Ambient air pollution and mortality: The role of socioeconomic conditions.

Background: There is a vast body of literature covering the association between air pollution exposure and nonaccidental mortality. However, the role of socioeconomic status (SES) in this relationship is still not fully understood. Objectives: We investigated if individual and contextual SES modified the relationship between short-term exposure to ozone (O3), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter <10 µm (PM10) on cardiovascular, respiratory, and all nonaccidental mortality. Methods: We conducted a time-stratified case-crossover study. Analyses were based on information on 280,685 deaths from 2011 to 2015 in the city of São Paulo. Education was used as an individual SES, and information on the district of residence was used to build a contextual SES. Exposure to PM10, NO2, and O3 was accessed from monitoring stations and linked to each case based on the date of death. Conditional logistic regression models were used to estimate the effects of air pollutants, and interaction terms were added to access the effect modification of SES. Results: Individuals with lower education had an increased chance of dying for all nonaccidental outcomes (1.54% [0.91%, 2.14%]) associated with exposure to PM10. Individuals living in lower SES areas had an increased chance of dying for nonaccidental (0.52% [0.16%, 0.88%]), cardiovascular (1.17% [0.88%, 1.46%]), and respiratory (1.70% [0.47%, 2.93%]) causes owing to NO2 exposure. Conclusion: Exposure to air pollutants increases the chance of dying by nonaccidental, cardiovascular, and respiratory causes. Lower educational levels and living on lower contextual SES increased the risk of mortality associated with air pollution exposure.

Individual and contextual socioeconomic status as effect modifier in the air pollution-birth outcome association.

BACKGROUND: Several studies have examined whether air pollution is associated with adverse births outcomes, but it is not clear if socioeconomic status (SES) modifies this relationship. OBJECTIVES: We investigated if maternal education and area-level socioeconomic status modified the relationship between ozone, nitrogen dioxide and particulate matter with aerodynamic diameter <10 µm (PM10) on preterm births (PTB; gestational age <37 weeks) and term low birth weight (TLBW; weight < 2500 g on term deliveries). METHODS: Analyses were based on almost 1 million singleton live births in São Paulo municipality between 2011 and 2016. The final sample included 979,306 births for PTB analysis and 888,133 for TLBW analysis. Exposure to PM10, NO2 and O3 were based on date of birth and estimated for the entire gestation and for each trimester. Multilevel logistic regression models were conducted to examine the effect of air pollutants on both adverse birth outcomes and whether it was modified by individual and area-level SES. RESULTS: In fully adjusted models, over the entire pregnancy, a 10 µg/m3 increase in O3 and PM10 was associated with increased chance of PTB (odds ratio; OR = 1.14 CI 1.13, 1.16 and 1.08 CI = 1.02, 1.15 respectively) and PM10 with TLBW (OR = 1.08 CI 1.03, 1.14). Associations were modified by maternal educational and area-level SES for both outcomes. Mothers of lower education had an additional chance of PTB and TLBW due to PM10 exposure (OR = 1.04 CI 1.04, 1.05 and 1.10 CI 1.08, 1.14 respectively), while mothers living in low SES areas have an additional chance for TLBW (OR = 1.05 CI 1.03, 1.06). Similar modification effects were found for O3 exposure. Trimester specific associations were weaker but followed a similar pattern. CONCLUSION: Socioeconomic status modifies the effect of air pollution on adverse birth outcomes. Results indicate that mothers with lower SES may be more susceptible to air pollution effects.

Organochlorine pesticides levels and associated factors in a group of blood donors in São Paulo, Brazil.

The use of organochlorine pesticides (OCPs) is a worldwide public health concern given that high levels of these compounds in humans and animals can lead to serious health problems. This study aimed to evaluate the levels of 15 organochlorine pesticides in the serum of 547 blood donors in the São Paulo metropolitan region (SPMR) in 2009 and to investigate factors associated with higher levels of these compounds. The OCPs were determined by gas chromatography with micro electron capture detection. Multiple ordinal logistic regression models were employed to determine the factors associated with higher levels. Only ß-HCH and p,p'-DDE had a significant number of samples above the limit of quantification. Factors associated with higher levels of ß-HCH were age within 26 to 35 years (OR = 3.1 [1.05-9.09]), age within 36 to 45 years (OR = 18.27 [6.89-48.91]), and female gender (OR = 0.44 [0.24-0.82] for men). p,p'-DDE levels were associated with age within 26 to 35 years (OR = 2.65 [1.20-3.45]), age within 36 to 45 years (OR = 4.59 [2.64-7.92]), female gender (OR = 0.86 [0.43-0.94] for men), and previous work with pesticides (OR = 2.88 [1.22-6.84]). Lower levels of p,p'-DDE were associated with an income of 3 to 5 minimum wages (OR = 0.38 [0.19-0.75]) and with intake of foods from animal origin up to twice a week (OR = 0.15 [0.03-0.72]) and more than twice a week (OR = 0.10 [0.02-0.47]). The results of this study indicate that the study group was not exposed to high levels of OCPs.

What is the impact of interventions that prevent fetal mortality on the increase of preterm live births in the State of Sao Paulo, Brazil?

BACKGROUND: There is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil? METHODS: The time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010. RESULTS: Preterm births showed the highest annual increase (3.2%) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4%) in the same gestational age group. There was an increase of cesarean section births and it was higher in the < 28 weeks group (6.1%). There was a decreased annual trend of mothers with inadequate prenatal care (6.1%) and low education (8.8%) and an increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2% of all pregnancies resulted in preterm births (0.9% in fetal deaths and 7.3% in live births). In 2010, the preterm birth increased to 9.4% (0.8% were preterm fetal deaths and 8.6% preterm live births). CONCLUSIONS: The results suggest that 45.2% could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.