Air quality around schools and school-level academic performance in Brazil

High levels of air pollution surrounding schools may be posing a risk to children's health, including cardiorespiratory diseases and cognitive deficits. The literature on the effects of air pollution outside schools on cognitive outcomes (e.g., cognitive development, working memory, and academic performance) is still limited. Most of the studies are from high-income countries. In this paper, we performed a nationwide assessment to estimate the association between air pollution (PM2.5 and NO2) and school-level academic performance in Brazil. We assessed academic performance data (high school national exam) from 25,390 high schools in Brazil. Air pollution data was derived from satellite remote sensing observations. Then we used mixed-effects regression models adjusted for several variables (e.g., school characteristics, spatio-temporal factors, and socioeconomic status) to estimate the association between air pollution (PM2.5 and NO2) and school-level academic performance. We found that an increase of 10 mu g/m(3) in the long-term average PM2.5 around the Brazilian schools is associated with 2.98 points lower (95%CI: 0.37; 5.58) in the school-level academic performance (considering that the performance score varies from 0 to 1000). For NO2, an increase of 10 ppb corresponds to 55.73 points lower (95%CI: 34.98; 76.48) in the school-level academic performance. This represents 0.05 and 1.02% lower points in academic performance, respectively for the exposure to PM2.5 and NO2.