09\/Overview_of_2020_AIAN_Redistricting_Data_FINAL_8_13_2021.pdf."},{"key":"ref_31","unstructured":"O\u2019Connell, J., Guh, S., Ouellet, J., Rockell, J., Li, Y., Croy, C., and Gutilla, M. (2014). ARRA ACTION: Comparative Effectiveness of Health Care Delivery Systems for American Indians and Alaska Natives Using Enhanced Data Infrastructure: Final Report."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kim, S.-Y., Bechle, M., Hankey, S., Sheppard, L., Szpiro, A.A., and Marshall, J.D. (2020). Concentrations of criteria pollutants in the contiguous US, 1979\u20132015: Role of prediction model parsimony in integrated empirical geographic regression. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228535"},{"key":"ref_33","unstructured":"Jacob, D.J. (1999). Introduction to Atmospheric Chemistry, Princeton University Press."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1056\/NEJMoa0803894","article-title":"Long-term ozone exposure and mortality","volume":"360","author":"Jerrett","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jalz.2016.04.002","article-title":"Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011\u20132013","volume":"13","author":"Goodman","year":"2017","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/jech-2017-210116","article-title":"Cognitive function trajectories and their determinants in older people: 8 years of follow-up in the English Longitudinal Study of Ageing","volume":"72","author":"Zaninotto","year":"2018","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/gerona\/glab097","article-title":"Cardiometabolic conditions and all-cause dementia among American Indian and Alaska Native people","volume":"77","author":"Goins","year":"2022","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/aje\/kwu255","article-title":"Trends in diabetes incidence among 7 million insured adults, 2006-2011: The SUPREME-DM project","volume":"181","author":"Nichols","year":"2015","journal-title":"Am. J. Epidemiol."},{"key":"ref_39","unstructured":"(Sightlines\u2122 DxCG Risk Solutions, 2011). Sightlines\u2122 DxCG Risk Solutions, version 4.0.1."},{"key":"ref_40","unstructured":"(2023, February 23). 2010\u20132014 American Community Survey\u2014United States, Available online: https:\/\/www.census.gov\/programs-surveys\/acs\/technical-documentation\/table-and-geography-changes\/2014\/5-year.html."},{"key":"ref_41","unstructured":"Canchola, A.J., Stewart, S.L., Bernstein, L., West, D.W., Ross, R.K., Deapen, D., Pinder, R., Reynolds, P., Wright, W., and Anton-Culver, H. (2003). Western Users of SAS Software, Laxjansen.com."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"M337","DOI":"10.1093\/gerona\/53A.5.M337","article-title":"Left-truncated data with age as time scale: An alternative for survival analysis in the elderly population","volume":"53","author":"Lamarca","year":"1998","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1198\/000313006X152207","article-title":"On the so-called \u201cHuber sandwich estimator\u201d and \u201crobust standard errors\u201d","volume":"60","author":"Freedman","year":"2006","journal-title":"Am. Stat."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/biomet\/81.3.515","article-title":"Proportional hazards tests and diagnostics based on weighted residuals","volume":"81","author":"Grambsch","year":"1994","journal-title":"Biometrika"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.neuro.2008.12.011","article-title":"Neurobehavioral effects of ambient air pollution on cognitive performance in US adults","volume":"30","author":"Chen","year":"2009","journal-title":"Neurotoxicology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1289\/ehp.1408973","article-title":"Long-term PM2. 5 exposure and neurological hospital admissions in the northeastern United States","volume":"124","author":"Kioumourtzoglou","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"375","DOI":"10.3389\/fpubh.2019.00375","article-title":"Gender Difference in the Effects of Outdoor Air Pollution on Cognitive Function Among Elderly in Korea","volume":"7","author":"Kim","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1016\/S2542-5196(22)00001-8","article-title":"Outdoor air pollution exposure and cognitive performance: Findings from the enrolment phase of the CONSTANCES cohort","volume":"6","author":"Yang","year":"2022","journal-title":"Lancet Planet Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"163980","DOI":"10.1016\/j.scitotenv.2023.163980","article-title":"Sex disparity in cognitive aging related to later-life exposure to ambient air pollution","volume":"886","author":"Mo","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S359","DOI":"10.2105\/AJPH.2013.301715","article-title":"Trends and disparities in heart disease mortality among American Indians\/Alaska Natives, 1990\u20132009","volume":"104","author":"Veazie","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S496","DOI":"10.2105\/AJPH.2014.301968","article-title":"Diabetes-related mortality among American Indians and Alaska Natives, 1990\u20132009","volume":"104","author":"Cho","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/ije\/30.6.1343","article-title":"Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects","volume":"30","author":"Greenland","year":"2001","journal-title":"Int. J. Epidemiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1289\/ehp.94102s825","article-title":"Design and analysis of multilevel analytic studies with applications to a study of air pollution","volume":"102","author":"Navidi","year":"1994","journal-title":"Environ. Health Perspect."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1146\/annurev-publhealth-040218-044058","article-title":"Ambient air pollution, noise, and late-life cognitive decline and dementia risk","volume":"40","author":"Paul","year":"2019","journal-title":"Annu. Rev. Public Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the Lancet Commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"105954","DOI":"10.1016\/j.envint.2020.105954","article-title":"Air pollution, physical activity and health: A mapping review of the evidence","volume":"147","author":"Tainio","year":"2021","journal-title":"Environ. Int."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/2\/128\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:48:49Z","timestamp":1760104129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/2\/128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["ijerph21020128"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21020128","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,24]]}}}