{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:41:51Z","timestamp":1759365711228,"version":"build-2065373602"},"reference-count":35,"publisher":"PAGEPress Publications","issue":"2","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geospat Health"],"abstract":"<jats:p>Congenital Heart Disease (CHD) is a major cause of neonatal and infant morbidity and mortality and it has a multifactorial aetiology. This study aimed to analyse the spatial association between exposure to air pollutants during the first trimester of pregnancy, social vulnerability, and maternal factors with the occurrence of CHD between 2012 and 2022 in the state of S\u00e3o Paulo, Brazil. Data were obtained from the live birth information system for maternal outcomes and characteristics, the S\u00e3o Paulo social vulnerability index as a contextual indicator, and concentrations of fine particulate matter (PM2.5), Carbon Monoxide (CO) and ozone, estimated using the Copernicus Atmosphere Monitoring Service (CAMS-EAC4) reanalysis dataset of environmental exposure. A Bayesian hierarchical spatial model with a Besag\u2013York\u2013 Molli\u00e9 2 (BYM2) specification was applied using the INLA approach. The results showed that exposure to PM2.5 was significantly associated with an increased risk of CHD (RR = 1.022; 95% CrI: 1.005-1.040), as were advanced maternal age (&gt;35 years) (RR = 1.649; 95% CrI: 1.587-1.715) and inadequate prenatal care (RR = 1.112; 95% CrI: 1.070-1.155). Conversely, municipalities classified as having medium (RR = 0.757; 95% CrI: 0.641-0.894) and high social vulnerability (RR = 0.643; 95% CrI: 0.492-0.844) showed a significantly lower adjusted risk compared to those with low vulnerability. No significant associations were identified for CO or ozone. Spatial analysis revealed persistently high risks in municipalities within the S\u00e3o Paulo Metropolitan Region, even after adjusting for environmental and socio-demographic variables, highlighting population profiles and priority areas for public health surveillance and targeted interventions.<\/jats:p>","DOI":"10.4081\/gh.2025.1407","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T09:25:14Z","timestamp":1758187514000},"source":"Crossref","is-referenced-by-count":0,"title":["Spatial analysis of congenital heart disease in S\u00e3o Paulo State, Brazil 2012-2022: associations with air pollution, maternal factors and social vulnerability"],"prefix":"10.4081","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9491-0336","authenticated-orcid":false,"given":"Amar\u00edlis","family":"Bahia Bezerra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7322-6789","authenticated-orcid":false,"given":"Ligia","family":"Vizeu Barrozo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4038-4953","authenticated-orcid":false,"given":"Alfredo","family":"Pereira de Queiroz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"27868","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2024.123345"},{"key":"27869","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2013.03.005"},{"key":"27870","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232074"},{"key":"27871","doi-asserted-by":"publisher","DOI":"10.1007\/BF00116466"},{"key":"27872","unstructured":"Bezerra AB, 2025. R script and data used for the analysis of factors associated with congenital heart disease in the state of S\u00e3o Paulo, Brazil (2012\u20132022). Zenodo. https:\/\/doi.org\/10.5281\/zenodo.16897066"},{"key":"27873","doi-asserted-by":"publisher","DOI":"10.1289\/EHP11120"},{"key":"27874","doi-asserted-by":"publisher","DOI":"10.1029\/2024GH001042"},{"key":"27875","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30505-6"},{"key":"27876","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2011.01.022"},{"key":"27877","unstructured":"DATASUS, 2025. Transfer\u00eancia de Arquivos. 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Available from: https:\/\/cidades.ibge.gov.br\/brasil\/sp\/panorama."},{"key":"27883","doi-asserted-by":"publisher","DOI":"10.4081\/gh.2016.428"},{"key":"27884","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v063.i19"},{"key":"27885","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.111014"},{"key":"27886","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.2152"},{"key":"27887","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18020795"},{"key":"27888","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.34130"},{"key":"27889","doi-asserted-by":"publisher","DOI":"10.1021\/acs.est.1c01006"},{"key":"27890","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-013-0775-4"},{"key":"27891","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24863"},{"key":"27892","unstructured":"Pinto J\u00fanior VC, Branco KM, Cavalcante RC, Carvalho Junior W, Lima JR, Freitas SM, Fraga MN, Souza NM, 2015. Epidemiology of congenital heart disease in Brazil. 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