Estimating the risk of anemia associated with PM_2.5 exposure in Nepalese women of reproductive age

Background: Although evidence links particulate matter exposure to anemia, research focused on women remains scarce. This study investigates the risk of anemia associated with PM_2.5 exposure among Nepalese women of reproductive age. Methods: This study used nationally representative data from the 2022 Nepal Demographic and Health Survey, including a sample of 4133 women of reproductive age. Anemia was defined according to WHO guidelines (blood hemoglobin levels <12 g/dl for non-pregnant women and <11 g/dl for pregnant women), and mean PM_2.5 exposure data were obtained from the national air quality monitoring department. Results: Here we show that higher PM_2.5 exposure is associated with an increased risk of anemia among Nepalese women. Weighted regression models revealed a consistent inverse relationship between PM_2.5 and blood hemoglobin levels (β, 95% CI: −0.161, −0.228 ~ −0.099). Each 10-µg/m³ increase in PM_2.5 resulted in a 29% greater risk of anemia (OR, 95% CI: 1.29, 1.14–1.42). The associated risk was more pronounced among women with lower educational attainment and those residing in mountainous regions. Conclusions: This study provides substantial evidence linking air pollution to anemia in women of reproductive age, underscoring the urgent need for targeted health interventions and stricter air quality regulations in low-resource settings. (Figure presented.)