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Zhou X, Cai S, Wang H, Fang J, Gao J, Kuang H, Xie D, He J, Wang A. Update from a cohort study for birth defects in Hunan Province, China, 2010-2020. Sci Rep 2023; 13:20257. [PMID: 37985789 PMCID: PMC10662386 DOI: 10.1038/s41598-023-47741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
To define the relationship between sex, residence, maternal age, and a broad range of birth defects by conducting a comprehensive cross-analysis based on up-to-date data. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2010-2020. Prevalences of birth defects (number of cases per 10,000 fetuses (births and deaths at 28 weeks of gestation and beyond)) with 95% confidence intervals (CI) were calculated by sex, residence, maternal age, year, and 23 specific defects. Cross-analysis of sex, residence, and maternal age was conducted, and crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with birth defects. A total of 1,619,376 fetuses and 30,596 birth defects were identified. The prevalence of birth defects was 188.94/10,000 (95% CI 186.82-191.05). Birth defects were more frequent in males than females (210.46 vs. 163.03/10,000, OR = 1.30, 95% CI 1.27-1.33), in urban areas than in rural areas (223.61 vs. 162.90/10,000, OR = 1.38, 95% CI 1.35-1.41), and in mothers ≥ 35 than mothers 25-29 (206.35 vs. 187.79/10,000, OR = 1.10, 95% CI 1.06-1.14). Cross-analysis showed that the prevalence of birth defects was higher in urban females than in rural males (194.53 vs. 182.25/10,000), the difference in prevalence between males and females was more significant for maternal age < 20 compared to other age groups (OR = 1.64, 95% CI 1.37-1.95), and the prevalence difference between urban and rural areas is more significant for maternal age 25-34 compared to other age groups (OR = 1.49, 95% CI 1.43-1.57). Cleft palates were more frequent in males, and nine specific defects were more frequent in females. Five specific defects were more frequent in rural areas, and eight were more frequent in urban areas. Compared to mothers 25-29, five specific defects were more frequent in mothers < 20, seven specific defects were more frequent in mothers 20-24, two specific defects were more frequent in mothers 30-34, and ten specific defects were more frequent in mothers ≥ 35. Our data indicate that sex, residence, and maternal age differences in the prevalences of birth defects and most specific defects are common. We have found some new epidemiological characteristics of birth defects using cross-analysis, such as residence is the determining factor for the prevalence of birth defects, the difference in prevalence between males and females was more significant for maternal age < 20 compared to other age groups, the prevalence difference between urban and rural areas is more significant for maternal age 25-34 compared to other age groups. And differences in the epidemiological characteristics of some specific defects from previous studies. Future studies should examine mechanisms. Our findings contributed to clinical counseling and advancing research on the risk factors for birth defects.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Shenglan Cai
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Hua Wang
- The Hunan Children's Hospital, Changsha, Hunan, China.
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Jie Gao
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Donghua Xie
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Krajewski AK, Patel A, Gray CL, Messer LC, Keeler CY, Langlois PH, Reefhuis J, Gilboa SM, Werler MM, Shaw GM, Carmichael SL, Nembhard WN, Insaf TZ, Feldkamp ML, Conway KM, Lobdell DT, Desrosiers TA. Is gastroschisis associated with county-level socio-environmental quality during pregnancy? Birth Defects Res 2023; 115:1758-1769. [PMID: 37772934 PMCID: PMC10878499 DOI: 10.1002/bdr2.2250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Gastroschisis prevalence more than doubled between 1995 and 2012. While there are individual-level risk factors (e.g., young maternal age, low body mass index), the impact of environmental exposures is not well understood. METHODS We used the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) as a county-level estimate of cumulative environmental exposures for five domains (air, water, land, sociodemographic, and built) and overall from 2006 to 2010. Adjusted odds ratios (aOR) and 95% confidence interval (CI) were estimated from logistic regression models between EQI tertiles (better environmental quality (reference); mid; poorer) and gastroschisis in the National Birth Defects Prevention Study from births delivered between 2006 and 2011. Our analysis included 594 cases with gastroschisis and 4105 infants without a birth defect (controls). RESULTS Overall EQI was modestly associated with gastroschisis (aOR [95% CI]: 1.29 [0.98, 1.71]) for maternal residence in counties with poorer environmental quality, compared to the reference (better environmental quality). Within domain-specific indices, only the sociodemographic domain (aOR: 1.51 [0.99, 2.29]) was modestly associated with gastroschisis, when comparing poorer to better environmental quality. CONCLUSIONS Future work could elucidate pathway(s) by which components of the sociodemographic domain or possibly related psychosocial factors like chronic stress potentially contribute to risk of gastroschisis.
