The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study
Background: Autism spectrum disorder (ASD) incidence has increased in past decades. ASD etiology remains inconclusive, but research suggests genetic, epigenetic, and environmental contributing factors and likely prenatal origins. Few studies have examined modifiable environmental risk factors for AS...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-09-01
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| Series: | Environment International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0160412022003725 |
| _version_ | 1811216383463129088 |
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| author | Lief Pagalan Tim F. Oberlander Gillian E. Hanley Laura C. Rosella Celeste Bickford Whitney Weikum Nancy Lanphear Bruce Lanphear Michael Brauer Matilda van den Bosch |
| author_facet | Lief Pagalan Tim F. Oberlander Gillian E. Hanley Laura C. Rosella Celeste Bickford Whitney Weikum Nancy Lanphear Bruce Lanphear Michael Brauer Matilda van den Bosch |
| author_sort | Lief Pagalan |
| collection | DOAJ |
| description | Background: Autism spectrum disorder (ASD) incidence has increased in past decades. ASD etiology remains inconclusive, but research suggests genetic, epigenetic, and environmental contributing factors and likely prenatal origins. Few studies have examined modifiable environmental risk factors for ASD, and far fewer have examined protective exposures. Greenspace has been associated with positive child development, but very limited greenspace research has examined ASD risk or prenatal exposures. Only one ecological study in 2017 has evaluated the association between greenspace and ASD, observing protective benefits. Greenspace may have direct effects on ASD risk and indirect effects by reducing air pollution exposure, a growing suspected ASD risk factor. Objectives: To measure the association between prenatal greenspace exposure and ASD risk and examine if reduced air pollution levels in areas of higher greenspace mediate this association. Methods: We linked a population-based birth cohort of all deliveries in Metro Vancouver, Canada, from 2004 to 2009, with follow-up to 2014. Diagnoses were based on Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised instruments. Greenspace was quantified as the average of the annual mean Normalized Difference Vegetation Index (NDVI) within a 250 m buffer of a residential postal code. Air pollutant exposures—particulate matter with a diameter less than 2.5 µm (PM2.5), nitric oxide (NO), and nitrogen dioxide (NO2)—were derived from previously developed and temporally adjusted land use regression models. We estimated air pollutant exposures as the mean concentration per month during pregnancy. We calculated odds ratios (ORs) using logistic regression per NDVI interquartile range (IQR) increase, adjusting for child sex, birth month and year, maternal age and birthplace, and neighborhood-level urbanicity and income. To estimate the health impact of greenspace on ASD at the population level, we used the logistic regression model and marginal standardization to derive risk differences (RDs). Lastly, to quantify the mediating effect of greenspace on ASD risk through air pollution reduction, we used marginal structural models and a potential outcomes framework to calculate marginal risk differences (RDs) to decompose the total effect of greenspace on ASD into natural direct and indirect effects. Results: Of 129,222 births, 1,921 (1.5 %) children were diagnosed with ASD. The adjusted OR for ASD per NDVI IQR (0.12) increase was 0.96 (95 % CI: 0.90, 1.02) in 250 m buffer zones and 0.94 (95 % CI: 0.89, 1.00) in 100 m buffer zones. On the additive scale, the adjusted RDs were null. Natural direct, natural indirect, and total effect RDs were null for PM2.5, NO, and NO2 mediation models. Conclusion: Prenatal greenspace exposure was associated with reduced odds of ASD, but in the additive scale, this effect was null at the population level. No mediating effect was observed through reduced air pollution, suggesting that air pollution may act as a confounder rather than as a mediator. |
| first_indexed | 2024-04-12T06:38:10Z |
| format | Article |
| id | doaj.art-86faaa2a4409419e92f9f9d2b4ae2f01 |
| institution | Directory Open Access Journal |
| issn | 0160-4120 |
| language | English |
| last_indexed | 2024-04-12T06:38:10Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
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| series | Environment International |
