Psychosocial Factors Outweigh Environmental Exposures in Subjective Cognitive Difficulties: A Causal AI Analysis
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Objective
To evaluate the associations of short-term environmental exposures with subjective cognitive difficulties and attention-related outcomes and to compare their relative importance with psychosocial factors.
Materials and Methods
We linked daily weather and air-pollution exposures to repeated cognitive and attention-related outcomes in the All of Us Research Program (2018–2024). Associations were evaluated using complementary longitudinal and causal-inference approaches, including fixed-effects, lagged-exposure, and event-study analyses. Machine-learning and causal AI approaches, including double machine learning, causal forests, and latent representation learning, were used to assess heterogeneity and psychosocial structure. Findings were independently evaluated using 2024 Behavioral Risk Factor Surveillance System data.
Results
Temperature-shock exposure was associated with attention impairment in pooled analyses ( β = 0.0315, p = 0.032), but estimates attenuated substantially in fixed-effects models ( β = 0.011, p = 0.617) and other within-location analyses. Environmental associations with subjective cognitive difficulty were generally weak. In contrast, mental-health burden ( β = − 0.114), social functioning ( β = − 0.102), loneliness ( β = 0.053), and literacy-related measures ( β = − 0.082) showed substantially larger associations (all p < 0.001). Similar patterns were observed in BRFSS, where loneliness was associated with subjective cognitive decline (OR=1.81, 95% CI 1.76–1.86). Exploratory causal AI analyses produced findings consistent with the primary longitudinal models.
Discussion
The attenuation of environmental associations under within-location identification strategies suggests that some pooled associations may reflect broader geographic and contextual differences rather than short-term environmental effects.
Conclusion
Psychosocial factors were more strongly and consistently associated with subjective cognitive difficulties than short-term environmental exposures across longitudinal causal-inference and causal AI frameworks.
