College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA.
Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
Environ Res. 2023 Aug 15;231(Pt 2):116091. doi: 10.1016/j.envres.2023.116091. Epub 2023 May 12.
Gestational diabetes mellitus (GDM) is a major pregnancy complication affecting approximately 14.0% of pregnancies around the world. Air pollution exposure, particularly exposure to PM, has become a major environmental issue affecting health, especially for vulnerable pregnant women. Associations between PM exposure and adverse birth outcomes are generally assumed to be the same throughout a large geographical area. However, the effects of air pollution on health can very spatially in subpopulations. Such spatially varying effects are likely due to a wide range of contextual neighborhood and individual factors that are spatially correlated, including SES, demographics, exposure to housing characteristics and due to different composition of particulate matter from different emission sources. This combination of elevated environmental hazards in conjunction with socioeconomic-based disparities forms what has been described as a "double jeopardy" for marginalized sub-populations. In this manuscript our analysis combines both an examination of spatially varying effects of a) unit-changes in exposure and examines effects of b) changes from current exposure levels down to a fixed compliance level, where compliance levels correspond to the Air Quality Standards (AQS) set by the U.S. Environmental Protection Agency (EPA) and World Health Organization (WHO) air quality guideline values. Results suggest that exposure reduction policies should target certain "hotspot" areas where size and effects of potential reductions will reap the greatest rewards in terms of health benefits, such as areas of southeast Los Angeles County which experiences high levels of PM exposures and consist of individuals who may be particularly vulnerable to the effects of air pollution on the risk of GDM.
妊娠期糖尿病（GDM）是一种主要的妊娠并发症，影响着全球约 14.0%的妊娠。空气污染暴露，特别是 PM 的暴露，已成为影响健康的主要环境问题，尤其是对脆弱的孕妇。PM 暴露与不良出生结局之间的关联通常被认为在很大的地理区域内是相同的。然而，空气污染对健康的影响在亚人群中可能存在很大的空间差异。这种空间差异的影响可能是由于广泛的与空间相关的邻里和个体因素，包括 SES、人口统计学、住房特征暴露以及不同排放源的颗粒物组成不同。这种环境危害的升高与基于社会经济的差异相结合，为边缘化的亚人群形成了所谓的“双重困境”。在本文中，我们的分析结合了对 a）暴露的单位变化的空间变化效应的考察，以及对 b）从当前暴露水平下降到固定合规水平的效应的考察，其中合规水平对应于美国环境保护署（EPA）和世界卫生组织（WHO）空气质量标准（AQS）规定的空气质里 guideline 值。结果表明，暴露减少政策应针对某些“热点”地区，这些地区的规模和潜在减少的效应将在健康效益方面带来最大的回报，例如洛杉矶县东南部地区，该地区 PM 暴露水平较高，且包括可能特别容易受到空气污染对 GDM 风险影响的人群。
