Associations of short-term exposure to air pollution and increased ambient temperature with psychiatric hospital admissions in older adults in the USA: a case–crossover study

BACKGROUND: Little is known about the associations between ambient environmental exposures and the risk of acute episodes of psychiatric disorders. We aimed to estimate the link between short-term exposure to atmospheric pollutants, temperature, and acute psychiatric hospital admissions in adults aged 65 years and older in the USA. METHODS: For this study, we included all people (aged ≥65 years) enrolled in the Medicare programme in the USA who had an emergency or urgent hospital admission for a psychiatric disorder recorded between Jan 31, 2000, and Dec 31, 2016. We applied a case-crossover design to study the associations between short-term exposure to air pollution (fine particulate matter [PM(2·5)], ozone, and nitrogen dioxide [NO(2)]), ambient temperature, and the risk of acute hospital admissions for depression, schizophrenia, and bipolar disorder in this population. The percentage change in the risk of hospital admission and annual absolute risk differences were estimated. FINDINGS: For each 5°C increase in short-term exposure to cold season temperature, the relative risk of acute hospital admission increased by 3·66% (95% CI 3·06–4·26) for depression, by 3·03% (2·04–4·02) for schizophrenia, and by 3·52% (2·38–4·68) for bipolar disorder in the US Medicare population. Increased short-term exposure to PM(2·5) and NO(2) was also associated with a significant increase in the risk of acute hospital admissions for psychiatric disorders. Each 5 μg/m(3) increase in PM(2·5) was associated with an increase in hospital admission rates of 0·62% (95% CI 0·23–1·02) for depression, 0·77% (0·11–1·44) for schizophrenia, and 1·19% (0·49–1·90) for bipolar disorder; each 5 parts per billion (ppb) increase in NO(2), meanwhile, was linked to an increase in hospital admission rates of 0·35% (95% CI 0·03–0·66) for depression and 0·64% (0·20–1·08) for schizophrenia. No such associations were found with warm season temperature. INTERPRETATION: In the US Medicare population, short-term exposure to elevated concentrations of PM(2·5) and NO(2) and cold season ambient temperature were significantly associated with an increased risk of hospital admissions for psychiatric disorders. Considering the increasing burden of psychiatric disorders in the US population, these findings suggest that intervening on air pollution and ambient temperature levels through stricter environmental regulations or climate mitigation could help ease the psychiatric health-care burden.