Background: While research links outdoor air pollution, temperature, and social stressors to various health outcomes, their impact on pediatric neurological conditions remains underexplored. We used covariance-based structural equation modeling (CBSEM) to examine the effects of air pollutants, temperature, and social stressors at the census tract level on seizures and epilepsy among children aged 0-4 years in New York City (NYC).
Methods: Data on pediatric seizure and epilepsy cases (n = 143,372) presented at NYC emergency departments (EDs) from 2005 to 2019 were obtained from the New York Statewide Planning and Research Cooperative System. Age-standardized annual ED visit rates were calculated for each census tract. Tract-level, annual average concentrations of fine particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2), nitric oxide (NO), ozone (O3), sulfur dioxide (SO2), minimum temperature (Tmin) were assigned using data from NYC Community Air Survey and satellite data. Point-level New York Police Department violent crime data were aggregated to create tract-level, annual average crime rates. From American Community Survey, 54 indicators of tract-level poverty, income, education, unemployment, sex, race/ethnicity, marital status, disability, residential mobility, citizenship, and health insurance status were derived. Pollutants, temperature, and social stressors were fitted in a CBSEM as potential predictors of ED visit rates under maximum likelihood estimation.
Results: PM2.5 was positively associated with ED visits [standardized path coefficient: 0.143 (95% Confidence Interval: 0.105, 0.181)], while NO was negatively associated [-0.182 (-0.217, -0.148)]. PM2.5 also showed a positive association with crime [0.241 (0.229, 0.253)]. Crime was positively associated with ED visits [0.097 (0.076, 0.119)] and racial/ethnic minority status [0.453 (0.437, 0.468)]. Variable representing social assistance programs was positively associated with both ED visits [0.043 (0.021, 0.065)] and crime [0.263, 95% CI: 0.248, 0.278]. The observed relationships persisted even at low levels of U.S. EPA National Ambient Air Quality Standards for PM2.5 and NO2.
Conclusion: This study underscores the impact of air pollution and social stressors on pediatric seizures and epilepsy. Public health interventions targeting both air quality improvement and social stress alleviation are essential in addressing neurological health disparities among vulnerable children.