To examine the association between individual lifetime measures of mean exposure to air pollution and postneonatal respiratory deaths, we have conducted a matched population-based case-control study covering all births registered in the Czech Republic from 1989 to 1991 that were linked to death records. For each case of infant death, we have randomly selected 20 controls from infants of the same sex born on the same day and alive when the case died. Exposure was assigned as the arithmetic mean of all 24-hour air pollution measurements in the district of residence of each case and control for the period between the birth and death of the index case. We used conditional logistic regression to estimate the effects of suspended particles, sulfur dioxide, and nitrogen oxides on risk of death in the neonatal and postneonatal period, controlling for maternal socioeconomic status and birth weight, birth length, and gestational age. There were 2,494 infant deaths with exposure data on at least one pollutant, 133 of them from respiratory causes. The effects of all pollutants were strongest in the postneonatal period and were specific for respiratory causes. For these, rate ratios for a 50 microg/m3 increase in particles, sulfur dioxide, and nitrogen oxides were 1.95 [95% confidence interval (CI) = 1.09-3.50], 1.74 (95% CI = 1.01-2.98), and 1.66 (95% CI = 0.98-2.81), respectively, after controlling for all covariates. Only particles showed a consistent association when all pollutants were entered in one model. We found no evidence of a relation between any pollutant and mortality from other causes. These results indicate that the effects of air pollution on infant mortality are specific for respiratory causes in the postneonatal period, are independent of socioeconomic factors, and are not mediated by birth weight or gestational age.

• MeSH
• gestační stáří MeSH
• kouření MeSH
• lidé MeSH
• logistické modely MeSH
• nemoci dýchací soustavy mortalita   MeSH
• novorozenec MeSH
• porodní hmotnost MeSH
• socioekonomické faktory MeSH
• studie případů a kontrol MeSH
• znečištění ovzduší škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: Outdoor air pollution has consistently been shown to predict mortality. The finding that this association is stronger in infants than in children or adults raises the question whether air pollution could also be related to pregnancy outcomes--such as birthweight and stillbirth. The association between outdoor air pollution and stillbirths and low birthweight in the Czech Republic, where air pollution was high, was examined. METHODS: An ecological study was conducted, with routinely collected data on stillbirths and low birthweight (< 2500 g), air pollution (total suspended particulates, sulphur dioxide (SO2), and nitrogen oxides (NOx)), and socioeconomic factors (mean income, car ownership, divorce rate, etc). The analyses were restricted to 45 districts on which data on air pollution were available for the period 1986-8. The effects of exposure variables on frequency of pregnancy outcomes were estimated by logistic regression with district-years as the units of analysis. RESULTS: Stillbirth rate (4.2/1000 births in monitored districts) was not significantly associated with any indicator of air pollution, and was weakly related to mean income and proportion of births outside marriage. Crude prevalence of low birthweight (prevalence 5.5%) showed highly significant associations with several socioeconomic factors; after controlling for these, odds ratios (ORs)/50 micrograms/m3 increase in pollutant were: 1.04 (95% confidence interval (95% CI) 0.96 to 1.12) for total suspended particles, 1.10 (1.02 to 1.17) for SO2, and 1.07 (0.98 to 1.16) for NOx. When all pollutants were included in one model, SO2 remained related to low birthweight (OR 1.10 (1.01 to 1.20), p = 0.033). CONCLUSION: These results are consistent with a recent study in China where birthweight was also associated with total suspended particles and SO2 but ecological studies must be interpreted cautiously. Residual confounding by socioeconomic factors cannot be ruled out. The association between air pollution and birthweight requires further investigation.

• MeSH
• charakteristiky bydlení MeSH
• faktory vyvracející (epidemiologie) MeSH
• lidé MeSH
• logistické modely MeSH
• novorozenec s nízkou porodní hmotností * MeSH
• novorozenec MeSH
• odumření plodu epidemiologie   MeSH
• prevalence MeSH
• socioekonomické faktory MeSH
• těhotenství MeSH
• znečištění ovzduší škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• dítě MeSH
• gestační stáří MeSH
• kojenecká mortalita MeSH
• lidé MeSH
• novorozenec MeSH
• porodní hmotnost MeSH
• socioekonomické faktory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Švédsko MeSH

• MeSH
• dítě MeSH
• kojenecká mortalita MeSH
• lidé MeSH
• novorozenec MeSH
• porodní hmotnost MeSH
• předčasný porod MeSH
• regresní analýza MeSH
• sociální podmínky MeSH
• socioekonomické faktory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• novorozenec MeSH
• Geografické názvy
• Česká republika MeSH

All livebirths resulting from singleton pregnancies reported to the Czech (n = 380,633) and Swedish (n = 351,775) birth registries in 1989-91 were studied with respect to social variation in birthweight, ponderal index (weight/length at birth3) and preterm delivery. The mean birthweight was significantly lower in the Czech population (3310 g vs. 3522 g, P < 0.001). The mean difference in birthweight between children of mothers with primary and university education was 197 g [95% CI 190, 205] in the Czech and 136 g [95% CI 128, 144] in the Swedish population, adjusted for maternal age, parity and sex of the infant. Mean birthweight was significantly higher in mothers who were married or lived with partners in both countries; the difference was 167 g [95% CI 161, 173] in the Czech Republic (CR) and 86 g [95% CI 78, 94] in Sweden, adjusted for age, parity and sex. The extent of social variation in ponderal index and frequency of preterm birth was also greater in the CR. Between 1989 and 1991, mean birthweight in the CR fell from 3323 g to 3292 g (P < 0.001) and the social differences increased, largely as a result of more rapid worsening in the lower socio-economic groups. There did not appear to be such a decline in birthweight in Sweden. We suggest that the fall in mean birthweight and the increasing social variation in birth outcome in the CR is related to decline and divergence in living standards in 1989-91.

• MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• logistické modely MeSH
• mladiství MeSH
• novorozenec nedonošený * MeSH
• novorozenec s nízkou porodní hmotností MeSH
• novorozenec MeSH
• porodní hmotnost * MeSH
• registrace MeSH
• socioekonomické faktory * MeSH
• těhotenství MeSH
• tělesná výška * MeSH
• výsledek těhotenství MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Švédsko MeSH

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.

• MeSH
• dospělí MeSH
• fertilita MeSH
• kojenecká mortalita trendy   MeSH
• lidé MeSH
• manželský stav MeSH
• novorozenec MeSH
• odds ratio MeSH
• porodní hmotnost * MeSH
• reprodukovatelnost výsledků MeSH
• sběr dat MeSH
• společenská třída MeSH
• stupeň vzdělání MeSH
• surveillance populace MeSH
• těhotenství MeSH
• výsledek těhotenství epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• bronchiální astma epidemiologie   MeSH
• dítě MeSH
• ekzém epidemiologie   MeSH
• lidé MeSH
• městské obyvatelstvo MeSH
• předškolní dítě MeSH
• prevalence statistika a číselné údaje   MeSH
• sezónní alergická rýma epidemiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH

• MeSH
• dítě MeSH
• lidé MeSH
• předškolní dítě MeSH
• socioekonomické faktory MeSH
• tělesná výška MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• předškolní dítě MeSH
• Geografické názvy
• Česká republika MeSH