| spelling | doaj.art-86faaa2a4409419e92f9f9d2b4ae2f012022-12-22T03:43:48ZengElsevierEnvironment International0160-41202022-09-01167107445The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort studyLief Pagalan0Tim F. Oberlander1Gillian E. Hanley2Laura C. Rosella3Celeste Bickford4Whitney Weikum5Nancy Lanphear6Bruce Lanphear7Michael Brauer8Matilda van den Bosch9Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Schwartz Reisman Institute for Technology and Society, University of Toronto, Ontario, CanadaBritish Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Sunny Hill Health Centre for Children, British Columbia Children’s Hospital, Vancouver, British Columbia, CanadaBritish Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, CanadaDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CanadaSchool of Population and Public Health, University of British Columbia, Vancouver, British Columbia, CanadaDepartment of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Sunny Hill Health Centre for Children, British Columbia Children’s Hospital, Vancouver, British Columbia, CanadaBritish Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, CanadaFaculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, CanadaSchool of Population and Public Health, University of British Columbia, Vancouver, British Columbia, CanadaSchool of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Forest & Conservation Sciences, University of British Columbia, Vancouver, British Columbia, Canada; ISGlobal, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Corresponding author at: Matilda van den Bosch Barcelona Institute for Global Health - Campus MAR Barcelona Biomedical Research Park (PRBB) C/Doctor Aiguader, 88 08003 Barcelona Spain.Background: Autism spectrum disorder (ASD) incidence has increased in past decades. ASD etiology remains inconclusive, but research suggests genetic, epigenetic, and environmental contributing factors and likely prenatal origins. Few studies have examined modifiable environmental risk factors for ASD, and far fewer have examined protective exposures. Greenspace has been associated with positive child development, but very limited greenspace research has examined ASD risk or prenatal exposures. Only one ecological study in 2017 has evaluated the association between greenspace and ASD, observing protective benefits. Greenspace may have direct effects on ASD risk and indirect effects by reducing air pollution exposure, a growing suspected ASD risk factor. Objectives: To measure the association between prenatal greenspace exposure and ASD risk and examine if reduced air pollution levels in areas of higher greenspace mediate this association. Methods: We linked a population-based birth cohort of all deliveries in Metro Vancouver, Canada, from 2004 to 2009, with follow-up to 2014. Diagnoses were based on Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised instruments. Greenspace was quantified as the average of the annual mean Normalized Difference Vegetation Index (NDVI) within a 250 m buffer of a residential postal code. Air pollutant exposures—particulate matter with a diameter less than 2.5 µm (PM2.5), nitric oxide (NO), and nitrogen dioxide (NO2)—were derived from previously developed and temporally adjusted land use regression models. We estimated air pollutant exposures as the mean concentration per month during pregnancy. We calculated odds ratios (ORs) using logistic regression per NDVI interquartile range (IQR) increase, adjusting for child sex, birth month and year, maternal age and birthplace, and neighborhood-level urbanicity and income. To estimate the health impact of greenspace on ASD at the population level, we used the logistic regression model and marginal standardization to derive risk differences (RDs). Lastly, to quantify the mediating effect of greenspace on ASD risk through air pollution reduction, we used marginal structural models and a potential outcomes framework to calculate marginal risk differences (RDs) to decompose the total effect of greenspace on ASD into natural direct and indirect effects. Results: Of 129,222 births, 1,921 (1.5 %) children were diagnosed with ASD. The adjusted OR for ASD per NDVI IQR (0.12) increase was 0.96 (95 % CI: 0.90, 1.02) in 250 m buffer zones and 0.94 (95 % CI: 0.89, 1.00) in 100 m buffer zones. On the additive scale, the adjusted RDs were null. Natural direct, natural indirect, and total effect RDs were null for PM2.5, NO, and NO2 mediation models. Conclusion: Prenatal greenspace exposure was associated with reduced odds of ASD, but in the additive scale, this effect was null at the population level. No mediating effect was observed through reduced air pollution, suggesting that air pollution may act as a confounder rather than as a mediator.http://www.sciencedirect.com/science/article/pii/S0160412022003725Autism spectrum disorderGreenspaceAir pollutionCausal mediationCohortPrenatal exposure |
| spellingShingle | Lief Pagalan Tim F. Oberlander Gillian E. Hanley Laura C. Rosella Celeste Bickford Whitney Weikum Nancy Lanphear Bruce Lanphear Michael Brauer Matilda van den Bosch The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study Environment International Autism spectrum disorder Greenspace Air pollution Causal mediation Cohort Prenatal exposure |
| title | The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study |
| title_full | The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study |
| title_fullStr | The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study |
| title_full_unstemmed | The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study |
| title_short | The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study |
| title_sort | association between prenatal greenspace exposure and autism spectrum disorder and the potentially mediating role of air pollution reduction a population based birth cohort study |
| topic | Autism spectrum disorder Greenspace Air pollution Causal mediation Cohort Prenatal exposure |
| url | http://www.sciencedirect.com/science/article/pii/S0160412022003725 |
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