Survival Analysis of Long-Term Exposure to Different Sizes of Airborne Particulate Matter and Risk of Infant Mortality Using a Birth Cohort in Seoul, Korea

BACKGROUND: Several studies suggest that airborne particulate matter (PM) is associated with infant mortality; however, most focused on short-term exposure to larger particles. OBJECTIVES: We evaluated associations between long-term exposure to different sizes of particles [total suspended particles (TSP), PM <= 10 mu m in aerodynamic diameter (PM10), <= 10-2.5 mu m (PM10-2.5), and <= 2.5 mu m (PM2.5)] and infant mortality in a cohort in Seoul, Korea, 2004-2007. METHODS: The study includes 359,459 births with 225 deaths. We applied extended Cox proportional hazards modeling with time-dependent covariates to three mortality categories: all causes, respiratory, and sudden infant death syndrome (SIDS). We calculated exposures from birth to death (or end of eligibility for outcome at 1 year of age) and pregnancy (gestation and each trimester) and treated exposures as time-dependent variables for subjects' exposure for each pollutant. We adjusted by sex, gestational length, season of birth, maternal age and educational level, and heat index. Each cause of death and exposure time frame was analyzed separately. RESULTS: We found a relationship between gestational exposures to PM and infant mortality from all causes or respiratory causes for normal-birth-weight infants. For total mortality (all causes), risks were 1.44 (95% confidence interval, 1.06-1.97), 1.65 (1.18-2.31), 1.53 (1.22-1.90), and 1.19 (0.83-1.70) per interquartile range increase in TSP, PM10, PM2.5, and PM10-2.5, respectively; for respiratory mortality, risks were 3.78 (1.18-12.13), 6.20 (1.50-25.66), 3.15 (1.26-7.85), and 2.86 (0.76-10.85). For SIDS, risks were 0.92 (0.33-2.58), 1.15 (0.38-3.48), 1.42 (0.71-2.87), and 0.57 (0.16-1.96), respectively. CONCLUSIONS: Our findings provide supportive evidence of an association of long-term exposure to PM air pollution with infant mortality.