Details

Autor(en) / Beteiligte

• Day, Drew B.
• LeWinn, Kaja Z.
• Karr, Catherine J.
• Loftus, Christine T.
• Carroll, Kecia N.
• Bush, Nicole R.
• Zhao, Qi
• Barrett, Emily S.
• Swan, Shanna H.
• Nguyen, Ruby H.N.
• Trasande, Leonardo
• Moore, Paul E.
• Adams Ako, Ako
• Ji, Nan
• Liu, Chang
• Szpiro, Adam A.
• Sathyanarayana, Sheela

Titel

Subpopulations of children with multiple chronic health outcomes in relation to chemical exposures in the ECHO-PATHWAYS consortium

Ist Teil von

• Environment international, 2024-03, Vol.185, p.108486-108486, Article 108486

Ort / Verlag

Netherlands: Elsevier Ltd

Erscheinungsjahr

2024

Link zum Volltext

Quelle

Electronic Journals Library - Freely accessible e-journals

Beschreibungen/Notizen

• The three clusters of child health outcomes that we discovered are summarized in the graphical abstract by showing the mean of the cluster center z-score coordinates for every outcome within each of the domains of obesity-related (blue), neurodevelopmental (green), and respiratory (red). This shows the low levels of outcomes across domains in the largest Cluster 1, the high neurodevelopmental but also moderately elevated obesity-related and respiratory outcomes of Cluster 2, and the high respiratory but also moderately elevated obesity-related and neurodevelopmental outcomes of Cluster 3. Full-scale IQ was reversed when calculating the mean neurodevelopmental z-score so that all outcomes would have the same directional interpretation. Finally, the observed male-specific positive association between the Weighted Quantile Sum (WQS) regression phthalate mixture index and Cluster 3 is shown on the right. The highly weighted mixture components of monoethyl phthalate (MEP), monoheptyl phthalate (MHPP), and the sum of di(2-ethylhexyl) phthalate metabolites (ΣDEHP) are highlighted among the phthalate metabolites included in WQS regressions. [Display omitted] •Subpopulations of children with co-occurring chronic health outcomes were clustered.•One cluster had high neurodevelopmental and moderate BMI/respiratory outcomes.•Another had the highest rates of respiratory outcomes: asthma, wheeze, and rhinitis.•In boys the latter cluster was associated with endocrine-disrupting chemicals.•These multimorbid phenotypes could inform high-impact public health interventions. A multimorbidity-focused approach may reflect common etiologic mechanisms and lead to better targeting of etiologic agents for broadly impactful public health interventions. Our aim was to identify clusters of chronic obesity-related, neurodevelopmental, and respiratory outcomes in children, and to examine associations between cluster membership and widely prevalent chemical exposures to demonstrate our epidemiologic approach. Early to middle childhood outcome data collected 2011–2022 for 1092 children were harmonized across the ECHO-PATHWAYS consortium of 3 prospective pregnancy cohorts in six U.S. cities. 15 outcomes included age 4–9 BMI, cognitive and behavioral assessment scores, speech problems, and learning disabilities, asthma, wheeze, and rhinitis. To form generalizable clusters across study sites, we performed k-means clustering on scaled residuals of each variable regressed on study site. Outcomes and demographic variables were summarized between resulting clusters. Logistic weighted quantile sum regressions with permutation test p-values associated odds of cluster membership with a mixture of 15 prenatal urinary phthalate metabolites in full-sample and sex-stratified models. Three clusters emerged, including a healthier Cluster 1 (n = 734) with low morbidity across outcomes; Cluster 2 (n = 192) with low IQ and higher levels of all outcomes, especially 0.4–1.8-standard deviation higher mean neurobehavioral outcomes; and Cluster 3 (n = 179) with the highest asthma (92 %), wheeze (53 %), and rhinitis (57 %) frequencies. We observed a significant positive, male-specific stratified association (odds ratio = 1.6; p = 0.01) between a phthalate mixture with high weights for MEP and MHPP and odds of membership in Cluster 3 versus Cluster 1. These results identified subpopulations of children with co-occurring elevated levels of BMI, neurodevelopmental, and respiratory outcomes that may reflect shared etiologic pathways. The observed association between phthalates and respiratory outcome cluster membership could inform policy efforts towards children with respiratory disease. Similar cluster-based epidemiology may identify environmental factors that impact multi-outcome prevalence and efficiently direct public policy efforts.