The modifying effect of vitamin C on the association between perfluorinated compounds and insulin resistance in the Korean elderly: a double-blind, randomized, placebo-controlled crossover trial.

PURPOSE: There is limited evidence whether environmental exposure to perfluorinated compounds (PFCs) affects insulin resistance (IR) and whether vitamin C intake protects against the adverse effect of PFCs. This study was carried out to investigate the effect of PFCs on IR through oxidative stress, and the effects of a 4-week consumption of vitamin C supplement compared placebo on development of IR by PFCs. METHODS: For a double-blind, community-based, randomized, placebo-controlled crossover intervention of vitamin C, we assigned 141 elderly subjects to both vitamin C and placebo treatments for 4 weeks. We measured serum levels of PFCs to estimate PFC exposures and urinary levels of malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) for oxidative stress. We also measured levels of fasting glucose and insulin and derived the homeostatic model assessment (HOMA) index to assess IR. RESULTS: Perfluorooctane sulfonate (PFOS) and perfluorododecanoic acid (PFDoDA) levels were found to be positively associated with HOMA index at the baseline and after placebo treatment. Risks of IR for the top decile of PFOS and PFDoDA exposures were significantly elevated compared with those with lower PFOS and PFDoDA exposures (both, P < 0.0001). However, the effects of PFOS and PFDoDA on HOMA disappeared after vitamin C supplementation (both, P > 0.30). Furthermore, PFOS and PFDoDA levels were also significantly associated with MDA and 8-OHdG levels, and MDA levels were positively associated with HOMA index. CONCLUSION: PFOS and PFDoDA exposures were positively associated with IR and oxidative stress, and vitamin C supplementation protected against the adverse effects of PFOS and PFDoDA on IR.

Low-level Mercury Exposure and Risk of Asthma in School-age Children.

BACKGROUND: Mercury (Hg) has been reported to have adverse effects on the immune system. However, the association between Hg exposure and asthma remains unclear. We hypothesized that blood Hg concentrations are associated with asthma and immune system blood profile changes in school-age children. METHODS: Between 2005 and 2010, we evaluated 4,350 Korean children at 7-8 years of age with no previous asthma diagnosis. Follow-up surveys were conducted twice, each 2 years apart, until 11-12 years of age. For every survey, we evaluated asthma through a questionnaire and blood profile. We analyzed the association of Hg concentration with asthma by logistic and Cox regression models and the association with blood profile by generalized additive and linear mixed models. RESULTS: Blood Hg concentrations at 7-8 years of age were associated with an increased risk of asthma (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0, 1.6) at ages up to 11-12 years (n = 191). Hg concentration was also associated with wheezing (OR = 1.2; 95% CI = 1.0, 1.3), asthma medication use (OR = 1.4; 95% CI = 0.97, 2.0), and airway hyperresponsiveness (OR = 1.2; 95% CI = 1.0, 1.3). Further adjustment for fish consumption did not change the results appreciably. CONCLUSIONS: Low-level Hg exposure was associated with asthma and blood profile changes in school-age children.

Utilizing Genetic Predisposition Score in Predicting Risk of Type 2 Diabetes Mellitus Incidence: A Community-based Cohort Study on Middle-aged Koreans.

Contribution of genetic predisposition to risk prediction of type 2 diabetes mellitus (T2DM) was investigated using a prospective study in middle-aged adults in Korea. From a community cohort of 6,257 subjects with 8 yr' follow-up, genetic predisposition score with subsets of 3, 18, 36 selected single nucleotide polymorphisms (SNPs) (genetic predisposition score; GPS-3, GPS-18, GPS-36) in association with T2DM were determined, and their effect was evaluated using risk prediction models. Rs5215, rs10811661, and rs2237892 were in significant association with T2DM, and hazard ratios per risk allele score increase were 1.11 (95% confidence intervals: 1.06-1.17), 1.09 (1.01-1.05), 1.04 (1.02-1.07) with GPS-3, GPS-18, GPS-36, respectively. Changes in AUC upon addition of GPS were significant in simple and clinical models, but the significance disappeared in full clinical models with glycated hemoglobin (HbA1c). For net reclassification index (NRI), significant improvement observed in simple (range 5.1%-8.6%) and clinical (3.1%-4.4%) models were no longer significant in the full models. Influence of genetic predisposition in prediction ability of T2DM incidence was no longer significant when HbA1c was added in the models, confirming HbA1c as a strong predictor for T2DM risk. Also, the significant SNPs verified in our subjects warrant further research, e.g. gene-environmental interaction and epigenetic studies.

