The short-term effect of ozone on pregnancy loss modified by temperature: Findings from a nationwide epidemiological study in the contiguous United States.
The short-term effect of ozone on pregnancy loss modified by temperature: Findings from a nationwide epidemiological study in the contiguous United States.
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臭氧对受温度影响的妊娠丢失的短期影响：来自美国邻近地区的一项全国性流行病学研究的结果。
DOI：
10.1016/j.scitotenv.2023.166088
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Xue,Tao
中科院分区：
文献类型：
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作者：
Tong,Mingkun;Wang,Meng;Li,Pengfei;Gong,Jicheng;Zhu,Tong;Xue,Tao
妊娠损失是影响人类可持续发展的一个主要健康问题，与短期暴露于地面臭氧（O3）有关。然而，这种关联是不一致的，可能是因为O3和热事件的共同发生，因为温度升高是妊娠丢失的风险因素。为了解释这种不一致性，O3对妊娠损失的影响需要联合检查与高温。MethodsA共247，305妊娠损失在温暖的季节，从胎儿死亡证明中提取的386个县在美国毗邻1989年至2005年。我们评估了环境暴露的基础上，每天最大的8小时平均O3从空气质量系统监测器和24小时平均温度从北美区域再分析产品。我们进行了一项双向的、时间分层的病例交叉研究，探讨了妊娠丢失与暴露于O3和温度之间的关系以及它们之间的乘法相互作用。暴露评估的主要时间窗是病例发生当天和之前3天。为了估计这种关联，我们使用了条件logistic回归，并对相对湿度、行星边界层高度和假期进行了调整。进行敏感性分析的滞后结构，非线性，和亚群之间的异质性估计联合effect.ResultsThe联合效应首先估计的回归对分类暴露的三分位数。与低-低暴露组相比（O3≤ 78 μg/m3和温度≤ 18 °C），妊娠丢失的几率显著增加6.0%，（95%置信区间[CI] 2.4- 9.7%），9.8%在高-低（>104 μg/m3且≤18 °C）、低-高（≤78 μg/m3且>23 °C）和高-高（>104 μ g/m3且> 23 ° C）组中，为6.1- 13.8%和7.5%（4.7- 10.3%）。线性暴露模型和乘法相互作用模型得出了类似的结果。O3每增加10 μg/m3，温度每增加1 °C，流产几率分别增加3.0%（2.0%-4.0%）和3.9%（3.5%-4.3%）。比值降低0.2%（0.1%-0.2%）与温度× O3相互作用相关。通过将联合暴露参数化为替代非线性项（即，二维样条项或变系数项），并且对各种暴露滞后和分层是鲁棒的。因此，O3的边际效应估计因气候带而异。在北方，但不是南部，Uniteds.ConclusionJoint暴露于O3和高温之间的显着关联O3和妊娠丢失可以增加妊娠丢失的风险。O3的不利影响可能会受到环境温度的影响。在高纬度城市，控制O3污染可以保护孕产妇健康。
BackgroundPregnancy loss, a major health issue that affects human sustainability, has been linked to short-term exposure to ground-surface ozone (O3). However, the association is inconsistent, possibly because of the co-occurrence of O3and heat episodes, as increased temperature is a risk factor for pregnancy loss. To explain this inconsistency, the effect of O3on pregnancy loss needs to be examined jointly with that of high temperature.MethodsA total of 247,305 pregnancy losses during the warm season were extracted from fetal death certificates from across the 386 counties in contiguous United States from 1989 to 2005. We assessed environmental exposure based on the daily maximum 8 h average of O3from Air Quality System monitors and the 24 h average temperature from the North American Regional Reanalysis product. We conducted a bidirectional, time-stratified case-crossover study of the association between pregnancy loss and exposure to O3and temperature and their multiplicative interaction. The main time window for the exposure assessment was the day of case occurrence and the preceding 3 days. To estimate the association, we used conditional logistic regression with adjustment for relative humidity, height of the planetary boundary layer, and holidays. Sensitivity analyses were performed on the lagged structure, nonlinearity, and between-subpopulation heterogeneity of the estimated joint effect.ResultsThe joint effect was first estimated by the regression against categorical exposure by tertile. Compared to the low-low exposure group (O3≤ 78 μg/m3and temperature ≤ 18 °C), the odds of pregnancy loss was significantly higher by 6.0 % (95 % confidence interval [CI] 2.4–9.7 %), 9.8 % (6.1–13.8 %), and 7.5 % (4.7–10.3 %) in the high-low (>104 μg/m3and ≤18 °C), low-high (≤78 μg/m3and >23 °C), and high-high (>104 μg/m3and >23 °C) groups. The model of linear exposure and the multiplicative interaction yielded similar results. Each increment of 10 μg/m3in O3and 1 °C in temperature was associated with a 3.0 % (2.0 %–4.0 %) and 3.9 % (3.5 %–4.3 %), respectively, increase in the odds of pregnancy loss. A decrease in odds of 0.2 % (0.1 %–0.2 %) was associated with the temperature×O3interaction. The finding of an antagonistic interaction between temperature and O3was confirmed by models parametrizing the joint exposure as alternative nonlinear terms (i.e., a two-dimensional spline term or a varying-coefficient term) and was robust to a variety of exposure lags and stratifications. Therefore, the marginal effect of O3was estimated to vary by climate zone. A significant association between O3and pregnancy loss was observed in the northern, but not southern, United States.ConclusionJoint exposure to O3and high temperature can increase the risk for pregnancy loss. The adverse effect of O3is potentially modified by ambient temperature. In high-latitude cities, controlling for O3pollution could protect maternal health.