Source-specific multi-pollutant exposures and the neighborhood context in disparities in stillbirth

摘要 产科结局中种族和民族差异的根源似乎既不是遗传的，也不是完全解释的。 由个人层面的因素决定。因此，我们必须着眼于物质、社会和建筑方面的更广泛的背景 为了解和减轻孕产妇和儿童健康方面的差距创造环境。在物质上、社会上和建造上 环境、空气污染、社区劣势和居民区绿化可能起到重要作用。AS 与低出生体重、胎儿生长受限和早产相比，人们对空气的了解要少得多 污染暴露对死产的影响，死产的定义是发生在20周或之后的宫内死亡 怀孕了。城市空气污染是颗粒物和气态污染物的复杂混合物，通常相关的原因是 它们受到共同的邻近震源和气象的影响，因此，同时研究暴露 对多种空气污染物的控制是具有挑战性的。以往关于空气污染与死产风险的研究 暴露主要集中在污染物特有的影响上，包括我们对臭氧和金属的研究。 美国第四大城市得克萨斯州休斯敦的总理选民。运用源头分解法进行评估 空气污染物暴露利用空气污染物混合物高度相关的性质，量化 不同来源类别的贡献，并提供信息，以便制定更有针对性的控制战略 有待开发。到目前为止，我们知道只有一项研究应用了细颗粒物的来源解析。 物质，并使用正矩阵分解(PMF)受体建模。然而，那次调查使用了 在不考虑空间失调误差的情况下，估计源贡献，就好像它们是真实的曝光一样 以及该方法本身固有的不确定性。针对这些缺点，我们将应用创新的 贝叶斯空间多元受体模型(BSMRM)与土地利用和交通数据的集成 以及考虑到健康影响估计中的暴露测量误差。就像空气污染一样，社会 而建成的环境聚集了对健康产生不利影响的邻里水平的暴露。这些压力源是 在遭受所谓“双重危险”的少数群体和低收入人群中，这种情况往往更严重。 拟议研究的目标有三个方面。首先，我们希望评估特定来源的影响 使用BSMRM与土地利用和土地利用相结合的创新方法对死产进行多污染物暴露 交通数据和健康影响估计中的暴露测量误差。我们假设 空气污染物来源分配浓度的增加将与死产风险增加和 这种影响的大小对于不同的来源类别将是不同的。第二，我们希望研究一下 关于死产风险的邻里关系。第三，考虑到美国国立卫生研究院和国家的健康差距问题， 另一个目标是评估少数族裔将遭受不成比例的死产风险的假设。 空气污染物来源分配浓度和生活在贫困社区的情况，由 社区劣势和居住区绿色化。

ABSTRACT The origin of racial and ethnic disparities in obstetric outcomes does not appear to be genetic nor fully explained by individual-level factors. Hence, we must look toward the broader context in the physical, social and built environments to understand and mitigate disparities in maternal and child health. In the physical, social and built environments, air pollution, neighborhood disadvantage, and residential greenness may play important roles. As compared to low birth weight, fetal growth restriction and preterm birth, considerably less is known about air pollution exposure's impact on stillbirth, defined as an intrauterine fetal death that occurs at or after 20 weeks of gestation. Urban air pollution is a complex mixture of particle and gaseous pollutants, often correlated because they are influenced by common nearby sources and meteorology and thus, simultaneously studying exposure to multiple air pollutants is challenging. Previous studies on the risk of stillbirth associated with air pollution exposure have largely focused on pollutant-specific effects, including our studies examining ozone and metal constituents of PM in the fourth largest city in the U.S., Houston, Texas. Using source apportionment to assess air pollutant exposures takes advantage of the highly correlated nature of the air pollutant mixture, quantifies the contributions of different source categories and provides information that allows more targeted control strategies to be developed. To date, we are aware of only one study that applied source apportionment for fine particulate matter, and it used the Positive Matrix Factorization (PMF) receptor modeling. Yet, that investigation used estimated source contributions as if they were true exposures without accounting for spatial misalignment error and inherent uncertainty in the method itself. Addressing these shortcomings, we will apply an innovative approach that integrates Bayesian spatial multivariate receptor models (BSMRM) with land-use and traffic data as well as accounting for exposure measurement errors in health effects estimation. Like air pollution, the social and built environments cluster neighborhood-level exposures that adversely impact health. These stressors are often greater among minority and low-income populations who suffer what has been termed “double jeopardy”. The objective of the proposed study is three-fold. First, we wish to evaluate the impact of source-specific multipollutant exposures on stillbirth using an innovative approach that integrates BSMRM with land-use and traffic data and accounting for exposure measurement errors in health effects estimation. We hypothesize that increased air pollutant source-apportioned concentrations will be associated with increased risk of stillbirth and that effect sizes will be different for different source categories. Second, we wish to examine the impact of the neighborhood context on risk of stillbirth. Third, given the priority of health disparities for the NIH and the nation, another objective is to evaluate the hypothesis that minorities will suffer disproportionate stillbirth risks associated with air pollutant source-apportioned concentrations and with living in deprived neighborhoods, as assessed by neighborhood disadvantage and residential greenness.