Influence of genetic polymorphisms on the association between phthalate exposure and pulmonary function in the elderly.

BACKGROUND: Phthalates are prevalent environmental exposure chemicals with rising concern on various health effects, including pulmonary function. Meanwhile, elderly people are more susceptible to environmental exposure, and their decreasing lung function is an important health issue. OBJECTIVES: To investigate the association between urinary phthalate metabolite levels and indices for pulmonary function, and evaluate effect modification by genetic polymorphisms of oxidative-stress related genes, catalase (CAT), superoxide dismutase (SOD2), and myeloperoxidase (MPO) in elderly Koreans. METHODS: We conducted a panel study on 418 individuals over 60 years old in Seoul, Korea, and repeatedly measured urinary phthalate metabolite levels and ran pulmonary function tests. Genetic polymorphisms of CAT (rs769218, rs769217), SOD2 (rs4880, rs2758331, rs5746136) and MPO (rs2071409, rs7208693) were determined. Mixed effect model was used to investigate association of phthalate levels with pulmonary function indices and to examine the effect of CAT, SOD2 and MPO polymorphisms on the association. RESULTS: Inverse association was demonstrated between sum of mono-(2-ethyl-5-hydroxyhexyl) phthalate and mono-(2-ethyl-5-oxohexyl) phthalate (∑DEHP) levels and FEV1/FVC (ß=-0.632, p=0.0275) or FEF25-75 (ß=-0.077, p=0.025) after adjusting for age, months after previous measurements, sex, body mass index, cotinine, mean temperature and dew point. The effect of ∑DEHP on lung function was significant only in subjects with certain genotypes, and having all significant genotypes in three genes showed significant difference in the phthalate-pulmonary function association (FEV1/FVC: ß=-2.169, p=0.0032; FEF25-75: ß=-0.155, p=0.0103), while other combinations showed less estimate size without any significance. CONCLUSIONS: Urinary phthalate metabolites levels are associated with decreasing pulmonary function in elderly Koreans, and effect modification of certain CAT, SOD2 and MPO polymorphisms on the association is suggested.

Colonoscopic Screening and Risk of All-Cause and Colorectal Cancer Mortality in Young and Older Individuals.

PURPOSE: The incidence of early-onset colorectal cancer (CRC) and associated mortality have been increasing. However, the potential benefits of CRC screening are largely unknown in young individuals. We aimed to evaluate the effect of CRC screening with colonoscopy on all-cause and CRC mortality among young (aged < 45 years) and older (aged ≥ 45 years) individuals. Materials and Methods: This cohort study included 528,046 Korean adults free of cancer at baseline who underwent a comprehensive health examination. The colonoscopic screening group was defined as those who reported undergoing colonoscopy for CRC screening. Mortality follow-up until December 31, 2019 was ascertained based on nationwide death certificate data from the Korea National Statistical Office. RESULTS: Colonoscopic screening was associated with a lower risk of all-cause mortality in both young and older individuals. Multivariable-adjusted time-dependent hazard ratios (95% confidence intervals) for all-cause mortality comparing ever- to never-screening were 0.86 (0.75-0.99) for young individuals and 0.71 (0.65-0.78) for older individuals. Colonoscopic screenings were also associated with a reduced risk of CRC mortality without significant interaction by age, although this association was significant only among participants aged ≥ 45 years, with corresponding time-dependent hazard ratios of 0.47 (0.15-1.44) for young individuals and 0.52 (0.31-0.87) for those aged ≥ 45 years. CONCLUSION: Colonoscopic CRC screening decreased all-cause mortality among both young and older individuals, while significantly decreased CRC mortality was observed only in those aged ≥ 45 years. Screening initiation at an earlier age warrants more rigorous confirmatory studies.

