Prenatal Exposure to Air Pollution and Pediatric Biliary Atresia: A Nationwide Population-Based Cohort Study
Chieh-Chung Lin1,2, Shu-Yen Chan3, Wei-Szu Lin4
1Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung, 40201, Taiwan.
Insights
This study found no link between prenatal air pollution exposure and biliary atresia (BA) risk in Taiwan. Further research is needed to understand the causes of this serious pediatric liver disease.
Area of Science:
- Environmental Health
- Pediatric Gastroenterology
- Epidemiology
Background:
- Biliary atresia (BA) is a critical pediatric liver disease and the primary indication for pediatric liver transplantation.
- The etiology of BA remains unknown, but environmental factors like air pollution are suspected to play a role in childhood diseases.
Purpose of the Study:
- To investigate the potential association between prenatal exposure to ambient air pollutants and the incidence of biliary atresia (BA).
Main Methods:
- A nationwide, longitudinal matched case-control study was conducted using Taiwan's National Health Insurance Research Database.
- BA cases and controls were matched by age, month, and gender. Multivariable logistic regression models assessed the association between various air pollutants (PSI, SO2, CO, O3, PM2.5, PM10, NO, NO2, NOx) and BA risk, adjusting for confounders.
- Quartile analysis examined potential dose-dependent effects of cumulative air pollutant exposure.
Main Results:
- The study analyzed data from 1,655,214 newborns, identifying 253 BA cases.
- After adjusting for confounders, no statistically significant associations were observed between prenatal air pollution exposure and the risk of BA.
- Analysis of cumulative air pollutant exposure across quartiles revealed no dose-response relationship with BA risk.
Conclusions:
- This population-based study in Taiwan found no statistically significant association between prenatal air pollution exposure and the risk of developing biliary atresia in newborns.
- The findings do not support a link between common air pollutants and BA incidence during the prenatal period.
Introduction:
Biliary atresia (BA) is a serious pediatric liver disease and the leading cause of liver transplants in children. Although its cause is unknown, prior research suggests air pollution may influence childhood diseases. This study examines the potential association between prenatal air pollution exposure and BA incidence.
Methods:
This nationwide, longitudinal matched case-control study used data from the National Health Insurance Research Database in Taiwan. BA cases were identified using ICD codes in children who underwent the Kasai procedure or liver transplantation. Controls, matched by age, index month, and gender, were selected at a 1:10 ratio. Multivariable logistic regression models, adjusted for potential confounders (age, gender, maternal age, delivery mode, and preterm birth), were utilized to assess the association between individual air pollutants (PSI, SO2, CO, O3, PM2.5, PM10, NO, NO2, and NOx) and BA. Quartiles of cumulative air pollutant amounts were analyzed for dose-dependent effects.
Results:
A total of 1,663,737 first-time pregnancies were identified from 2004 to 2016. After excluding 8,523 newborns due to congenital neonatal defects, 1,655,214 individuals remained. Among them, a cohort of 253 BA patients was identified. After adjusting for multiple confounders, no significant associations were found between prenatal exposure to air pollutants and BA risk. Quartile analysis of cumulative air pollutant exposure also indicated no dose-response relationship with BA risk for each air pollutant.
Conclusion:
This population-based study found no statistically significant association between prenatal air pollution exposure and the risk of BA in newborns in Taiwan.
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