Frailty Risk in Older Adults Associated With Long-Term Exposure to Ambient PM 2.5 in 6 Middle-Income Countries

Background: A series of studies have explored the health effects of long-term exposure to ambient PM 2.5 among older adults. However, few studies have investigated the adverse effect of long-term exposure to ambient PM2.5 on frailty, and the results are inconclusive. This study sought to investigate the associations between long-term exposure to ambient PM2.5 and frailty in 6 low- and middle-income countries. Methods: We included an analytical sample of 34 138 individuals aged 50 and older from the Study on global AGEing and adult health Wave 1 (2007/2010). Air pollution estimates were generated using a standard methodology derived from Moderate Resolution Imaging Spectroradiometer observations and Multiangle Imaging Spectroradiometer instruments from the Terra satellite, along with simulations from the GEOS-Chem chemical transport model. A 3-level hierarchical logistic model was used to evaluate the association between frailty index and long-term PM2.5 exposure at 3 levels (individual, province, and country). Results: In rural areas, each 10 μg/m3 increase in ambient PM 2.5 was associated with a 30% increase in the odds of frailty (OR = 1.30, 95% CI: 1.21–1.39) after adjusting for various potential confounding factors. The gender-stratified analysis showed that the association seemed to be slightly stronger in men (OR = 1.31, 95% CI: 1.18–1.46) than in women (OR = 1.21, 95% CI: 1.07–1.36) in rural areas. Conclusion: In a large sample of community-based older adults from 6 middle-income countries, we found evidence that long-term PM2.5 exposure was associated with frailty in rural areas.