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Affiliation(s)
- Alison K. Krajewski
- United States Environmental Protection Agency (U.S. EPA), Office of Research and Development, Center for Public Health & Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Achal Patel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Corinna Y. Keeler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Peter H. Langlois
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health—Austin Regional Campus, Austin, Texas, USA
| | - Jennita Reefhuis
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Infant Disorders, Atlanta, Georgia, USA
| | - Suzanne M. Gilboa
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Infant Disorders, Atlanta, Georgia, USA
| | - Martha M. Werler
- Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts, USA
| | - Gary M. Shaw
- Stanford University, School of Medicine, Stanford, California, USA
| | | | - Wendy N. Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, Little Rock, Arkansas, USA
| | - Tabassum Z. Insaf
- New York State Department of Health, Center for Environmental Health, Bureau of Environmental and Occupational Epidemiology, Albany, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany, Albany, New York, USA
| | - Marcia L. Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
| | - Kristin M. Conway
- Department of Epidemiology, The University of Iowa, College of Public Health, Iowa City, Iowa, USA
| | - Danelle T. Lobdell
- United States Environmental Protection Agency (U.S. EPA), Office of Research and Development, Center for Public Health & Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kabila B, Zhim M, Naggar A, el Hadad S, Allali N, Chat L. Superinfected and Ruptured Occipital Meningocele: Case Report. Glob Pediatr Health 2023; 10:2333794X231204498. [PMID: 37846398 PMCID: PMC10576911 DOI: 10.1177/2333794x231204498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/19/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
Meningocele is a rare congenital malformation of the central nervous system resulting from a herniation of the meninges containing cerebrospinal fluid through a bony defect in the skull. It is part of neural tube closure anomalies. The overall incidence of meningocele is 0.8 to 3 per 10 000 live births; it varies based on geographical location and race, with a predominance of occipital localization. Among diagnostic methods, computed tomography (CT) and magnetic resonance imaging (MRI) remain crucial examinations. Prenatal diagnosis of this malformation primarily relies on ultrasound and screening through maternal serum alpha-fetoprotein (AFP) levels. They typically manifest very early at birth with a highly suggestive radioclinical presentation. Surgical treatment usually allows for a definitive cure. Superinfection and rupture of the meningocele are exceptional, resulting from delayed diagnosis and management. In several developed countries, prevention through genetic counseling and the intake of folic acid during the periconceptional period, along with accurate prenatal diagnosis and the legalization of therapeutic abortion, has led to a decrease in the prevalence of meningoceles. In less developed countries, where there is a delay in diagnosis in exceptional cases, superinfection and rupture may occur. We present the case of an 8-month-old infant with a complicated occipital meningocele with superinfection and rupture.
