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Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs
Leonardo Trasande1, Patrick Malecha, Teresa M Attina
1Department of Pediatrics, New York University (NYU) School of Medicine, New York, New York, USA.
Insights
High preterm birth rates in the US are linked to fine particulate matter (PM2.5) exposure. Reducing PM2.5 could yield significant health and economic benefits.
Area of Science:
- Environmental Health
- Public Health
- Epidemiology
Background:
- Preterm birth (PTB) poses a significant public health challenge in the US, with high morbidity rates.
- Prenatal exposure to fine particulate matter (PM2.5) is associated with adverse birth outcomes.
- Previous studies have not fully quantified the burden and economic costs of PM2.5-attributable PTB in the US.
Purpose of the Study:
- To estimate the national burden of PTB attributable to PM2.5 exposure in the United States for the year 2010.
- To quantify the economic costs associated with PM2.5-attributable PTB, including direct medical care and lost productivity.
Main Methods:
- Utilized PM2.5 data from the U.S. Environmental Protection Agency and PTB odds ratios from meta-analyses, converting to relative risks.
- Applied a reference level of 8.8 μg/m3 for PM2.5 and county-level PTB prevalence to calculate attributable PTBs.
- Estimated direct medical costs and lost economic productivity (LEP) linked to PTB-associated IQ loss.
Main Results:
- An estimated 3.32% of national PTBs in 2010, totaling 15,808 births, were attributable to PM2.5 exposure.
- The economic cost of PM2.5-attributable PTBs was estimated at $5.09 billion, with $760 million for medical care.
- Higher attributable fractions of PTB were observed in urban counties, particularly in the Ohio Valley and southern US.
Conclusions:
- PM2.5 exposure significantly contributes to the burden and economic costs of preterm birth in the United States.
- Environmental regulatory interventions aimed at reducing PM2.5 exposure during pregnancy can lead to substantial health and economic benefits.
- Further research and policy interventions are warranted to mitigate the impact of air pollution on birth outcomes.
Background:
Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States.
Objectives:
We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010.
Methods:
Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07-1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars.
Results:
An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43-9.66 B], of which $760 million were spent for medical care (SA: $362 M-1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States.
Conclusions:
PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913-1918; http://dx.doi.org/10.1289/ehp.1510810.
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