Long-Term Exposure to Air Pollution and Incidence of Parkinson's Disease: A Danish Nationwide Administrative Cohort Study

Thomas Cole-Hunter; Sonja Antic; Youn Hee Lim; Jiawei Zhang; Laust Hvas Mortensen; Kees de Hoogh; Steffen Loft; George Maria Napolitano; Stéphane Tuffier; Marie Laura Bergmann; Bert Brunekreef; Gerard Hoek; Beate Ritz; Zorana Jovanovic Andersen; Rina So

doi:10.1002/mds.70234

Long-Term Exposure to Air Pollution and Incidence of Parkinson's Disease: A Danish Nationwide Administrative Cohort Study

Thomas Cole-Hunter
, Sonja Antic
, Youn Hee Lim
, Jiawei Zhang
, Laust Hvas Mortensen
, Kees de Hoogh
, Steffen Loft
, George Maria Napolitano
, Stéphane Tuffier
, Marie Laura Bergmann
, Bert Brunekreef
, Gerard Hoek
, Beate Ritz
, Zorana Jovanovic Andersen
, Rina So^*

^*Corresponding author for this work

University of Copenhagen
Aarhus University
Denmark Statistic
Swiss Tropical and Public Health Institute
University of Basel
University of California at Los Angeles

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Long-term exposure to air pollution has been linked to Parkinson's disease (PD) incidence, yet evidence is mixed, partly because of challenges with PD diagnosis and definition. We examined this association in a nationwide administrative cohort. Methods: We followed 3,280,190 Danish residents ≥30 years old from January 1, 2000 until December 31, 2018 for PD incidence, defined as either first hospital contact for primary PD or redeemed prescription of PD medication, as recorded in the Danish National Patient Registry or Prescription Registry, respectively. We assigned annual mean air pollution exposure concentrations at baseline residential address using the hybrid land-use regression model (fine particulate matter [PM_2.5], nitrogen dioxide [NO₂], ozone [warm-season, O₃w], black carbon [BC]) rendered at 0.1 × 0.1 km. We used Cox proportional hazard models adjusting for age, sex, individual-level, and area-level socioeconomic factors. Results: During a mean (standard deviation) follow-up of 15.7 (5.6) years, 36,665 participants developed PD. Median (interquartile range [IQR]) exposure levels of PM_2.5, NO₂, O₃w, and BC were 12.4 (2.0), 20.2 (7.9), 80.2 (4.3) μg/m³, and 1.01 (0.4) × 10⁻⁵/m, respectively. Hazard ratios (95% confidence intervals) for associations between air pollutants (per IQR) and PD incidence were: 1.05 (1.03, 1.07) for PM_2.5; 1.03 (1.01, 1.05) for NO₂; 0.98 (0.97, 1.00) for O₃w; and 1.04 (1.02, 1.06) for BC. Conclusions: In a representative nationwide cohort, we find that long-term exposure to air pollution is associated with PD incidence. This unique study, with access to incidence data from administrative health registers, provides new evidence supporting air pollution as a PD risk factor.

Original language	English
Journal	Movement Disorders
DOIs	https://doi.org/10.1002/mds.70234
Publication status	E-pub ahead of print - 2026

Bibliographical note

Publisher Copyright:
© 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Funding

This work was supported by funding from HEI Research Agreement (#4954‐RFA14‐3/16‐5‐3), jointly funded by the United States Environmental Protection Agency (EPA) (Assistance Award No. R‐82811201) and certain motor vehicle and engine manufacturers, by the Novo Nordisk Foundation Challenge Programme: Harnessing the Power of Big Data to Address the Societal Challenge of Aging (#NNF17OC0027812). The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.

