Association of air pollution and green space with endometriosis among women undergoing assisted reproductive technology: a cross-sectional study in Anhui, China

Air pollution has reproductive toxicity, while green space could lessen such harmful consequences. However, the current research on the link between air pollution/green space, and endometriosis remains scarce. Therefore, we investigated the separate and interactive relationships between air pollution, green space and endometriosis-related infertility. We collected data on 20,981 women from a large assisted reproductive center in Anhui, China, of whom 1,201 were diagnosed with endometriosis-related infertility. air pollution (PM_2.5, PM₁₀, NO₂, CO, and SO₂) and Green space (quantified using the normalized difference vegetation index [NDVI]) were evaluated using spatiotemporal models developed from satellite data. We employed multivariable logistic regression to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Per interquartile range (IQR) increase in exposure was associated with elevated odds of endometriosis prevalence for PM_2.5 (aOR = 1.20, 95%CI:1.11–1.30), PM₁₀ (1.17, 1.08–1.27), SO₂ (1.12, 1.02–1.24), NO₂ (1.18, 1.08–1.38), and CO (1.12, 1.05–1.19). Conversely, each IQR increase in NDVI_500 m showed protective effects (0.72, 0.63–0.83). Notably, an additive antagonistic effect was observed between NDVI_500 m and CO. Our findings indicated that air pollution could potentially increase the risk of endometriosis, while green space is its protective factor. Besides, green space might attenuate the negative impact of air pollution on endometriosis.