Association of serum 25-hydroxyvitamin D levels with markers for metabolic syndrome in the elderly: a repeated measure analysis.

The purpose of current study was to investigate associations of serum 25-hydroxyvitamin D (OHVD) levels with markers for metabolic syndrome in elderly Koreans. We conducted a panel study on 301 individuals over 60 yr old in Seoul, Korea, and repeatedly measured serum OHVD, glucose, insulin, and lipid levels. Mixed effect model and generalized estimating equations were used to investigate relationships between serum OHVD levels with marker levels for metabolic syndrome and each of its categories. Of all subjects, 76.6% were vitamin D deficient (< 50 nM) and 16.9% were insufficient (< 75 nM). Inverse association was demonstrated between serum OHVD levels and insulin (P = 0.004), triglyceride (P = 0.023) and blood pressure (systolic blood pressure: P = 0.002; diastolic blood pressure: P < 0.001). Vitamin D deficiency was found to increase risk of 'hypertriglyceridemia' category of metabolic syndrome (odds ratio: 1.73, 95% confidence interval: 1.13-2.66). In conclusion, we found from our repeated measure analysis that decreasing serum OHVD levels are associated with increasing insulin resistance, increasing serum triglyceride levels and increasing blood pressure in elderly Koreans, and confirmed on the risk of 'hypertriglyceridemia' in vitamin D deficient subjects.

Environmental and Occupation Factors Associated with Vitamin D Deficiency in Korean Adults: The Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2014.

While exposure to sunlight is a well-documented primary source of vitamin D supply, factors leading to vitamin D deficiency vary according to population characteristics. Using nationwide data from the Korea National Health and Nutrition Examination Survey (KNHANES), we aimed to investigate a diverse range of potential factors in association with vitamin D deficiency. Overall, 21,208 participants aged ≥20 years were selected from KNHANES conducted between 2010 and 2014. The associations between various environmental and occupational factors and vitamin D deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL) were evaluated in logistic regression models after controlling for potential covariates and also after stratification for age and sex. Under given criteria, 15,138 (71.4%) participants were vitamin D deficient. Significant associations were observed between vitamin D deficiency and average environmental temperature and radiation, weekly walking frequency, type of occupation, and shift work. When participants were stratified by age and sex, we observed greater associations of vitamin D deficiency with walking frequency among young males (odds ratio [OR] and 95% confidence interval [95% CI]: 1.24 [1.05-1.47] for those walking <5 times per week compared to those walking ≥5 times per week) and shift work (OR [95% CI]: 1.40 [1.10-1.78] for those working at night compared to those working during the day). We also observed a significant association of vitamin D deficiency with educational attainment (OR [95% CI]: 1.43 [1.09-1.89] for those with ≤middle school compared to those with ≥high school) among older group of females. This study suggests that vitamin D deficiency is related to geographical conditions and subpopulation characteristics. The age and sex-specific associations may urge the effective promotion of vitamin D supply recommendations.

Vitamin D status and risk of non-Hodgkin lymphoma: An updated meta-analysis.

