Robust relationship between ambient air pollution and infant mortality in India

Priyanka N deSouza; Sagnik Dey; Kevin M Mwenda; Rockli Kim; S V Subramanian; Patrick L Kinney

doi:10.1016/j.scitotenv.2021.152755

Robust relationship between ambient air pollution and infant mortality in India

Sci Total Environ. 2022 Apr 1:815:152755. doi: 10.1016/j.scitotenv.2021.152755. Epub 2022 Jan 6.

Authors

Priyanka N deSouza¹, Sagnik Dey², Kevin M Mwenda³, Rockli Kim⁴, S V Subramanian⁵, Patrick L Kinney⁶

Affiliations

¹ Department of Urban and Regional Planning, University of Colorado Denver, Denver, CO 80217, USA. Electronic address: priyanka.desouza@ucdenver.edu.
² Centre of Excellence for Research on Clean Air (CERCA), Indian Institute of Technology Delhi, India; Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, India.
³ Spatial Structures in the Social Sciences, Brown University, Providence, RI, USA; Population Studies and Training Center, Brown University, Providence, RI, USA.
⁴ Division of Health Policy & Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, South Korea; Harvard Center for Population and Development Studies, Bow Street, Cambridge, MA 02138, USA.
⁵ Harvard Center for Population and Development Studies, Bow Street, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
⁶ Boston University School of Public Health, Boston, MA, USA.

PMID: 34999065
DOI: 10.1016/j.scitotenv.2021.152755

Abstract

Background: Ambient exposure to fine particulate matter (PM_2.5) is one of the top global health concerns. We estimate the associations between in-utero and perinatal exposure to PM_2.5 and infant, neonatal and postneonatal mortality in India. We evaluate the sensitivity of this association to two widely-used exposure assessments.

Method: We linked nationally representative anthropometric data from India's 2015-2016 Demographic and Health Survey (n = 259,627 children under five across 640 districts of India) with satellite-based PM_2.5 concentrations during the month of birth of each child. We then estimated the associations between PM_2.5 from each dataset and child mortality, after controlling for child, mother and household factors including trends in time and seasonality. We examined if factors: urban/rural, sex, wealth quintile and state modified the associations derived from the two datasets using Wald tests.

Results: We found evidence that PM_2.5 impacts infant mortality primarily through neonatal mortality. The estimated association between neonatal mortality and PM_2.5 in trimester 3 was OR: 1.016 (95% CI: 1.003, 1.030) for every 10 μg/m³ increase in exposure. This association was robust to the exposure assessment used. Child sex was a significant effect modifier, with PM_2.5 impacting mortality in infant girls more than boys.

Conclusions: Our results revealed a robust association between ambient exposure to PM_2.5 in the latter period of pregnancy and early life with infant and neonatal mortality in India. Urgent air pollution management plans are needed to improve infant mortality in India.

Keywords: Air pollution; Demographic and Health Survey (DHS); India; Infant mortality; Neonatal mortality.

MeSH terms

Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / analysis
Air Pollution* / statistics & numerical data
Child
Environmental Exposure / analysis
Environmental Exposure / statistics & numerical data
Female
Humans
India / epidemiology
Infant
Infant Mortality
Infant, Newborn
Male
Particulate Matter / analysis
Particulate Matter / toxicity
Pregnancy

Substances

Air Pollutants
Particulate Matter