Exploring the association between air pollution and urogenital congenital anomalies: a global ecological analysis

The relationship between air pollution and urogenital congenital anomalies (UCAs) remains poorly understood. This study performed an ecological analysis of air pollution emissions and the burden of UCAs, aiming to offer new global insights for air pollution control. Data were obtained from the Global Burden of Disease Study (2021) and Emission Database for Global Atmospheric Research. Joinpoint regression assessed temporal trends in burden of UCAs, mixed-effects, nonlinear lag and time-varying effect models were used to investigate potential associations between air pollution emissions and burden. The burden indicators were incidence, deaths and disability-adjusted life years. From 1990 to 2021, the global incidence of UCAs generally declined, with a significant increase observed since 2016. Our analysis identified a positive correlation between burden of UCAs and several air pollutants. Sulfur dioxide(SO₂), ammonia and nitrogen oxides(NO_X) are significantly associated with the incidence of UCAs, while SO₂, NO_X, and non-methane volatile organic compounds are significantly associated with the mortality and disability-adjusted life years rate of UCAs. Sex-specific subgroup analysis indicated differing responses to these pollutants. However, the effect of sulfur dioxide on burden was consistent across sex. Notably, we also found that some pollutants have hysteresis effects that contradict the immediate effects. Additionally, the relationship between air pollution and burden displayed distinct variations over years. This study enhances our understanding of the health impacts on UCAs associated with air pollution, suggested that pregnant women should stay away from ammonia and SO₂. It also emphasizes that strengthening air pollution control should be a key monitoring policy.