PURPOSE: This meta-analysis aimed to extensively investigate the association between various measures of vitamin D status and non-Hodgkin lymphoma (NHL) and its subtypes. METHODS: We searched MEDLINE (PubMed), Embase, and the Cochrane Library in February 2018. Two authors independently reviewed and selected articles based on predetermined criteria. RESULTS: A total of 30 studies with 56,458 NHL cases were finally selected, with 24, 9, and 3 studies on sunlight/ultraviolet radiation (UVR) exposure, dietary intake, and serum/plasma 25-hydroxyvitamin D levels, respectively. Significant protective effects of overall sunlight/UVR exposure on NHL and subtypes were observed, with summary relative risks (RRs) ranging from 0.67-0.80 (RR for NHL = 0.80; 95% confidence interval [CI]: 0.71-0.90) among subjects with high exposure compared to those with low exposure. The results were consistent with various classifications of sunlight/UVR exposure. In contrast, when exposure measures of dietary vitamin D intake (RR for NHL = 1.03; 95% CI: 0.90-1.19) and serum/plasma 25-hydroxyvitamin D levels (RR for NHL = 0.97; 95% CI: 0.82-1.15) were used, risk estimates were inconsistent or non-significant for NHL and the subtypes. CONCLUSION: While risk estimates varied by different measures of vitamin D status, a protective effect of sunlight/UVR exposure on NHL incidence was verified, across most of the tested subtypes as well as exposure categories.

Gaps in universal health coverage in South Korea: Association with depression onset in a community cohort.

BACKGROUND: While controversies on limitation of coverage by the national health insurance and relatively high direct or "out-of-pocket" household payments by the national health insurance in South Korea still remain, potential unfavorable influence of the insufficiency of the universal health coverage on depression has not yet been evaluated. METHODS AND FINDINGS: Baseline information were obtained from a community cohort (The Korean Genome and Epidemiology Study) of middle-aged subjects without depression at enrollment period (2001-2002). Subjects were followed-up biennially, and new onset depression was assessed using Becks Depression Inventory at 2nd round follow-up (2005-2006). Influence of direct medical expenditure on depression onset was investigated in all subjects and in stratified groups of different income level. Increasing risk of depression onset was observed for increased medical expenditure (OR [95% CI];1.44 [0.97-2.13], 1.90 [1.19-3.05], 1.71 [1.01-2.91] for spending <50000 KRW, 50000-100000 KRW, and ≥100000 KRW, respectively, vs. almost no expenditure per month; P for trend = 0.012), after adjusting for covariates such as monthly income and chronic disease history. Similar associations were observed in subjects less than or at average national income, but results were not significant in subgroup with monthly income above national average. CONCLUSIONS: Even with the universal coverage, high co-payments and uninsured services in the Korean health insurance system yet possibly make the insured pay much for medical service utilization. This might have led to onset of an unfavorable health condition such as depression.

Simple Coiling versus Stent-Assisted Coiling of Paraclinoid Aneurysms: Radiological Outcome in a Single Center Study.

OBJECTIVE: Paraclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms. METHODS: Data of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups: simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results. RESULTS: Complete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005-0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106-9.302). CONCLUSION: Use of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.

PM10 exposure and non-accidental mortality in Asian populations: a meta-analysis of time-series and case-crossover studies.

OBJECTIVES: We investigated the association between particulate matter less than 10 µm in aerodynamic diameter (PM10) exposure and non-accidental mortality in Asian populations by meta-analysis, using both time-series and case-crossover analysis. METHODS: Among the 819 published studies searched from PubMed and EMBASE using key words related to PM10 exposure and non-accidental mortality in Asian countries, 8 time-series and 4 case-crossover studies were selected for meta-analysis after exclusion by selection criteria. We obtained the relative risk (RR) and 95% confidence intervals (CI) of non-accidental mortality per 10 µg/m³ increase of daily PM10 from each study. We used Q statistics to test the heterogeneity of the results among the different studies and evaluated for publication bias using Begg funnel plot and Egger test. RESULTS: Testing for heterogeneity showed significance (p<0.001); thus, we applied a random-effects model. RR (95% CI) per 10 µg/m³ increase of daily PM10 for both the time-series and case-crossover studies combined, time-series studies relative risk only, and case-crossover studies only, were 1.0047 (1.0033 to 1.0062), 1.0057 (1.0029 to 1.0086), and 1.0027 (1.0010 to 1.0043), respectively. The non-significant Egger test suggested that this analysis was not likely to have a publication bias. CONCLUSIONS: We found a significant positive association between PM10 exposure and non-accidental mortality among Asian populations. Continued investigations are encouraged to contribute to the health impact assessment and public health management of air pollution in Asian countries.

