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Exploring prenatal outdoor air pollution, birth outcomes and neonatal health care utilization in a nationally representative sample

Journal of Exposure Science & Environmental Epidemiology volume 23, pages 315–321 (2013)Cite this article

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Abstract

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/m3 increase in PM2.5 (both P<0.0001). PM2.5 and NO2 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. NO2 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 O3 (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.

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Abbreviations

AIRS:

Aerometric Information Retrieval System

BRFSS:

behavioral risk factor surveillance system

CO:

carbon monoxide

ICD-9-CM:

International Classification of Diseases and Related Health Problems version 9

KID:

Kids Inpatient Database

NIS:

Nationwide Inpatient Sample

NO2:

nitrogen dioxide

LOS:

length of stay

PM2.5:

particulate matter of diameter ≤2.5 μm

PM10:

particulate matter <10 μm in diameter

SO2:

sulfur dioxide

USEPA:

US Environmental Protection Agency

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Authors and Affiliations

  1. Department of Pediatrics, New York University School of Medicine, New York, New York, USA

    Leonardo Trasande

  2. Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA

    Leonardo Trasande & George Thurston

  3. New York University Wagner School of Public Service, New York, New York, USA

    Leonardo Trasande

  4. Center for Retirement Research, Boston College, Chestnut Hill, Massachusetts, USA

    Kendrew Wong

  5. Department of Pediatrics, Northwestern University, and Erie Family Health Center, Chicago, Illinois, USA

    Angkana Roy

  6. Department of Epidemiology, Brown University, Providence, Rhode Island, USA

    David A Savitz

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  1. Leonardo Trasande
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Correspondence to Leonardo Trasande.

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Trasande, L., Wong, K., Roy, A. et al. Exploring prenatal outdoor air pollution, birth outcomes and neonatal health care utilization in a nationally representative sample. J Expo Sci Environ Epidemiol 23, 315–321 (2013). https://doi.org/10.1038/jes.2012.124

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