The association of air pollution with new‐onset epilepsy

Abstract Objective Air pollution has been associated with certain neurological disorders, but its association with epilepsy has been insufficiently explored. The study's objective was to estimate the association of long‐term exposure to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ) with the risk of new‐onset epilepsy among adults in Ontario, Canada. Methods We used a nested case–control study design and linked health and environmental databases, including Ontario residents ages 18 to 80 as of January 1, 2010, without prior diagnoses of seizures or epilepsy. We identified cases as those who developed epilepsy by December 31, 2016, and matched each with up to five controls on age and sex. We used individual‐ and multi‐pollutant conditional logistic regression models to estimate the associations between interquartile range (IQR) increases in each pollutant and new‐onset epilepsy. Results We included 24 761 cases and 118 692 controls. The median (IQR) pollutant concentrations were 7.9 (1.3) μg/m 3 for PM 2.5 , 9.6 (9.2) ppb for NO 2 , and 42.7 (5.4) ppb for O 3 . In the individual pollutant models, we observed significant associations with epilepsy for PM 2.5 (incident rate ratio [IRR] = 1.055, 95% confidence interval [CI]: 1.034–1.076), NO 2 (IRR = 0.938, 95% CI: 0.903–0.974), and O 3 (IRR = 1.096, 95% CI: 1.074–1.119). In the multi‐pollutant model, we observed significant associations with epilepsy for NO 2 (IRR = 0.928, 95% CI: 0.891–0.965) and O 3 (IRR = 1.090, 95% CI: 1.060–1.121). Although the association for NO 2 was negative overall, the association was positive among individuals 65 and older. Significance PM 2.5 and O 3 may be associated with an increased risk of new‐onset epilepsy. We also observed a negative association for NO 2 . However, residual confounding may have occurred. Future research should continue exploring the associations between specific air pollutants and new‐onset epilepsy.