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

Moreira, Tiana C. L.; Polizel, Jefferson L.; Réquia, Weeberb J.; Saldiva, Paulo Hilario Nascimento; Silva Filho, Demostenes F. da; Saldiva, Silvia Regina Dias Medici; Mauad, Thais

doi:10.11606/s1518-8787.2024058005504

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Original Article • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058005504 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM_2.5) 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 PM_2.5. 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 (PM_2.5) 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.

Parks, Recreational; Air Pollution; Infant, Premature; Built Environment

Land cover	Q1 (%)	Q2 (%)	Q3 (%)	Q4 (%)
Green areas	15.4 (24.8)	25.8 (33.6)	34.6 (45.0)	46.0 (84.8)
Tree cover	6.9 (14.7)	15.7 (23.3)	24.3 (33.6)	34.6 (73.4)
Grass cover	3.4 (8.0)	9.05 (9.31)	10.31 (11.6)	12.6 (17.7)
Built area	4.6 (21.0)	22.0 (29.9)	30.9 (36.7)	37.7 (49.7)
PM_2.5	11.8 (12.1)	13.2 (12.3)	13.3 (12.7)	13.7 (13.7)
Street trees	0.5 (4.8)	5.82 (6.8)	7.8 (9.73)	10.73 (16.2)

Characteristics	n	%
Sociodemographic (n = 166,384)
Maternal age
Mean (CV%)	27.7 (23.8%)
Median [Min, Max]	28.0 [11.0, 52.0]
Standard deviation	6.6
Marital status of the mother
Single	75,261.	43.2
Married	68,082	39.08
Widow	278	0.16
Separated/divorced	2,451	1.41
Stable union	27,878	16
No data	58	0.03
Educational level
No schooling	17	0.01
Primary Education I	294	0.17
Primary Education II	2,019	1.16
Secondary Education	20,487	11.76
Incomplete Higher Education	103,185	59.23
Complete Higher Education	47,896	27.49
No data	169	0.1
Newborn health (n = 166,384)
APGAR Scale
0		0.09
1		0.13
2		0.05
3		0.06
4		0.11
5		0.22
6		0.33
7		0.94
8		4.23
9		34.86
10		58.65
No data		0.1
Presence of congenital abnormalities
Yes		1.84
No		98.02
No data		0.1
Gestational age
Preterm	18,434	12.31
Early term	61,147	36.06
Full term	73,537	42.63
Late term	9,702	5.62
Post-term	3,628	2.12
Birth Weight (CV)
Mean (CV)	3,162.90	17.7
Median [Min, Max]	[500, 4,990]
Standard deviation	354
No data	6	0
Gestational age at delivery (CV)
Mean (CV%)	38.3	5.8
Median [Min, Max]	39.0 (19.0, 46.0)
Standard deviation	2.21
No data	2,196	1.3

