ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
This article is part of the Research TopicImpact of inhaled particulates and toxicants on brain health: inflammation mechanisms and behavioral consequencesView all 4 articles
Ambient Air Pollution, Sleep Quality, and Cerebral Hemorrhage Risk in Older Adults: Development and Validation of the Anhui Environmental Exposure Questionnaire in a 460 Participant Cohort Study
Provisionally accepted
- 1Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
- 2Department of General Surgery II,Shannan People's Hospital, Shannan, China
- 3First Affiliated Hospital of Anhui Medical University, Hefei, China
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Objectives: To develop and validate the Anhui Environmental Exposure Questionnaire (AEEQ) and evaluate whether its composite score independently predicts incident cerebral haemorrhage in older adults. Methods: In a prospective cohort (January 2022–April 2024) from Hefei, we enrolled 460 participants aged 60–79 years with ≥5 years' residence and MMSE ≥24, excluding prior stroke/ICH/TBI, heavy-industry/mining workers, lifetime smoking ≥5 pack-years, and recent (≤6 months) antihypertensive changes. The 42-item AEEQ spans six domains. Content validity used Delphi procedures; construct validity used split-sample EFA/CFA; reliability used Cronbach's α, split-half, and 14 ± 3-day ICCs; criterion validity correlated domains with annual-mean residential PM₂.₅ (calendar year prior to baseline) and PSQI. Incident haemorrhage was ascertained over ≈24 months; Cox models adjusted for age, sex, hypertension, alcohol, and anticoagulation tested the AEEQ (Z-score), with a prespecified antihypertensive interaction. Results: Content validity was high (S-CVI/Ave 0.96). Factorability was adequate (KMO 0.91); EFA supported six factors (66.1% variance). CFA fit was excellent (χ²/df 2.19; CFI 0.965; TLI 0.958; RMSEA 0.041; SRMR 0.052). Reliability was strong (total α 0.90; domain α 0.78–0.86; total ICC 0.86). Criterion validity was consistent with hypotheses (air-pollution domain vs PM₂.₅ r = 0.62; sleep domain vs PSQI ρ = −0.56). Sixteen haemorrhages occurred (3.5%; ~920 person-years), with monotonic incidence across AEEQ quartiles (0.9%, 1.7%, 2.6%, 8.7%; p-trend = 0.0047). Each 1-SD higher AEEQ predicted greater risk (HR 1.47, 95% CI 1.12–1.93) and improved discrimination beyond clinical covariates (C-statistic 0.72→0.80; NRI 0.15, p = 0.045); effects were stronger in participants not using antihypertensives (interaction p = 0.048). Equity profiling showed higher AEEQ scores in lower education and renters. Conclusions: The AEEQ reliably quantifies chronic environmental burden and adds independent, dose-responsive prognostic value for cerebral haemorrhage, supporting its use in community screening and targeted prevention.
Keywords: Ambient air pollution, sleep quality, cerebral haemorrhage, questionnaire validation, risk prediction, older adults
Received: 08 Jul 2025; Accepted: 03 Oct 2025.
Copyright: © 2025 Song, Shi, Su and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hong Su, suhong5151@ahmu.edu.cn
Ke Zhang, zhangke@ahmu.edu.cn
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