American Journal of Epidemiology Advance Access originally published online on June 22, 2005
American Journal of Epidemiology 2005 162(2):140-148; doi:10.1093/aje/kwi173
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ORIGINAL CONTRIBUTIONS |
Preterm Birth: The Interaction of Traffic-related Air Pollution with Economic Hardship in Los Angeles Neighborhoods
1 Department of Health Services, School of Public Health, University of California at Los Angeles, Los Angeles, CA
2 Center for Health Policy and Research, School of Public Health, University of California at Los Angeles, Los Angeles, CA
3 Department of Epidemiology, School of Public Health, University of California at Los Angeles, Los Angeles, CA
4 Department of Environmental Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CA
Reprint requests to Dr. Ninez A. Ponce, Department of Health Services, 31-254B CHS, School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095-1772 (e-mail: nponce{at}ucla.edu).
Preterm birth may be affected by the interaction of residential air pollution with neighborhood economic hardship. The authors examined variations in traffic-related pollution exposure—measured by distance-weighted traffic density—using a framework reflecting the social and physical environments. An adverse social environment was conceptualized as low socioeconomic status (SES) neighborhoods—census tracts with concentrated poverty, unemployment, and dependence on public assistance. An adverse physical environment was depicted by the winter season, when thermal inversions trap motor vehicle pollutants, thereby increasing traffic-related air pollution. Los Angeles County, California, birth records from 1994 to 1996 were linked to traffic counts, census data, and ambient air pollution measures. The authors fit multivariate logistic models of preterm birth, stratified by neighborhood SES and third pregnancy trimester season. Traffic-related air pollution exposure disproportionately affected low SES neighborhoods in the winter. Further, in these poorer neighborhoods, the winter season evidenced increased susceptibility among women with known risk factors. Health insurance was most beneficial to women residing in neighborhoods exposed to economic hardship and an adverse physical environment. Reducing preterm births warrants a concerted effort of social, economic, and environmental policies, focused on not only individual risk factors but also the reduction of localized air pollution, expansion of health-care coverage, and improvement of neighborhood resources.
air pollution; premature birth; socioeconomic factors
Abbreviations: CI, confidence interval; DWTD, distance-weighted traffic density; OR, odds ratio; SES, socioeconomic status
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