Air pollution, temperature, and social stressors in pediatric seizures and epilepsy across New York City

Rachit Sharma

doi:10.17918/00010885

This dissertation examines how environmental exposures such as air pollution and temperature, and social stressors together influence pediatric seizures and epilepsy in New York City (NYC). Focusing on children aged 0-4 years from 2005 to 2019, the work integrates data on air pollution, temperature, and various social stressor indicators to explore their combined effects on hospital visits for pediatric seizures and epilepsy in NYC. In the first aim, using covariance-based structural equation modeling, the simultaneous relationships of multiple air pollutants (including PM_[2.5], BC, NO₂, NO, O₃, and SO₂), temperature measures (Tmin, Tmean, and Tmax), and social stressor indicators such as violent crime rates and multiple material deprivation indicators were assessed, at the same spatial (census tract) and temporal (annual average) scales, with hospital visit rates for pediatric seizures and epilepsy. The results revealed that higher PM_[2.5] levels and increased rates of violent crime and the proportion of minority population were associated with greater hospital visits, whereas higher levels of NO and a larger proportion of children under five showed negative associations. These relationships persisted even at pollutant levels below current ambient air quality standards. In the second aim, using a time-stratified, case-crossover approach, short-term associations of daily environmental exposures with first hospital visits for pediatric seizures were quantified, and effect measure modification by season, individual-level age and sex, and neighborhood level social stressors was assessed. Findings indicated that daily PM_[2.5] exposure was most strongly associated with increased hospital visit risk for pediatric seizures, with the association being particularly pronounced during the cool season. Additionally, effect modification by age and sex was observed, with children aged 2-4 years and male children showing stronger associations. Neighborhood-level social stressors did not appear to modify these relationships. In the third aim, using spatial Bayesian hierarchical modeling, neighborhood-level spatial variability in the daily associations of PM_[2.5] exposure with hospital visits for pediatric seizures and epilepsy was explored. By examining associations across Zip Code Tabulation Areas (ZCTAs) the analyses found that the strength of the association varies notably across NYC, with social stressors such as elevated violent crime rates, and demographic characteristics, particularly higher proportions of children aged under five, serving as important predictors of this variability. Collectively, these findings underscore that both environmental exposures and social stressors play a role in pediatric seizures and epilepsy in NYC, necessitating public health strategies that address environmental and social determinants to help reduce neurological health disparities in vulnerable communities.

Air pollution, temperature, and social stressors in pediatric seizures and epilepsy across New York City

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Air pollution, temperature, and social stressors in pediatric seizures and epilepsy across New York City

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