The association of short-term increases in ambient PM_2.5 and temperature exposures with stillbirth: racial/ethnic disparities among Medicaid recipients

Racial/ethnic disparities in the association between short-term (eg, days, weeks), ambient fine particulate matter (PM_2.5) and temperature exposures and stillbirth in the United States have been understudied. A time-stratified, case-crossover design using a distributed lag nonlinear model (0- to 6-day lag) was used to estimate stillbirth odds due to short-term increases in average daily PM_2.5 and temperature exposures among 118 632 Medicaid recipients from 2000 to 2014. Disparities by maternal race/ethnicity (Black, White, Hispanic, Asian, American Indian) and zip code–level socioeconomic status (SES) were assessed. In the temperature-adjusted model, a 10 μg m⁻³ increase in PM_2.5 concentration was marginally associated with increased stillbirth odds at lag 1 (0.68%; 95% CI, −0.04% to 1.40%) and lag 2 (0.52%; 95% CI, −0.03 to 1.06) but not lag 0-6 (2.80%; 95% CI, −0.81 to 6.45). An association between daily PM_2.5 concentrations and stillbirth odds was found among Black individuals at the cumulative lag (0-6 days: 9.26% 95% CI, 3.12%-15.77%) but not among other races or ethnicities. A stronger association between PM_2.5 concentrations and stillbirth odds existed among Black individuals living in zip codes with the lowest median household income (lag 0-6: 14.13%; 95% CI, 4.64%-25.79%). Short-term temperature increases were not associated with stillbirth risk among any race/ethnicity. Black Medicaid enrollees, and especially those living in lower SES areas, may be more vulnerable to stillbirth due to short-term increases in PM_2.5 exposure.