Diethylhexyl phthalates is associated with insulin resistance via oxidative stress in the elderly: a panel study.

BACKGROUND: Insulin resistance (IR) is believed to be the underlying mechanism of metabolic syndrome and type 2 diabetes mellitus (DM). Recently, a few studies have demonstrated that phthalates could cause oxidative stress which would contribute to the development of IR. Therefore, we evaluated whether exposure to phthalates affects IR, and oxidative stress is involved in the phthalates-IR pathway. METHODS: We recruited 560 elderly participants, and obtained blood and urine samples during repeated medical examinations. For the determination of phthalate exposure, we measured urinary levels of mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) as metabolites of diethylhexyl phthalates (DEHP), and mono-n-butyl phthalate (MnBP) as a metabolite of di-butyl phthalate (DBP). Malondialdehyde (MDA), an oxidative stress biomarker, was also measured in urine samples. We measured serum levels of fasting glucose and insulin, and derived the homeostatic model assessment (HOMA) index to assess IR. A mixed-effect model and penalized regression spline were used to estimate the associations among phthalate metabolites, MDA, and IR. RESULTS: The molar sum of MEHHP and MEOHP (∑DEHP) were significantly associated with HOMA (ß = 0.26, P = 0.040), and the association was apparent among participants with a history of DM (ß = 0.88, P = 0.037) and among females (ß = 0.30, P = 0.022). However, the relation between MnBP and HOMA was not found. When we evaluated whether oxidative stress is involved in increases of HOMA by ∑DEHP, MDA levels were significantly associated with increases of ∑DEHP (ß = 0.11, P<0.001) and HOMA (ß = 0.49, P = 0.049). CONCLUSIONS: Our study results suggest that exposure to DEHP in the elderly population increases IR, which is related with oxidative stress, and that participants with a history of DM and females are more susceptible to DEHP exposure.

Socioeconomic inequalities in adolescent depression in South Korea: a multilevel analysis.

BACKGROUND: In recent years, South Korea has witnessed a sustained rise in the prevalence of adolescent depression. In the present study, we sought to investigate family and school environmental influences on adolescent depression. METHODS AND FINDINGS: Middle and high school students (N = 75,066) were randomly selected respondents to a web-based survey and answered questions on their academic and socioeconomic backgrounds, parental support, parental education level, physical activities, lifestyle habits and their experience of depression in the past one year. Two-level multilevel analysis was used to investigate the relationship between depression and individual (level 1) and school (level 2) factors. Girls reported having experienced depression in greater numbers than boys (43.96% vs. 32.03%). A significant association was found between adolescent depression experience and gender, grade, self-rated academic achievement, family affluence scale, parental support, parental education level, lifestyle habits, physical activity and sleep dissatisfaction. The students living with rich parents were more likely to be depressive, and maternal higher education was significantly associated with higher probability of boys' depression experience. Low academic achievement was highly associated with the experience of depression. In school level contexts, girls were found to be less likely to be depressive in girls-only schools. CONCLUSION: The adolescent depression experience is not only an individual phenomenon but is highly associated with other factors such as parents, peers, academic achievement, and even gender mix in the school. Thus, prevention measures on youth depression need to focus on emphasizing less pressure from parents on academic performance, and establishing healthy inter-gender relationships within co-education schools.

Associations of bisphenol A exposure with heart rate variability and blood pressure.