Gestational Age at Delivery		No adjustment			Logistic
	Predictor	Odds ratio	CI	p	Odds ratio	CI	p
Marital status - ref: single	Married ref	---------	------------	------	-------	-------------	------
	Single	1.11	1.08 – 1.15	0.001	1.12	1.04 – 1.12	0.001
	Widow	1.09	0.73 – 1.56	0.629	1.10	0.71 – 1.52	0.747
	Separated/divorced	1.06	0.92 – 1.20	0.379	1.06	0.92 – 1.20	0.418
	Stable union	1.11	1.06 – 1.16	0.001	1.11	1.02 – 1.12	0.003
Educational level - ref: no schooling	No schooling	1.07	0.63 – 1.80	0.794	1.06	0.60 – 1.73	0.815
	Primary Education I	1.46	1.04 – 2.05	0.026	1.42	1.00 – 1.97	0.040
	Primary Education II	1.27	1.10 – 1.45	0.001	1.23	1.07– 1.41	0.003
	Secondary Education	1.20	1.14 – 1.26	0.001	1.17	1.10 – 1.23	0.001
	Incomplete Higher Education	1.09	1.04 – 1.12	0.001	1.06	1.02 – 1.10	0.003
	Complete Higher Education ref	---------	------------	------	-------	-------------	------
Age - ref: 20-34.9	Ref: 20-34.9	---------	------------	------	-------	-------------	------
	= 15	1.59	1.30 – 1.92	0.001	1.08	0.86 – 1.36	0.472
	15-19.9	1.27	1.21 – 1.32	0.001	1.05	0.99 – 1.11	0.064
	35-39.9	1.19	1.13 – 1.23	0.001	1.20	1.14 – 1.27	0.001
	≥40	1.43	1.32 – 1.54	0.001	1.30	1.18 – 1.42	0.001
Ethnicity - ref: white	White	---------	------------	------	-------	-------------	------
	Black	1.09	1.02 – 1.15	0.006	1.04	‘	0.142
	Asian	0.93	0.80 – 1.06	0.278	0.94	0.82 – 1.08	0.426
	Mixed-race	1.01	0.97 – 1.04	0.519	0.96	0.93 – 1.00	0.065
	Indigenous	0.86	0.68 – 1.06	0.177	0.80	0.63 – 0.99	0.050
Type of delivery - ref: vaginal	Vaginal delivery	---------	------------	------	-------	-------------	------
Type of delivery - ref: vaginal	Cesarean section	0.98	0.94 – 1.00	0.145	0.96	0.92 – 0.99	0.039
Prenatal appointments	Number of appointments	0.933	0.92 - 0.93	0.001	0.93	0.93 - 0.94	0.022
Birth data	APGAR at 5 minutes	0.82	0.81 – 0.83	0.001	0.97	0.96 – 0.98	0.001
Birth data	Birth weight (kg)	1.00	0.99 – 0.99	0.001	0.99	0.99 – 0.99	0.001
Green spaces - quartiles	Green Area Q1 [15.4-24.8]	1.07	1.02 – 1.11	0.002	1.08	1.03 – 1.13	0.001
	Green Area Q2 [25.8-33.6]	1.04	0.99 – 1.08	0.104	1.05	1.00 – 1.10	0.018
	Green Area Q3 [34.6-45]	0.99	0.94 – 1.029	0.516	0.99	0.94 – 1.3	0.671
	Green Area Q4 [46-84.8]	---------	------------	------	-------	-------------	------
Tree cover - quartiles	Tree cover Q1 [6.9-14.7]	1.06	1.01 – 1.10	0.011	1.07	1.02- 1.12	0.001
	Tree cover Q2 [15.7-23.3]	1.03	0.98 – 1.07	0.206	1.04	0.99-1.09	0.059
	Tree cover Q3 [24.3-33.6]	0.98	0.93 – 1.02	0.384	0.98	0.94 – 1.03	0.571
	Tree cover Q4 [34.6-73.4]	-------	-------------	------	-------	-------------	------
Grass cover- quartiles	Grass cover - Q1 [3.4-8]	1.11	1.06 – 1.16	0.001	1.09	1.04 – 1.14	0.001
	Grass cover - Q2 [9.05-9.31]	1.11	1.06 – 1.16	0.001	1.08	1.03 – 1.13	0.001
	Grass cover - Q3 [10.31-11.6]	1.04	0.99 – 1.08	0.125	1.02	0.97 – 1.07	0.301
	Grass cover - Q4 [12.6-17.7]	-------	-------------	------	-------	-------------	------
Built area - quartiles	Built area - Q1 [4.6-21]	---------	------------	------	-------	-------------	------
	Built area - Q2 [22-29.9]	1.02	0.97 – 1.06	0.297	1.03	0.99 – 1.08	0.123
	Built area - Q3 [30.9-36.7]	1.02	0.97 – 1.06	0.314	1.02	0.97 – 1.07	0.357
	Built area - Q4 [37.7-49.7]	1.09	1.04 – 1.13	0.001	1.09	1.04 – 1.14	0.001
PM_2.5 - quartiles	PM_2.5 - Q1 [11.8-12.1]	---------	------------	------	-------	-------------	------
	PM_2.5 - Q2 [13.2-12.3]	0.98	0.93 – 1.01	0.275	0.97	0.93 – 1.02	0.380
	PM_2.5 - Q3 [13.3-12.7]	1.02	0.97 – 1.06	0.388	1.01	0.96 – 1.05	0.613
	PM_2.5 - Q4 [13.7-13.7]	0.99	0.94 – 1.03	0.546	1.00	0.95 – 1.05	0.943
	GeoSES Mean	0.96	0.91 – 0.99	0.035	1.00	0.95 – 1.05	0.915
Street trees – quartiles (ref: 9.73-16.2)	Street trees - Q1 [0.53-4.82]	1.01	0.96 – 1.05	0.595	1.00	0.95-1.04	0.940
	Street trees - Q2 [5.82-6.8]	0.97	0.92 – 1.00	0.11	0.95	0.91-0.99	0.034
	Street trees - Q3 [7.8-9.73]	1.00	0.95 – 1.04	0.975	1.01	0.95-1.04	0.945
	Street trees - Q4 [9.73-16.2]	-------	-------------	------	-------	-------------	------

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Tiana Carla Lopes Moreira, Universidade de São Paulo, Faculdade de Medicina, Avenida Dr. Arnaldo, 455, sala 1.145, 01246-903 - São Paulo, SP, Brazil. Email: tianacarla@alumni.usp.br