Air pollution attributable postneonatal infant mortality in U.S. metropolitan areas: a risk assessment study

BACKGROUND: The impact of outdoor air pollution on infant mortality has not been quantified. METHODS: Based on exposure-response functions from a U.S. cohort study, we assessed the attributable risk of postneonatal infant mortality in 23 U.S. metropolitan areas related to particulate matter <10 μm in diameter (PM(10)) as a surrogate of total air pollution. RESULTS: The estimated proportion of all cause mortality, sudden infant death syndrome (normal birth weight infants only) and respiratory disease mortality (normal birth weight) attributable to PM(10 )above a chosen reference value of 12.0 μg/m(3 )PM(10 )was 6% (95% confidence interval 3–11%), 16% (95% confidence interval 9–23%) and 24% (95% confidence interval 7–44%), respectively. The expected number of infant deaths per year in the selected areas was 106 (95% confidence interval 53–185), 79 (95% confidence interval 46–111) and 15 (95% confidence interval 5–27), respectively. Approximately 75% of cases were from areas where the current levels are at or below the new U.S. PM(2.5 )standard of 15 μg/m(3 )(equivalent to 25 μg/m(3 )PM(10)). In a country where infant mortality rates and air pollution levels are relatively low, ambient air pollution as measured by particulate matter contributes to a substantial fraction of infant death, especially for those due to sudden infant death syndrome and respiratory disease. Even if all counties would comply to the new PM(2.5 )standard, the majority of the estimated burden would remain. CONCLUSION: Given the inherent limitations of risk assessments, further studies are needed to support and quantify the relationship between infant mortality and air pollution.