Bisphenol A (BPA) is a high-volume production chemical that has been suspected to have adverse health effects. Recent studies have suggested that cardiovascular diseases are associated with the BPA exposure. The aim of present study was to investigate the associations of urinary BPA with heart rate variability and blood pressure. We recruited 560 noninstitutionalized elderly citizens from August 2008 to August 2010 in Seoul. All of the participants were ≥60 years old. The participants took medical examinations ≤5 times. Urinary BPA concentration, heart rate variability, and blood pressure were measured at each time. A total of 1511 observations from 521 participants were included in the analyses. We observed that urinary BPA was associated negatively with the root mean square of successive differences for heart rate and positively with blood pressure. The odds ratio of showing hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) was 1.27 (95% CI, 0.85-1.88) in the fourth quartile compared with the first quartile of urinary BPA concentration. When the analyses were restricted to participants who did not report previous history of hypertension (n=258), the odds ratio was increased to 2.35 (95% CI, 1.33-4.17).

eNOS gene polymorphisms modify the association of PM(10) with oxidative stress.

Previous studies have suggested that air pollution increases various health outcomes through oxidative stress and oxidative stress-related genes modify the relationship between air pollution and health outcomes. Therefore, we evaluated the effect of PM(10) on the levels of malondialdehyde (MDA), oxidative stress biomarker, and the effect modification by genetic polymorphisms of eNOS, oxidative stress-related gene, in the 560 Korean elderly. We obtained urine samples repeatedly from participants during five medical examinations between 2008 and 2010 and all ambient air pollutant concentration data from the Korea National Institute of Environmental Research air quality monitoring system. We measured urinary levels of MDA to assess oxidative stress and genotyped eNOS (rs1799983, rs2853796, and rs7830). Mixed-effect model was used to estimate the effect of PM(10) on the level of oxidative stress biomarker and their modification by genotypes. PM(10) showed apparent positive effect on MDA level after adjusting for age, sex, BMI, cotinine level, temperature, dew point, levels of SO(2), O(3), NO(2), and CO, and season (p=0.0133). Moreover, the association of PM(10) with MDA was found only in participants with eNOS GG genotype for rs1799983 (p=0.0107), TT genotype for rs2853796 (p=0.0289), or GT genotype for rs7830 (p=0.0158) and in participants with a set of risky haplotypes (GTT, GTG, GGT, and TGT) (p=0.0093). Our results suggest that PM(10) affect oxidative stress in the elderly and eNOS genotype affect the oxidative stress level in regard of exposure to PM(10).

Air pollution and symptoms of depression in elderly adults.

BACKGROUND: Although the effect of air pollution on various diseases has been extensively investigated, few studies have examined its effect on depression. OBJECTIVES: We investigated the effect of air pollution on symptoms of depression in an elderly population. METHODS: We enrolled 537 participants in the study who regularly visited a community center for the elderly located in Seoul, Korea. The Korean version of the Geriatric Depression Scale-Short Form (SGDS-K) was used to evaluate depressive symptomatology during a 3-year follow-up study. We associated ambient air pollutants with SGDS-K results using generalized estimating equations (GEE). We also conducted a factor analysis with items on the SGDS-K to determine which symptoms were associated with air pollution. RESULTS: SGDS-K scores were positively associated with interquartile range (IQR) increases in the 3-day moving average concentration of particulate matter with an aerodynamic diameter ≤ 10 µm (PM10) [17.0% increase in SGDS-K score, 95% confidence interval (CI): 4.9%, 30.5%], the 0-7 day moving average of nitrogen dioxide [NO2; 32.8% (95% CI: 12.6%, 56.6%)], and the 3-day moving average of ozone [O3; 43.7% (95% CI: 11.5%, 85.2%)]. For these three pollutants, factor analysis showed that air pollution was more strongly associated with emotional symptoms such as feeling happy and satisfied than with somatic or affective symptoms. CONCLUSIONS: Our study suggests that increases in PM10, NO2, and O3 may increase depressive symptoms among the elderly. Of the symptoms evaluated, ambient air pollution was most strongly associated with emotional symptoms.