Modeling spatial effects of PM{sub 2.5} on term low birth weight in Los Angeles County
Air pollution epidemiological studies suggest that elevated exposure to fine particulate matter (PM{sub 2.5}) is associated with higher prevalence of term low birth weight (TLBW). Previous studies have generally assumed the exposure–response of PM{sub 2.5} on TLBW to be the same throughout a large geographical area. Health effects related to PM{sub 2.5} exposures, however, may not be uniformly distributed spatially, creating a need for studies that explicitly investigate the spatial distribution of the exposure–response relationship between individual-level exposure to PM{sub 2.5} and TLBW. Here, we examine the overall and spatially varying exposure–response relationship between PM{sub 2.5} and TLBW throughout urban Los Angeles (LA) County, California. We estimated PM{sub 2.5} from a combination of land use regression (LUR), aerosol optical depth from remote sensing, and atmospheric modeling techniques. Exposures were assigned to LA County individual pregnancies identified from electronic birth certificates between the years 1995-2006 (N=1,359,284) provided by the California Department of Public Health. We used a single pollutant multivariate logistic regression model, with multilevel spatially structured and unstructured random effects set in a Bayesian framework to estimate global and spatially varying pollutant effects on TLBW at the census tract level. Overall, increased PM{sub 2.5} level was associated with higher prevalence of TLBW county-wide. The spatial random effects model, however, demonstrated that the exposure–response for PM{sub 2.5} and TLBW was not uniform across urban LA County. Rather, the magnitude and certainty of the exposure–response estimates for PM{sub 2.5} on log odds of TLBW were greatest in the urban core of Central and Southern LA County census tracts. These results suggest that the effects may be spatially patterned, and that simply estimating global pollutant effects obscures disparities suggested by spatial patterns of effects. Studies that incorporate spatial multilevel modeling with random coefficients allow us to identify areas where air pollutant effects on adverse birth outcomes may be most severe and policies to further reduce air pollution might be most effective. - Highlights: • We model the spatial dependency of PM{sub 2.5} effects on term low birth weight (TLBW). • PM{sub 2.5} effects on TLBW are shown to vary spatially across urban LA County. • Modeling spatial dependency of PM{sub 2.5} health effects may identify effect 'hotspots'. • Birth outcomes studies should consider the spatial dependency of PM{sub 2.5} effects.