Funders	Funder number
Health Effects Institute	4954‐RFA14‐3/16‐5‐3
U.S. Environmental Protection Agency	R‐82811201

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 15 Life on Land

Keywords

administrative cohort study; air pollution; incidence; medication; Parkinson's disease

Access to Document

10.1002/mds.70234Licence: CC BY-NC-ND

Cite this

Cole-Hunter, T., Antic, S., Lim, Y. H., Zhang, J., Mortensen, L. H., de Hoogh, K., Loft, S., Napolitano, G. M., Tuffier, S., Bergmann, M. L., Brunekreef, B., Hoek, G., Ritz, B., Andersen, Z. J., & So, R. (2026). Long-Term Exposure to Air Pollution and Incidence of Parkinson's Disease: A Danish Nationwide Administrative Cohort Study. Movement Disorders. Advance online publication. https://doi.org/10.1002/mds.70234

@article{5ae111e9611746228a5bdbbbff514b19,

title = "Long-Term Exposure to Air Pollution and Incidence of Parkinson's Disease: A Danish Nationwide Administrative Cohort Study",

abstract = "Background: Long-term exposure to air pollution has been linked to Parkinson's disease (PD) incidence, yet evidence is mixed, partly because of challenges with PD diagnosis and definition. We examined this association in a nationwide administrative cohort. Methods: We followed 3,280,190 Danish residents ≥30 years old from January 1, 2000 until December 31, 2018 for PD incidence, defined as either first hospital contact for primary PD or redeemed prescription of PD medication, as recorded in the Danish National Patient Registry or Prescription Registry, respectively. We assigned annual mean air pollution exposure concentrations at baseline residential address using the hybrid land-use regression model (fine particulate matter [PM2.5], nitrogen dioxide [NO2], ozone [warm-season, O3w], black carbon [BC]) rendered at 0.1 × 0.1 km. We used Cox proportional hazard models adjusting for age, sex, individual-level, and area-level socioeconomic factors. Results: During a mean (standard deviation) follow-up of 15.7 (5.6) years, 36,665 participants developed PD. Median (interquartile range [IQR]) exposure levels of PM2.5, NO2, O3w, and BC were 12.4 (2.0), 20.2 (7.9), 80.2 (4.3) μg/m3, and 1.01 (0.4) × 10−5/m, respectively. Hazard ratios (95\% confidence intervals) for associations between air pollutants (per IQR) and PD incidence were: 1.05 (1.03, 1.07) for PM2.5; 1.03 (1.01, 1.05) for NO2; 0.98 (0.97, 1.00) for O3w; and 1.04 (1.02, 1.06) for BC. Conclusions: In a representative nationwide cohort, we find that long-term exposure to air pollution is associated with PD incidence. This unique study, with access to incidence data from administrative health registers, provides new evidence supporting air pollution as a PD risk factor.",

keywords = "administrative cohort study; air pollution; incidence; medication; Parkinson's disease",

author = "Thomas Cole-Hunter and Sonja Antic and Lim, \{Youn Hee\} and Jiawei Zhang and Mortensen, \{Laust Hvas\} and \{de Hoogh\}, Kees and Steffen Loft and Napolitano, \{George Maria\} and St{\'e}phane Tuffier and Bergmann, \{Marie Laura\} and Bert Brunekreef and Gerard Hoek and Beate Ritz and Andersen, \{Zorana Jovanovic\} and Rina So",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.",

