Iron Trace Elements Concentration in PM₁₀ and Alzheimer's Disease in Lima, Peru: Ecological Study

Alzheimer's disease (AD) has been linked to air pollution, especially particulate matter (PM). PM comprises various elements, including iron-rich particles that may reach the brain through inhalation. Lima, Peru is one of the most polluted cities in Latin America, with a high rate of AD. The study aims to evaluate the association between iron (Fe) trace elements in PM₁₀ and AD cases in Lima, Peru. This retrospective ecological study used monthly Fe concentration data from the Peruvian Ministry of Health. AD cases (ICD-10-G30) and dementia in AD cases (DAD, ICD-10-F00) were obtained from the Peruvian CDC. Fe trace element data were available for six districts in Lima for the years 2017-2019 and 2022. Cases were standardized based on ≥60-year-old populations of each district. Hierarchical mixed-effects models of Gaussian and negative binomial families were constructed to evaluate both outcomes jointly (AD + DAD) and separately (AD, and DAD). A sensitivity analysis was conducted by excluding data from Lima's downtown district. In the complete model, log-Fe concentration was associated with a higher rate of AD + DAD and DAD, and with a higher IRR for the three outcomes. After controlling for other metals, a higher DAD rate was observed (β-coeff = 6.76, 95%CI 0.07; 13.46, p = 0.048), and a higher IRR for AD + DAD (1.55, 95%CI 1.09; 2.20, p = 0.014) and DAD (1.83, 95%CI 1.21; 2.78, p = 0.004). The association was not significant in the sensitivity analysis. In conclusion, exposure to Fe through PM₁₀ inhalation may be associated with the presence of AD in Lima.