Exposure to Air Pollution and Emergency Department Visits During the First Year of Life Among Preterm and Full-term Infants

IMPORTANCE: Previous studies have focused on exposure to fine particulate matter 2.5 μm or less in diameter (PM(2.5)) and on birth outcome risks; however, few studies have evaluated the health consequences of PM(2.5) exposure on infants during their first year of life and whether prematurity could exacerbate such risks. OBJECTIVE: To assess the association of PM(2.5) exposure with emergency department (ED) visits during the first year of life and determine whether preterm birth status modifies the association. DESIGN, SETTING, AND PARTICIPANTS: This individual-level cohort study used data from the Study of Outcomes in Mothers and Infants cohort, which includes all live-born, singleton deliveries in California. Data from infants’ health records through their first birthday were included. Participants included 2 175 180 infants born between 2014 and 2018, and complete data were included for an analytic sample of 1 983 700 (91.2%). Analysis was conducted from October 2021 to September 2022. EXPOSURES: Weekly PM(2.5) exposure at the residential ZIP code at birth was estimated from an ensemble model combining multiple machine learning algorithms and several potentially associated variables. MAIN OUTCOMES AND MEASURES: Main outcomes included the first all-cause ED visit and the first infection- and respiratory-related visits separately. Hypotheses were generated after data collection and prior to analysis. Pooled logistic regression models with a discrete time approach assessed PM(2.5) exposure and time to ED visits during each week of the first year of life and across the entire year. Preterm birth status, sex, and payment type for delivery were assessed as effect modifiers. RESULTS: Of the 1 983 700 infants, 979 038 (49.4%) were female, 966 349 (48.7%) were Hispanic, and 142 081 (7.2%) were preterm. Across the first year of life, the odds of an ED visit for any cause were greater among both preterm (AOR, 1.056; 95% CI, 1.048-1.064) and full-term (AOR, 1.051; 95% CI, 1.049-1.053) infants for each 5-μg/m(3) increase in exposure to PM(2.5). Elevated odds were also observed for infection-related ED visit (preterm: AOR, 1.035; 95% CI, 1.001-1.069; full-term: AOR, 1.053; 95% CI, 1.044-1.062) and first respiratory-related ED visit (preterm: AOR, 1.080; 95% CI, 1.067-1.093; full-term: AOR,1.065; 95% CI, 1.061-1.069). For both preterm and full-term infants, ages 18 to 23 weeks were associated with the greatest odds of all-cause ED visits (AORs ranged from 1.034; 95% CI, 0.976-1.094 to 1.077; 95% CI, 1.022-1.135). CONCLUSIONS AND RELEVANCE: Increasing PM(2.5) exposure was associated with an increased ED visit risk for both preterm and full-term infants during the first year of life, which may have implications for interventions aimed at minimizing air pollution.