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Affiliation(s)
- Badr Kabila
- UHC Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Meriem Zhim
- UHC Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Amine Naggar
- UHC Ibn Sina, Mohamed V University, Rabat, Morocco
| | | | - Nazik Allali
- UHC Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Latifa Chat
- UHC Ibn Sina, Mohamed V University, Rabat, Morocco
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Urban-rural residence and birth defects prevalence in Texas: a phenome-wide association study. Pediatr Res 2022; 91:1587-1594. [PMID: 34400788 PMCID: PMC8855441 DOI: 10.1038/s41390-021-01700-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Some assessments indicate the prevalence of certain birth defects varies by urban-rural status. We evaluated associations between urban-rural residence and a spectrum of birth defects, using a phenome-wide association study approach in Texas, a state with large urban centers and expansive rural areas. METHODS Data for birth defects and livebirths during 1999-2015 were obtained from the Texas Birth Defects Registry and the Center for Health Statistics. Maternal residence was classified as urban or rural, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated for any defect and 140 specific defects by Poisson regression. RESULTS Overall, birth defects were less frequent in rural compared to urban counties (PR = 0.88, 95% CI: 0.87-0.89). Twelve specific defects were less prevalent in rural counties, including ventricular septal defects (VSDs; PR = 0.76, 95% CI: 0.73-0.79) and hypospadias (PR = 0.86, 95% CI: 0.82-0.89). For some birth defects, including VSDs, there was evidence of decreasing prevalence with decreasing population size. CONCLUSIONS In our large population-based assessment, we demonstrated that several birth defects were less prevalent in rural counties, suggesting that characteristics of urban settings may be relevant to their etiologies, diagnosis, or surveillance. Further research is needed to identify specific exposures underlying these associations. IMPACT There are few studies of birth defects prevalence in urban versus rural settings. To address this, we investigated a comprehensive range of birth defects, including several rare defects that have not been previously studied, in a large and diverse population. We identified 12 structural birth defects that were less prevalent in rural areas. Findings suggest possible differential exposures among urban and rural women, and/or possible underdiagnosis of certain birth defects in rural areas. Findings highlight the need for further study of geographically referenced risk factors for birth defects, and of the completeness of birth defects ascertainment in rural areas.
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Krajewski AK, Rappazzo KM, Langlois PH, Messer LC, Lobdell DT. Associations between cumulative environmental quality and ten selected birth defects in Texas. Birth Defects Res 2020; 113:161-172. [PMID: 32864854 DOI: 10.1002/bdr2.1788] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Causes of most birth defects are largely unknown. Genetics, maternal factors (e.g., age, smoking) and environmental exposures have all been linked to some birth defects, including neural tube, oral cleft, limb reduction, and gastroschisis; however, the contribution of cumulative exposures across several environmental domains in association with these defects is not well understood. METHODS The Environmental Quality Index (EQI) and its domains (air, water, land, sociodemographic, built) were used to estimate county-level cumulative environmental exposures from 2006-2010 and matched to birth defects identified from Texas Birth Defects Registry and live birth records from births in years 2007-2010 (N = 1,610,709). Poisson regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI) for associations between 10 birth defects and the EQI. RESULTS We observed some positive associations between worst environmental quality and neural tube, anencephaly, spina bifida, oral cleft, cleft palate, cleft lip with and without cleft palate, and gastroschisis [PR range: 1.12-1.55], but near null associations with limb reduction defects. Among domain specific results, we observed the strongest positive associations with the sociodemographic domain across birth defects but varied positive associations among the air and water domains, and negative or null associations with the land and built domains. Overall, few exposure-response patterns were evident. CONCLUSIONS Our results highlight the complexities of cumulative, simultaneous environmental exposures in the prevalence rates of 10 selected birth defects. We were able to explore the impact of overall and domain specific environmental quality on birth defects and identify potential domain specific drivers of these associations.
