Preterm birth and its associations with residence and ambient vehicular traffic exposure.
Preterm birth and its associations with residence and ambient vehicular traffic exposure.
复制标题
DOI：
10.1016/j.ajog.2016.01.171
复制
发表时间：
2016-07
影响因子：
9.8
通讯作者：
Aagaard KM
中科院分区：
文献类型：
--
作者：
Kahr MK;Suter MA;Ballas J;Ramphul R;Lubertino G;Hamilton WJ;Aagaard KM
早产（PTB）是一种多因素疾病，空气污染已被认为会增加发生的风险。然而，缺乏控制高密度环境中已建立通勤模式的多重暴露措施的大型人口研究。我们使用一个公开可用的数据库进行了地理空间分析，以确定怀孕期间居住，特别是暴露于城市和郊区社区的交通密度和流动性，是否可能是早产的一个危险因素。在我们的队列研究中，我们分析了来自德克萨斯州哈里斯县的9004例怀孕，其中包含多达4900种不同的临床和人口统计学变量。基于主要居住地和职业邮政编码信息，进行地理空间分析。车辆行驶里程（VMT）和居民上班比例的数据按邮政编码收集，并根据三条公认的区域通勤环路高密度通道（由两条州际/高速公路带（内、中、外环路）组成）进行分组。PTB分为晚期（34 1/7至36 6/7周）和早期PTB（22 1/7至33 6/7周），未调整的优势比（OR）和调整的OR。我们的研究人群中PTB患病率为10.1%（晚期6.8%，早期早产儿3.3%），这与我们的研究和其他先前的研究一致。早期肺结核的患病率在区域通勤环线通道之间存在显著差异[内线与外线的OR值：0.58(95%可信区间，0.39-0.87)，中线与外线的OR值为0.74(0.57-0.96)]。PTB和早期PTB的OR值在VMT/acre最高的社区中显示较低[PTB OR值为0.82(0.68-0.98)，早期PTB OR值为0.78(0.62-0.98)]。相反，居住在上下班距离较远的居民比例较高的社区的被试患PTB和早期PTB的风险表现出相反的趋势[PTB的OR为1.18(1.03-1.35)，早期PTB的OR为1.48(1.17-1.86)]。在logistic回归模型中，所描述的PTB与居住地之间的关联经受住了检验，并且不能用母亲年龄、妊娠或种族、烟草使用或PTB病史的差异来解释。虽然PTB是多因素的，但目前的研究表明，基于社区的风险因素（即城市/郊区位置、交通密度暴露的差异以及沿高车辆密度通道上班的需要）可能会影响PTB的风险。进一步研究以前未被认识到的基于社区的风险因素可能导致未来创新的预防措施。
Preterm birth (PTB) is a multifactorial disorder, and air pollution has been suggested to increase the risk of occurrence. However, large population studies controlling for multiple exposure measures in high-density settings with established commuter patterns are lacking. We performed a geospatial analysis with the use of a publicly available database to identify whether residence during pregnancy, specifically with regard to exposure to traffic density and mobility in urban and suburban neighborhoods, may be a contributing risk factor for premature delivery. In our cohort study, we analyzed 9004 pregnancies with as many as 4900 distinct clinical and demographic variables from Harris County, Texas. On the basis of primary residency and occupational zip code information, geospatial analysis was conducted. Data on vehicle miles traveled (VMT) and percentages of inhabitants traveling to work were collected at the zip code level and additionally grouped by the three recognized regional commuter loop high-density thoroughfares resulting from two interstate/highway belts (inner, middle, and outer loops). PTB was categorized as late (34 1/7 to 36 6/7 weeks) and early PTB (22 1/7 to 33 6/7 weeks), and unadjusted odds ratios (OR) and adjusted ORs were ascribed. PTB prevalence in our study population was 10.1% (6.8% late and 3.3% early preterm), which is in accordance with our study and other previous studies. Prevalence of early PTB varied significantly between the regional commuter loop thoroughfares [OR for inner vs outer loop: 0.58 (95% confidence interval, 0.39–0.87), OR for middle vs outer loop, 0.74 (0.57–0.96)]. The ORs for PTB and early PTB were shown to be lower in gravidae from neighborhoods with the highest VMT/acre [OR for PTB, 0.82 (0.68–0.98), OR for early PTB, 0.78 (0.62–0.98)]. Conversely, risk of PTB and early PTB among subjects living in neighborhoods with a high percentage of inhabitants traveling to work over a greater distance demonstrated a contrary tendency [OR for PTB, 1.18 (1.03–1.35), OR for early PTB, 1.48 (1.17–1.86)]. In logistic regression models, the described association between PTB and residence withstood and could not be explained by differences in maternal age, gravidity or ethnicity, tobacco use, or history of PTB. While PTB is of multifactorial origin, the present study shows that community-based risk factors (namely urban/suburban location, differences in traffic density exposure, and need for traveling to work along highevehicle density thoroughfares) may influence risk for PTB. Further research focusing on previously unrecognized community-based risk factors may lead to innovative future prevention measures.