Abstract
BackgroundLower respiratory tract infections (LRTI) in early life, including pneumonia, bronchitis and bronchiolitis, can lead to decreased lung function, persistent lung damage and increased susceptibility to various respiratory diseases such as asthma. In-utero exposure to particulate matter (PM) during pregnancy may disrupt biological mechanisms that regulate fetal growth, maturation and development. We aimed to estimate the association between intrauterine exposure to PM of size < 2.5 μm in diameter (PM2.5) and incidence of LRTIs during the first year of life.MethodsA retrospective population-based cohort study in a population of mothers and infants born in Soroka University Medical Center (SUMC) in the years 2004–2012. All infants < 1 year old that were hospitalized due to LRTIs were included. The main exposure assessment was based on a hybrid model incorporating daily satellite-based predictions at 1 km2 spatial resolution. Data from monitoring stations was used for imputation of main exposure and other pollutants. Levels of environmental exposures were assigned to subjects based on their residential addresses and averaged for each trimester. Analysis was conducted by a multivariable generalized estimating equation (GEE) Poisson regression. Data was analyzed separately for the two main ethnic groups in the region, Jewish and Arab-Bedouin.ResultsThe study cohort included 57,331 deliveries that met the inclusion criteria. Overall, 1871 hospitalizations of infants < 1 year old due to pneumonia or bronchiolitis were documented. In a multivariable analysis, intrauterine exposure to high levels of PM2.5 (> 24 μg/m3) in the first and second trimesters was found to be adversely associated with LRTIs in the Arab-Bedouin population (1st trimester, RR = 1.31, CI 95% 1.08–1.60; 2nd trimester: RR = 1.34, CI 95% 1.09–1.66).ConclusionIntrauterine exposure to high levels of PM2.5 is associated with a higher risk of hospitalizations due to lower respiratory tract infections in Arab-Bedouin infants.
Highlights
Respiratory diseases are a major cause of mortality and morbidity worldwide, in infants and young children
Lower respiratory tract infections (LRTIs), including pneumonia and bronchiolitis, in early life may lead to a decreased lung function, and persistent lung damage, as well as increased susceptibility to various respiratory diseases like asthma later in life [1]
The Negev region in southern Israel is a part of the global dust belt extending from West Africa to the Arabian Desert, and is subjected to dust storms in which particulate matter (PM) levels may increase by 10–100 fold [8]
Summary
Respiratory diseases are a major cause of mortality and morbidity worldwide, in infants and young children. Lower respiratory tract infections (LRTIs), including pneumonia and bronchiolitis, in early life may lead to a decreased lung function, and persistent lung damage, as well as increased susceptibility to various respiratory diseases like asthma later in life [1]. Half of the ArabBedouin population lives in temporary settlements that cannot be hermetically sealed from outdoor pollutants and is more likely to be exposed to and affected by them These different lifestyles, coupled with the lower socioeconomic status create the difference between the two populations and has a potential to modify the environmental effects on health [9, 10]. Lower respiratory tract infections (LRTI) in early life, including pneumonia, bronchitis and bronchiolitis, can lead to decreased lung function, persistent lung damage and increased susceptibility to various respiratory diseases such as asthma. We aimed to estimate the association between intrauterine exposure to PM of size < 2.5 μm in diameter (PM2.5) and incidence of LRTIs during the first year of life
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