Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
J Expo Sci Environ Epidemiol. 2013 May-Jun;23(3):315-21. doi: 10.1038/jes.2012.124. Epub 2013 Jan 23.
The impact of air pollution on fetal growth remains controversial, in part, because studies have been limited to sub-regions of the United States with limited variability. No study has examined air pollution impacts on neonatal health care utilization. We performed descriptive, univariate and multivariable analyses on administrative hospital record data from 222,359 births in the 2000, 2003 and 2006 Kids Inpatient Database linked to air pollution data drawn from the US Environmental Protection Agency's Aerometric Information Retrieval System. In this study, air pollution exposure during the birth month was estimated based on birth hospital address. Although air pollutants were not individually associated with mean birth weight, a three-pollutant model controlling for hospital characteristics, demographics, and birth month identified 9.3% and 7.2% increases in odds of low birth weight and very low birth weight for each μg/m(3) increase in PM(2.5) (both P<0.0001). PM(2.5) and NO(2) were associated with -3.0% odds/p.p.m. and +2.5% odds/p.p.b. of preterm birth, respectively (both P<0.0001). A four-pollutant multivariable model indicated a 0.05 days/p.p.m. NO(2) decrease in length of the birth hospitalization (P=0.0061) and a 0.13 days increase/p.p.m. CO (P=0.0416). A $1166 increase in per child costs was estimated for the birth hospitalization per p.p.m. CO (P=0.0002) and $964 per unit increase in O(3) (P=0.0448). A reduction from the 75th to the 25th percentile in the highest CO quartile for births predicts annual savings of $134.7 million in direct health care costs. In a national, predominantly urban, sample, air pollutant exposures during the month of birth are associated with increased low birth weight and neonatal health care utilization. Further study of this database, with enhanced control for confounding, improved exposure assessment, examination of exposures across multiple time windows in pregnancy, and in the entire national sample, is supported by these initial investigations.
空气污染对胎儿生长的影响仍然存在争议，部分原因是研究仅限于美国的亚区域，这些区域的变异性有限。没有研究检查过空气污染对新生儿保健利用的影响。我们对 2000 年、2003 年和 2006 年《儿童住院数据库》中的 222359 例出生记录进行了描述性、单变量和多变量分析，这些数据与美国环境保护署的大气信息检索系统中的空气污染数据相关联。在这项研究中，根据出生医院的地址来估计出生月份的空气污染暴露情况。尽管污染物并没有单独与平均出生体重相关，但在控制医院特征、人口统计学和出生月份的三污染物模型中，发现 PM（2.5）每增加 1μg/m（3），低出生体重和极低出生体重的几率分别增加了 9.3%和 7.2%（均 P<0.0001）。PM（2.5）和 NO（2）与早产的几率分别降低了 3.0%/每 ppm 和增加了 2.5%/每 ppb（均 P<0.0001）。一个四污染物多变量模型表明，NO（2）每增加 0.05 天/ppm，出生住院时间减少 0.05 天（P=0.0061），CO 每增加 0.13 天/ppm（P=0.0416）。每增加 1 ppm CO 儿童每例的住院费用估计增加 1166 美元（P=0.0002），O（3）每增加一个单位增加 964 美元（P=0.0448）。出生时 CO 四分位数最高的第 75 个百分位到第 25 个百分位的降低，预计每年可节省 1.347 亿美元的直接医疗保健费用。在一个全国性的、主要是城市的样本中，出生月份的空气污染物暴露与低出生体重和新生儿保健利用增加有关。进一步研究这个数据库，包括加强混杂因素的控制、改善暴露评估、在妊娠的多个时间窗口以及整个国家样本中检查暴露情况，都得到了这些初步研究的支持。
