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

摘要 产科结果中种族和民族差异的根源似乎不是遗传的，也没有得到充分解释 受个人层面的因素影响。因此，我们必须着眼于物质、社会和建筑等更广泛的背景。 了解和减少孕产妇和儿童健康方面的差异的环境。在物质、社会和建筑方面 环境、空气污染、邻里劣势和住宅绿化可能发挥重要作用。作为 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，死产定义为妊娠 20 周或之后发生的宫内胎儿死亡 妊娠。城市空气污染是颗粒污染物和气态污染物的复杂混合物，通常相互关联，因为 他们受到附近常见来源和气象的影响，因此同时研究暴露 应对多种空气污染物具有挑战性。先前关于空气污染与死产风险的研究 暴露主要集中在特定污染物的影响上，包括我们对臭氧和金属的研究 美国第四大城市德克萨斯州休斯敦市的总理选民。使用源解析进行评估 空气污染物暴露利用空气污染物混合物的高度相关性，量化 不同来源类别的贡献，并提供允许更有针对性的控制策略的信息 待开发。迄今为止，我们只知道一项应用细颗粒物源解析的研究 它使用正矩阵分解（PMF）受体模型。然而，该调查使用了 估计源贡献就好像它们是真实曝光一样，而不考虑空间错位误差 以及方法本身固有的不确定性。针对这些不足，我们将采用创新的 将贝叶斯空间多元受体模型 (BSMRM) 与土地利用和交通数据相结合的方法 以及在健康影响估计中考虑暴露测量误差。与空气污染一样，社会 和建筑环境聚集了邻里层面的暴露，对健康产生不利影响。这些压力源是 遭受所谓“双重危险”的少数族裔和低收入人群往往更为严重。 拟议研究的目标有三个。首先，我们希望评估特定来源的影响 使用将 BSMRM 与土地利用和土地利用相结合的创新方法来研究死产的多污染物暴露 交通数据和对健康影响估计中暴露测量误差的解释。我们假设 空气污染物源分配浓度的增加将与死产和死产风险增加相关 对于不同的来源类别，效果大小会有所不同。其次，我们希望考察一下影响 社区环境对死产风险的影响。第三，考虑到 NIH 和国家的健康差异问题， 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 根据评估，空气污染物源分摊浓度以及生活在贫困社区的 邻里劣势和住宅绿化。

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.