Exposure to air pollution is associated with increased risk of developing limitations in physical function

1. Greater long-term exposure to particulate matter (PM) and nitrogen dioxide (NO2) was associated with increased risk of progressing from no disability to physical limitations and activities of daily living (ADLs) disability. 

2. Higher ozone (O3) was associated with lower disability progression risk. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Individuals have longer life expectancies, which has resulted in spending more years with physical disabilities, often adding emotional and financial burdens. Disability typically develops gradually, progressing from early physical limitations to difficulties with activities of daily living (ADLs). However, people can also move in and out of these states over time, as the process is not linear. Long-term exposure to air pollutants, such as particulate matter (PM), nitrogen dioxide (NO2), and ozone (O3), may contribute to the development of multiple chronic diseases. Past studies have examined these issues separately as opposed to a collective process. To address this research gap, this study aimed to contribute to previous research within the Health and Retirement Study (HRS) by examining the associations between long-term air pollution exposure and the transition between no physical limitations, physical function limitations, ADL disability, and death. Long-term exposure to higher levels of air pollution, particularly PM2.5, PM10-2.5, and NO2, is associated with increased progression and reduced recovery of physical disability in older adults. A key limitation is that the researchers only measured outdoor air pollution at participants’ homes, and did not account for indoor air quality or the amount of time participants spent away from home, resulting in inaccurate measurements. Despite this, the study suggests that reducing air pollution may help promote healthier aging.

Click here to read the study in JAMA Network Open 

Relevant Reading:  Long-term air pollution exposure and incident physical disability in older US adults: a cohort study

In-Depth [prospective cohort]: This prospective cohort study enrolled eligible participants older than 50 years from a diverse sample, with updates to the cohort every 6 years to maintain a representative sample. Physical function limitations and ADL disability were based on self-reported data. The study followed 29,790 adults (mean [SD] age, 63 [11] years, 16,878 [57%] women) for a mean (SD) duration of 8 (6) years. Higher long-term exposure to PM2.5, PM10-2.5, and NO2 was associated with an increased risk of transitioning from no physical limitations to physical disability. A 1-IQR increase in PM2.5 was associated with a 6% higher risk of developing physical function limitations (HR 1.06, 95% CI, 1.03-1.09), and a 4% risk of recovering back to no limitations (HR 0.96, 95% CI, 0.93-0.99). In contrast, greater exposure to ozone (O3) appeared to have a protective effect. A 1-IQR increase in O3 was associated with a lower risk of developing physical function limitations (HR 0.92, 95% CI, 0.86-0.98) and of progressing to ADL disability (HR 0.89, 95% CI, 0.81-0.97). Overall, this study highlights how air pollution may contribute to worsening disability in older adults, which is especially important given the extremely high cost of disability management on the government. Reducing air pollution could be an important strategy not only for improving health but also for potentially lowering long-term healthcare costs. 

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