Small-Scale Variations in Urban Air Pollution Levels Are Significantly Associated with Premature Births: A Case Study in São Paulo, Brazil

Effects of land cover and air pollution on the risk of preterm births

OBJECTIVE

To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level.

METHODS

The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations.

RESULTS

The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births.

CONCLUSIONS

The results of this study show that greener areas are less associated with preterm births when compared with less green areas.

The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil

BACKGROUND

Currently, more than half of the global population lives in cities. Contemporary urban planning practices result in environmental risk factors (e.g. air pollution, noise, lack of green space, excess heat) that put health and well-being of city dwellers at risk and contribute to chronic diseases and premature death. Despite a growing body of evidence on adverse health impacts related to current urban and transport planning practices, especially for cities in the Global North, not much is known about associated health impacts in South American cities. Therefore, we estimated the mortality burden attributable to breaching internationally-recommended or locally-preferable exposure levels of urban planning related environmental exposures in Sao Paulo, Brazil.

METHODS

We carried out a health impact assessment study, following the comparative risk assessment framework, to assess preventable mortality impacts of breaching exposure recommendations for air pollution, green spaces and temperature at the census tract (CT) level (n = 18,363). We also assessed the distribution thereof by socioeconomic vulnerability.

RESULTS

We estimated that annually 11,372 (95% CI: 7921; 15,910) attributable deaths could be prevented by complying with recommended exposure levels. The largest proportion of preventable mortality was due to breaching air pollution limits (i.e. 8409 attributable deaths), followed by insufficient green space (i.e. 2593), and excess heat (i.e. 370). Adverse health impacts were larger in CTs of lower socioeconomic vulnerability, due to demographic profile, traffic density and residential area configurations.

DISCUSSION

Not complying with the health limits for air pollution, green space and temperature exposures resulted in a considerable preventable mortality burden (i.e. 17% of total expected deaths) in Sao Paulo. This burden can be reduced by improving current urban and transport planning practices.

Assessing the association between air pollution and child development in São Paulo, Brazil

Background

Outdoor air pollution is increasingly recognised as a key threat to population health globally, with particularly high risks for urban residents. In this study, we assessed the association between residential nitrogen dioxide (NO₂) exposure and children’s cognitive and behavioural development using data from São Paulo Brazil, one of the largest urban agglomerations in the world.

Methods

We used data from the São Paulo Western Region Birth Cohort, a longitudinal cohort study aiming to examine determinants as well as long-term implications of early childhood development. Cross-sectional data from the 72-month follow-up was analysed. Data on NO₂ concentration in the study area was collected at 80 locations in 2019, and land use regression modelling was used to estimate annual NO₂ concentration at children’s homes. Associations between predicted NO₂ exposure and children’s cognitive development as well as children’s behavioural problems were estimated using linear regression models adjusted for an extensive set of confounders. All results were expressed per 10 μg/m³ increase in NO2.

Results

1143 children were included in the analysis. We found no association between NO₂ and children’s cognitive development (beta -0.05, 95% CI [-0.20; 0.10]) or behavioural problems (beta 0.02, 95% CI [-0.80; 0.12]).

Conclusion

No association between child cognition or child behaviour and NO₂ was found in this cross-sectional analysis. Further research will be necessary to understand the extent to which these null results reflect a true absence of association or other statistical, biological or adaptive factors not addressed in this paper.

Health and the Megacity: Urban Congestion, Air Pollution, and Birth Outcomes in Brazil

We studied the health effects of economic development in heavily urbanized areas, where congestion poses a challenge to environmental conditions. We employed detailed data from air pollution and birth records around the metropolitan area of São Paulo, Brazil, between 2002 and 2009. During this period, the megacity experienced sustained growth marked by the increases in employment rates and ownership of durable goods, including automobiles. While better economic conditions are expected to improve infant health, air pollution that accompanies it is expected to do the opposite. To untangle these two effects, we focused on episodes of thermal inversion—meteorological phenomena that exogenously lock pollutants closer to the ground—to estimate the causal effects of in utero exposure to air pollution. Auxiliary results confirmed a positive relationship between thermal inversions and several air pollutants, and we ultimately found that exposure to inversion episodes during the last three months of pregnancy led to sizable reductions in birth weight and increases in the incidence of preterm births. Increased pollution exposure induced by inversions also has a significant impact over fetal survival as measured by the size of live-birth cohorts.

