Assessing the impact of race, social factors and air pollution on birth outcomes: a population-based study.
BACKGROUND
Both air pollution exposure and socioeconomic status (SES) are important indicators of children's health. Using highly resolved modeled predictive surfaces, we examine the joint effects of air pollution exposure and measures of SES in a population level analysis of pregnancy outcomes in North Carolina (NC).


METHODS
Daily measurements of particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and ozone (O3) were calculated through a spatial hierarchical Bayesian model which produces census-tract level point predictions. Using multilevel models and NC birth data from 2002-2006, we examine the association between pregnancy averaged PM2.5 and O3, individual and area-based SES indicators, and birth outcomes.


RESULTS
Maternal race and education, and neighborhood household income were associated with adverse birth outcomes. Predicted concentrations of PM2.5 and O3 were also associated with an additional effect on reductions in birth weight and increased risks of being born low birth weight and small for gestational age.


CONCLUSIONS
This paper builds on and complements previous work on the relationship between pregnancy outcomes and air pollution exposure by using 1) highly resolved air pollution exposure data; 2) a five-year population level sample of pregnancies; and 3) including personal and areal level measures of social determinants of pregnancy outcomes. Results show a stable and negative association between air pollution exposure and adverse birth outcomes. Additionally, the more socially disadvantaged populations are at a greater risk; controlling for both SES and environmental stressors provides a better understanding of the contributing factors to poor children's health outcomes.
U,S, Environmental Protection Agency, Research Triangle Park, North Carolina, USA. simonegray@cdc.gov.
Simone C
SC
Gray
Sharon E
SE
Edwards
Bradley D
BD
Schultz
Marie Lynn
ML
Miranda
D000293:Adolescent; D000328:Adult; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D001724:Birth Weight; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006801:Humans; D007182:Income; D009657:North Carolina / Q000453:epidemiology; D010126:Ozone / Q000032:analysis / Q000633:toxicity; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D044469:Racial Groups; D012923:Social Class; D055815:Young Adult
D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone