Air pollution raises risk for first-year ED visits in preterm, full-term infants
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Preterm and full-term infants faced similar elevated risks for ED visits in their first year when they were exposed to higher levels of fine particulate matter 2.5 μm or less in diameter, according to results published in JAMA Network Open.
“The risk of an ED visit, especially respiratory-related visits, in infants during their first year of life increased with increasing air pollution exposure, and infants were most at risk during their fourth and fifth months of life,” Anaïs Teyton, MPH, doctoral student at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California, San Diego, told Healio. “The risk of an ED visit was similar between term and preterm infants, as well as between male and female infants. Given this positive relationship between air pollution exposure and ED visit risk in infants, strategies aimed at reducing this exposure, including policies or behavior changes, may be warranted.”
In an individual-level cohort study, Teyton and colleagues analyzed 1,983,700 infants (49.4% girls; 48.7% Hispanic; 7.2% preterm) who were live-born, singleton deliveries between 2014 and 2018 in California to see how exposure to fine particulate matter 2.5 μm or less in diameter (PM2.5) is related to ED visits in the infant’s first year of life. They also checked to see if being born preterm had an impact on this association.
Using each infant’s home zip code, researchers calculated their PM2.5 exposure each week of their first year through a model that combined several machine learning algorithms and some possible variables, such as aerosol optical depth and land use variables.
Researchers evaluated the relationship between PM2.5 levels and time to ED visits with pooled logistic regression models that included effect modifiers of preterm status, sex and payment type for delivery.
With each 5 μg/m3 increase in PM2.5 exposure, researchers found comparable higher odds for an all-cause ED visit within the first year in both preterm (adjusted OR = 1.056; 95% CI, 1.048-1.064) and term-born babies (aOR = 1.051; 95% CI, 1.049-1.053).
Further, both preterm and term-born babies had increased odds for infection-related ED visits, with a slightly higher risk in term-born infants (aOR = 1.053; 95% CI, 1.044-1.062) compared with preterm (aOR = 1.035; 95% CI, 1.001-1.069). However, for the first respiratory-related ED visit, researchers found a lower risk in term-born infants (aOR = 1.065; 95% CI, 1.061-1.069) when compared with preterm infants (aOR = 1.08; 95% CI, 1.067-1.093).
During weeks 18 to 23, or the fourth and fifth months, researchers observed the highest odds for all-cause ED visits for preterm and term-born babies (aOR range, 1.034; 95% CI, 0.976-1.094 to 1.077; 95% CI, 1.022-1.135). Notably, from weeks 16 to 23, term-born infants showed the highest susceptibility (aOR range, 1.037; 95% CI, 1.019-1.056 to 1.076; 95% CI, 1.06-1.093).
“It was interesting that both preterm and term infants were similarly at risk of an ED visit, despite preterm infants' impaired capacity to handle oxidative stress after birth,” Teyton told Healio. “Preterm and term infants also had a similar window of susceptibility at 18 to 23 weeks of life.”
Looking at the remaining effect modifiers, researchers found comparable ED visit odds ratios between boys (aOR = 1.052; 95% CI, 1.049-1.055) and girls (aOR = 1.051; 95% CI, 1.048-1.054). For delivery payment type, researchers observed associations for those with self-paid delivery (aOR = 1.086; 95% CI, 1.06-1.114) and those with Medi-Cal (aOR = 1.049; 95% CI, 1.046-1.052).
“There are several exciting avenues for potential future research, such as considering the role of mobility in PM2.5 exposure, assessing different specific-causes of ED visits, examining the presence of effect modification by additional factors, focusing on susceptibility by varying degrees of prematurity in infants and examining this relationship using various sources of PM2.5 exposure including from wildfires,” Teyton said. “Future studies may also wish to investigate why these windows of susceptibility were observed and to simulate the effectiveness of various interventions that aim to reduce this health burden in infants.”
For more information:
Anaïs Teyton, MPH, can be reached at ateyton@ucsd.edu.