year = "2026",

doi = "10.1002/mds.70234",

language = "English",

journal = "Movement Disorders",

issn = "0885-3185",

publisher = "Wiley",

}

TY - JOUR

T1 - Long-Term Exposure to Air Pollution and Incidence of Parkinson's Disease

T2 - A Danish Nationwide Administrative Cohort Study

AU - Cole-Hunter, Thomas

AU - Antic, Sonja

AU - Lim, Youn Hee

AU - Zhang, Jiawei

AU - Mortensen, Laust Hvas

AU - de Hoogh, Kees

AU - Loft, Steffen

AU - Napolitano, George Maria

AU - Tuffier, Stéphane

AU - Bergmann, Marie Laura

AU - Brunekreef, Bert

AU - Hoek, Gerard

AU - Ritz, Beate

AU - Andersen, Zorana Jovanovic

AU - So, Rina

PY - 2026

Y1 - 2026

N2 - Background: Long-term exposure to air pollution has been linked to Parkinson's disease (PD) incidence, yet evidence is mixed, partly because of challenges with PD diagnosis and definition. We examined this association in a nationwide administrative cohort. Methods: We followed 3,280,190 Danish residents ≥30 years old from January 1, 2000 until December 31, 2018 for PD incidence, defined as either first hospital contact for primary PD or redeemed prescription of PD medication, as recorded in the Danish National Patient Registry or Prescription Registry, respectively. We assigned annual mean air pollution exposure concentrations at baseline residential address using the hybrid land-use regression model (fine particulate matter [PM2.5], nitrogen dioxide [NO2], ozone [warm-season, O3w], black carbon [BC]) rendered at 0.1 × 0.1 km. We used Cox proportional hazard models adjusting for age, sex, individual-level, and area-level socioeconomic factors. Results: During a mean (standard deviation) follow-up of 15.7 (5.6) years, 36,665 participants developed PD. Median (interquartile range [IQR]) exposure levels of PM2.5, NO2, O3w, and BC were 12.4 (2.0), 20.2 (7.9), 80.2 (4.3) μg/m3, and 1.01 (0.4) × 10−5/m, respectively. Hazard ratios (95% confidence intervals) for associations between air pollutants (per IQR) and PD incidence were: 1.05 (1.03, 1.07) for PM2.5; 1.03 (1.01, 1.05) for NO2; 0.98 (0.97, 1.00) for O3w; and 1.04 (1.02, 1.06) for BC. Conclusions: In a representative nationwide cohort, we find that long-term exposure to air pollution is associated with PD incidence. This unique study, with access to incidence data from administrative health registers, provides new evidence supporting air pollution as a PD risk factor.

AB - Background: Long-term exposure to air pollution has been linked to Parkinson's disease (PD) incidence, yet evidence is mixed, partly because of challenges with PD diagnosis and definition. We examined this association in a nationwide administrative cohort. Methods: We followed 3,280,190 Danish residents ≥30 years old from January 1, 2000 until December 31, 2018 for PD incidence, defined as either first hospital contact for primary PD or redeemed prescription of PD medication, as recorded in the Danish National Patient Registry or Prescription Registry, respectively. We assigned annual mean air pollution exposure concentrations at baseline residential address using the hybrid land-use regression model (fine particulate matter [PM2.5], nitrogen dioxide [NO2], ozone [warm-season, O3w], black carbon [BC]) rendered at 0.1 × 0.1 km. We used Cox proportional hazard models adjusting for age, sex, individual-level, and area-level socioeconomic factors. Results: During a mean (standard deviation) follow-up of 15.7 (5.6) years, 36,665 participants developed PD. Median (interquartile range [IQR]) exposure levels of PM2.5, NO2, O3w, and BC were 12.4 (2.0), 20.2 (7.9), 80.2 (4.3) μg/m3, and 1.01 (0.4) × 10−5/m, respectively. Hazard ratios (95% confidence intervals) for associations between air pollutants (per IQR) and PD incidence were: 1.05 (1.03, 1.07) for PM2.5; 1.03 (1.01, 1.05) for NO2; 0.98 (0.97, 1.00) for O3w; and 1.04 (1.02, 1.06) for BC. Conclusions: In a representative nationwide cohort, we find that long-term exposure to air pollution is associated with PD incidence. This unique study, with access to incidence data from administrative health registers, provides new evidence supporting air pollution as a PD risk factor.

KW - administrative cohort study; air pollution; incidence; medication; Parkinson's disease

UR - https://www.scopus.com/pages/publications/105031697668

U2 - 10.1002/mds.70234

DO - 10.1002/mds.70234

M3 - Article

AN - SCOPUS:105031697668

SN - 0885-3185

JO - Movement Disorders

JF - Movement Disorders

ER -

Long-Term Exposure to Air Pollution and Incidence of Parkinson's Disease: A Danish Nationwide Administrative Cohort Study

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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