Fine particle components and risk of psychiatric hospitalization in the U.S

There is a lack of evidence for the associations between atmospheric particle components exposure and psychiatric health. We aimed to identify the most toxic particle component(s) and source(s) related with psychiatric illness.

Using Health Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs), we analyzed the relative risk (RR) of psychiatric hospitalization associated with increased residential exposure to 14 particle components (Zn, V, Si, Pb, Ni, K, Fe, Cu, Ca, Br, sulfate (SO₄^2-), nitrate (NO₃^-), organic carbon (OC), and elemental carbon (EC)). We covered the residents of eight U.S. states, who contributed to 5,012,041 psychiatric admissions over 2002-2018. Single component models were conducted via fitting zero-inflated negative binomial regression for each component with aggregated counts of total psychiatric hospitalizations per ZIP code per year as dependent variable. We used Nonnegative Matrix Factorization (NMF) to identify particle source factors and obtained the source-specific estimates. Generalized Weighted Quantile Sum (gWQS) Regression was applied to obtain an overall mixture effect. Separate but similar models were fitted for different age groups (<30 yrs. vs. ≥ 30 yrs) and psychiatric illness sub-categories to assess effect heterogeneity.

Sulfate, Fe, Pb and Zn were associated with the largest risk increases in single-component models. The biggest harmful associations were observed for metal industry source (high loadings of Pb and sulfate). For one quartile increase in components mixture score, we observed an adjusted RR of 1.24 (95 % CI, 1.21-1.26). Older population were more affected. We also observed higher increase in bipolar and psychotic admission risk for increased components source and mixture level.

Living in areas with higher levels of particle components was associated with increased risk of psychiatric hospitalization among the residents in eight U.S. states. Certain components (i.e. Pb, sulfate) and sources (metal industry) were the most related.