支气管肺发育不良早产儿出院后急性呼吸系统疾病的环境决定因素。
Environmental Determinants of Post-Discharge Acute Respiratory Illness among Preterm Infants with Bronchopulmonary Dysplasia.
发表日期:2024 May 20
作者:
Jonathan J Szeto, Joshua K Radack, Sara B DeMauro, Erik A Jensen, Kathleen Gibbs, Nicolas P Novick, Kristan A Scott, Daria C Murosko, Heather H Burris, Timothy D Nelin
来源:
Int J Env Res Pub He
摘要:
分析疾病控制与预防中心 (CDC) 环境正义指数 (EJI) 各组成部分与支气管肺发育不良 (BPD) 婴儿出院后一年内呼吸系统健康结果的关联。一组患有 BPD 的早产儿的回顾性队列研究。多变量逻辑回归模型估计了 EJI 及其组成部分与就医的急性呼吸道疾病(定义为新生儿重症监护病房出院一年内的急诊就诊或住院患者再入院)之间的关联。进行中介分析以评估环境不公正如何导致急性呼吸道疾病的种族差异。EJI 较高与就医呼吸道疾病的风险增加相关(根据 EJI 标准差增量,aOR 1.38,95% CI:1.12-1.69 )。在该指数的组成部分中,环境负担模块的空气污染领域关联性最大(aOR 1.44,95% CI:1.44-2.61)。就 EJI 内的各个指标而言,柴油颗粒物 (DSLPM) 和空气毒性癌症风险 (ATCR) 表现出最强的关系(aOR 2.06,95% CI:1.57-2.71 和 aOR 2.10,95% CI:1.59-2.78,分别)。在非西班牙裔黑人婴儿中,63% 的人患有急性呼吸道疾病,而非西班牙裔白人婴儿中这一比例为 18%。 DSLPM 介导了就医的急性呼吸道疾病中 39% 的黑白差异 (p = 0.004)。在调整临床、人口统计学、和社会脆弱性风险因素。某些类型的空气污染物,即 DSLPM,与急性呼吸道疾病的关系更为密切。环境暴露可能会导致边缘性人格障碍婴儿急性呼吸道疾病就医的种族差异。
To analyze the association of components of the Centers for Disease Control and Prevention (CDC) Environmental Justice Index (EJI) with respiratory health outcomes among infants with bronchopulmonary dysplasia (BPD) within one year after discharge from the neonatal intensive care unit.This was a retrospective cohort study of a cohort of preterm infants with BPD. Multivariable logistic regression models estimated associations of EJI and its components with medically attended acute respiratory illness, defined as an ED visit or inpatient readmission, within one year of discharge from the neonatal intensive care unit. A mediation analysis was conducted to evaluate how environmental injustice may contribute to racial disparities in acute respiratory illness.Greater EJI was associated with an increased risk of medically attended respiratory illness (per EJI standard deviation increment, aOR 1.38, 95% CI: 1.12-1.69). Of the index's components, the Environmental Burden Module's Air pollution domain had the greatest association (aOR 1.44, 95% CI: 1.44-2.61). With respect to individual indicators within the EJI, Diesel Particulate Matter (DSLPM) and Air Toxic Cancer Risk (ATCR) demonstrated the strongest relationship (aOR 2.06, 95% CI: 1.57-2.71 and aOR 2.10, 95% CI: 1.59-2.78, respectively). Among non-Hispanic Black infants, 63% experienced a medically attended acute respiratory illness as compared to 18% of non-Hispanic White infants. DSLPM mediated 39% of the Black-White disparity in medically attended acute respiratory illness (p = 0.004).Environmental exposures, particularly air pollution, are associated with post-discharge respiratory health outcomes among preterm infants with BPD after adjusting for clinical, demographic, and social vulnerability risk factors. Certain types of air pollutants, namely, DSLPM, are more greatly associated with acute respiratory illness. Environmental exposures may contribute to racial disparities in medically attended acute respiratory illness among infants with BPD.