摘要：Background:
Ambient fine particulate matter [PM
≤
2.5
μ
m
in aerodynamic diameter (
PM
2.5
)] is a major health risk for children, particularly in South Asia, which currently experiences the highest
PM
2.5
levels globally. Nevertheless, there is comparatively little epidemiological evidence from this region to quantify the effects of
PM
2.5
on child survival.
Objectives:
We estimated the association between
PM
2.5
exposure and child survival in India.
Methods:
We constructed a large, retrospective, and nationally representative cohort of children
<
5
years of age
, born between 2009–2016, from the publicly available, cross-sectional 2015–2016 Demographic Health Surveys in India.
In utero and post-delivery lifetime average ambient
PM
2.5
exposures were estimated with data from satellite remote sensing, meteorology, and land use information (model
R
2
=
0.82). We used Cox proportional hazards regression to estimate the association between both average
in utero and post-delivery lifetime
PM
2.5
and all-cause child mortality, controlling for individual- and household-level covariates, seasonality, location, and meteorology.
Results:
Over 7,447,724 child-months of follow-up, there were 11,559 deaths at
<
5
years of age
reported by the children’s mothers. The mean concentrations of 9-month
in utero and post-delivery lifetime average ambient
PM
2.5
exposure were
71.1
μ
g
/
m
3
(range:
20.9
–
153.5
μ
g
/
m
3
) and
73.7
μ
g
/
m
3
(range:
14.0
–
247.3
μ
g
/
m
3
), respectively. Estimated child mortality adjusted hazard ratios were 1.023 [95% confidence interval (CI): 1.008, 1.038] and 1.013 (95% CI: 1.001, 1.026) per
10
-
μ
g
/
m
3
increase of
in utero and post-delivery lifetime
PM
2.5
, with both exposures in the model.
Discussion:
This study adds to the growing body of evidence about the adverse health effects of
PM
2.5
by demonstrating the association between exposure, both
in utero and post-delivery, on child survival at the national level in India. Strategies to reduce ambient air pollution levels, including steps to minimize
in utero and early life exposures, are urgently needed in India and other countries where exposures are above recommended guideline values.
https://doi.org/10.1289/EHP8910