Evaluating spatial patterns of seasonal ozone exposure and incidence of respiratory emergency room visits in Dallas-Fort Worth

BACKGROUND

In urban environments, environmental air pollution poses significant risks to respiratory health. Moreover, the seasonal spatial variability of the air pollutant ozone, and respiratory illness within Dallas-Fort Worth (DFW) is not well understood. We examine the relationships between spatial patterns of long-term ozone exposure and respiratory illness to better understand impacts on health outcomes. We propose that this study will establish an enhanced understanding of the spatio-temporal characteristics of ozone concentrations and respiratory emergency room visits (ERV) incidence.

METHODS

Air pollution data (ozone) and ERV incidence data from DFW was used to evaluate the relationships between exposures and outcomes using three steps: (1) develop a geostatistical model to produce quarterly maps of ozone exposure for the DFW area; (2) use spatial analysis techniques to identify clusters of zip codes with high or low values of ozone exposure and respiratory ERV incidence; and (3) use concentration-response curves to evaluate the relationships between respiratory ERV incidence and ozone exposure.

RESULTS

Respiratory ERV incidence was highest in quarters 1 and 4, while ozone exposure was highest in quarters 2 and 3. Extensive statistically significant spatial clusters of ozone regions were identified. Although the maps revealed that there was no regional association between the spatial patterns of high respiratory ERV incidence and ozone exposure, the concentration-response analysis suggests that lower levels of ozone exposure may still contribute to adverse respiratory outcomes.

Effects of Air Pollution on Human Health and Costs: Current Situation in São Paulo, Brazil

This study focused on verifying whether the emission of air pollutants in São Paulo increases the costs and number of hospitalizations for respiratory diseases in Brazil. Data on pollutant emissions, hospitalizations, and hospital costs were collected from 2008 to 2017 and correlated with air quality standards. The results showed that the concentration of particulate matter increased each year during the study period and was highly correlated with hospitalizations due to respiratory diseases. Ozone (O3) was within the quality standard throughout the study period but registered an increase in the mean and a positive correlation with hospitalizations due to respiratory diseases. The carbon monoxide (CO), sulfur dioxide (SO2), and nitrogen dioxide (NO2) levels were within the quality standards throughout the study period with a decrease in the last years studied, but showed a positive correlation with hospitalizations due to respiratory diseases. The pollutant emissions and hospitalizations due to respiratory diseases had an inverse relationship with the monthly rainfall curve for São Paulo, which indicates that rainfall tended to reduce pollutant emissions and consequently hospitalizations due to inhalation of these pollutants. Because costs are directly associated with hospitalizations, both increased during the study period—302,000 hospitalizations at an average cost of 368 USD resulted in a total cost of 111 million USD. To reduce these costs, Brazil should implement stricter policies to improve the air quality of its major cities and develop a viable alternative to diesel vehicles.

The Use of the Internet of Things for Estimating Personal Pollution Exposure

This paper proposes a framework for an Air Quality Decision Support System (AQDSS), and as a proof of concept, develops an Internet of Things (IoT) application based on this framework. This application was assessed by means of a case study in the City of Madrid. We employed different sensors and combined outdoor and indoor data with spatiotemporal activity patterns to estimate the Personal Air Pollution Exposure (PAPE) of an individual. This pilot case study presents evidence that PAPE can be estimated by employing indoor air quality monitors and e-beacon technology that have not previously been used in similar studies and have the advantages of being low-cost and unobtrusive to the individual. In future work, our IoT application can be extended to include prediction models, enabling dynamic feedback about PAPE risks. Furthermore, PAPE data from this type of application could be useful for air quality policy development as well as in epidemiological studies that explore the effects of air pollution on certain diseases.