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Reducing the burden of anaemia in Indian women of reproductive age with clean-air targets

Abstract

India has one of the highest (53%) global prevalences of anaemia among women of reproductive age (WRA, 15–49 years). Long-term exposure to ambient fine particulate matter (PM2.5), a type of air pollution, may increase the prevalence of anaemia through systemic inflammation. Using a linear mixed model adjusted for potential confounding factors, we show that for every 10 µg m−3 increase in ambient PM2.5 exposure, the average anaemia prevalence among Indian WRA increases by 7.23% (95% uncertainty interval, 6.82–7.63). Among PM2.5 species, sulfate and black carbon are more associated with anaemia than organics and dust. Among sectoral contributors, industry was the greatest, followed by the unorganized, domestic, power, road dust, agricultural waste burning and transport sectors. If India meets its recent clean-air targets, such anaemia prevalence among WRA will fall from 53% to 39.5%, taking 186 districts below the national target of 35%. Our results suggest that the transition to clean energy would accelerate India’s progress towards the ‘anaemia-free’ mission target.

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Fig. 1: Spatial patterns of anaemia prevalence (%) and PM2.5 exposure in India.
Fig. 2: Exposure–response curve of ambient PM2.5 long-term (2007–2016) exposure against anaemia prevalence.
Fig. 3: Effect of PM2.5 exposure on odds ratio of anaemia and Hb level among WRA in India.
Fig. 4: Anaemia prevalence and clean-air targets.

Data availability

The satellite-based PM2.5 data that support the findings of this study are available in the Code Ocean database (https://codeocean.com/capsule/5860976/tree). The MERRA-2 reanalysis data were retrieved from https://gmao.gsfc.nasa.gov/reanalysis/MERRA-2/. The model data used in this study are available from the corresponding author on reasonable request. DHS data source: https://www.dhsprogram.com/data/available-datasets.cfm.

Code availability

The code that supports the findings of this study is available in the Code Ocean database (https://codeocean.com/capsule/5860976/tree) and from the corresponding author on reasonable request.

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Acknowledgements

The work is supported by a research grant under the SUPRA scheme from the SERB, Department of Science and Technology, GoI. The exposure database was generated as part of a project under the NCAP funded by the Ministry of Environment, Forest and Climate Change, GoI. S.D. acknowledges financial support for the Institute Chair fellowship and DST-FIST programme (SR/FST/ESII-016/2014) for computing support. S.J. acknowledges the Institute Postdoctoral fellowship from IIT Delhi. S.W. acknowledges the National Natural Science Foundation of China (grant no. 22188102).

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S.D. and E.C. conceived the study and wrote the initial article. E.C. analysed the data with the help of S.G. S.S., N.S., S.A., S.W., C.V. and K.T. did the model simulations and analysis of the model outputs. A.V.K. and A.J.C. provided a critical review of aspects of the epidemiological analysis and aetiological frameworks. S.J. provided the PM2.5 composition data for validating the model data. All authors provided comments and contributed to the final version of the article.

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Correspondence to Sagnik Dey or Santu Ghosh.

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Chaudhary, E., Dey, S., Ghosh, S. et al. Reducing the burden of anaemia in Indian women of reproductive age with clean-air targets. Nat Sustain 5, 939–946 (2022). https://doi.org/10.1038/s41893-022-00944-2

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