Department of Preventive Medicine, School of Medicine FMUSP, University of São Paulo, SP, Brazil.
Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil.
Sci Total Environ. 2022 Jan 10;803:149790. doi: 10.1016/j.scitotenv.2021.149790. Epub 2021 Aug 20.
Several studies have examined whether air pollution is associated with adverse births outcomes, but it is not clear if socioeconomic status (SES) modifies this relationship.
We investigated if maternal education and area-level socioeconomic status modified the relationship between ozone, nitrogen dioxide and particulate matter with aerodynamic diameter <10 μm (PM) on preterm births (PTB; gestational age <37 weeks) and term low birth weight (TLBW; weight < 2500 g on term deliveries).
Analyses were based on almost 1 million singleton live births in São Paulo municipality between 2011 and 2016. The final sample included 979,306 births for PTB analysis and 888,133 for TLBW analysis. Exposure to PM, NO and O were based on date of birth and estimated for the entire gestation and for each trimester. Multilevel logistic regression models were conducted to examine the effect of air pollutants on both adverse birth outcomes and whether it was modified by individual and area-level SES.
In fully adjusted models, over the entire pregnancy, a 10 μg/m increase in O and PM was associated with increased chance of PTB (odds ratio; OR = 1.14 CI 1.13, 1.16 and 1.08 CI = 1.02, 1.15 respectively) and PM with TLBW (OR = 1.08 CI 1.03, 1.14). Associations were modified by maternal educational and area-level SES for both outcomes. Mothers of lower education had an additional chance of PTB and TLBW due to PM exposure (OR = 1.04 CI 1.04, 1.05 and 1.10 CI 1.08, 1.14 respectively), while mothers living in low SES areas have an additional chance for TLBW (OR = 1.05 CI 1.03, 1.06). Similar modification effects were found for O exposure. Trimester specific associations were weaker but followed a similar pattern.
Socioeconomic status modifies the effect of air pollution on adverse birth outcomes. Results indicate that mothers with lower SES may be more susceptible to air pollution effects.
已有多项研究探讨了空气污染是否与不良生育结局有关，但目前尚不清楚社会经济地位（SES）是否会改变这种关系。
我们研究了母亲的教育程度和地区社会经济地位是否会改变臭氧、二氧化氮和空气动力学直径<10μm 的颗粒物（PM）与早产（PTB；妊娠周数<37 周）和足月低体重儿（TLBW；足月分娩时体重<2500g）之间的关系。
分析基于 2011 年至 2016 年期间圣保罗市近 100 万例单胎活产。最终样本包括 979306 例 PTB 分析和 888133 例 TLBW 分析。PM、NO 和 O 的暴露情况基于出生日期进行估计，并在整个妊娠期和每个孕期进行估计。多水平逻辑回归模型用于检查空气污染物对这两种不良出生结局的影响，以及其是否受个体和地区 SES 的影响。
在完全调整的模型中，整个孕期中，O 和 PM 每增加 10μg/m，PTB 的发生几率就会增加（比值比；OR=1.14，CI 1.13，1.16 和 1.08，CI=1.02，1.15），PM 与 TLBW 的发生几率也会增加（OR=1.08，CI 1.03，1.14）。这两个结局都受到母亲教育程度和地区 SES 的影响。受 PM 暴露影响，受教育程度较低的母亲发生 PTB 和 TLBW 的几率增加（OR=1.04，CI 1.04，1.05 和 1.10，CI 1.08，1.14），而生活在低 SES 地区的母亲发生 TLBW 的几率增加（OR=1.05，CI 1.03，1.06）。类似的修饰效果也适用于 O 暴露。孕期特定的关联较弱，但呈现出类似的模式。
社会经济地位改变了空气污染对不良生育结局的影响。结果表明，社会经济地位较低的母亲可能更容易受到空气污染的影响。