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Affiliation(s)
- Alison K Krajewski
- Oak Ridge Institute for Science and Education (ORISE) Postdoctoral Fellow at United States Environmental Protection Agency (US EPA), Research Triangle Park, North Carolina, USA
- US EPA, Office of Research and Development, Center of Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Kristen M Rappazzo
- US EPA, Office of Research and Development, Center of Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Peter H Langlois
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health - Austin Regional Campus, Austin, Texas, USA
| | | | - Danelle T Lobdell
- US EPA, Office of Research and Development, Center of Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
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Divergent trends in life expectancy across the rural-urban gradient and association with specific racial proportions in the contiguous USA 2000-2005. Int J Public Health 2019; 64:1367-1374. [PMID: 31273406 DOI: 10.1007/s00038-019-01274-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 12/17/2018] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relationship among life expectancy, rurality and specific race proportion. METHODS We used individual-level death data to estimate county-level life expectancy at age 25 (e25) for Whites, Black, AIAN and Asian in the contiguous USA for 2000-2005. Race-sex-stratified models were used to examine the associations among e25, rurality and specific race proportion, adjusted for socioeconomic variables. RESULTS Lower e25 was found in the central USA for AIANs and in the west coast for Asians. We found higher e25 in the most rural areas for Whites but in the most urban areas for AIAN and Asians. The associations between specific race proportion and e25 were positive or null for Whites but were negative for Blacks, AIAN, and Asians. The relationship between specific race proportion and e25 varied across rurality. CONCLUSIONS Identifying differences in adult life expectancy, both across and within racial groups, provides new insights into the geographic determinants of life expectancy disparities.
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Patel AP, Jagai JS, Messer LC, Gray CL, Rappazzo KM, Deflorio-Barker SA, Lobdell DT. Associations between environmental quality and infant mortality in the United States, 2000-2005. ACTA ACUST UNITED AC 2018; 76:60. [PMID: 30356923 PMCID: PMC6191999 DOI: 10.1186/s13690-018-0306-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022]
Abstract
Background The United States (U.S.) suffers from high infant mortality (IM) rates and there are significant racial/ethnic differences in these rates. Prior studies on the environment and infant mortality are generally limited to singular exposures. We utilize the Environmental Quality Index (EQI), a measure of cumulative environmental exposure (across air, water, land, sociodemographic, and land domains) for U.S. counties from 2000 to 2005, to investigate associations between ambient environment and IM across maternal race/ethnicity. Methods We linked 2000–2005 infant data from the U.S. Centers for Disease Control and Prevention to the EQI (n = 22,702,529; 144,741 deaths). We utilized multi-level regression to estimate associations between quartiles of county-level EQI and IM. We also considered associations between quartiles of county level domain specific indices with IM. We controlled for rural-urban status (RUCC1: urban, metropolitan; RUCC2: urban, non-metropolitan; RUCC3: less urbanized; RUCC4: thinly populated), maternal age, maternal education, marital status, infant sex, and stratified on race/ethnicity. Additionally, we estimated associations for linear combinations of environmental quality and rural-urban status. Results We found a mix of positive, negative, and null associations and our findings varied across domain and race/ethnicity. Poorer overall environmental quality was associated with decreased odds among Non-Hispanic whites (OR and 95% CI: EQIQ4 (ref. EQIQ1): 0.84[0.80,0.89]). For Non-Hispanic blacks and Hispanics, some increased odds were observed. Poorer air quality was monotonically associated with increased odds among Non-Hispanic whites (airQ4 (ref. airQ1): 1.05[0.99,1.11]) and blacks (airQ4 (ref. airQ1): 1.09 [0.9,1.31]). Rural status was associated with increased IM odds among Hispanics (RUCC4-Q4:1.36[1.04,1.78]; RUCC1-Q4: 1.04[0.92,1.16], ref. for both RUCC1-Q1). Conclusions This study is the first to report on associations between ambient environmental quality and IM across the United States. It corroborates prior research suggesting an association between air pollution and IM and identifies residence in thinly populated (rural) areas as a potential risk factor towards IM amongst Hispanics. Some of the counterintuitive findings highlight the need for additional research into potentially differential drivers of environmental quality across the rural-urban continuum, especially with regards to the sociodemographic environment. Electronic supplementary material The online version of this article (10.1186/s13690-018-0306-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Achal P Patel
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, NC USA
| | - Jyotsna S Jagai
- 2School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago, IL USA
| | - Lynne C Messer
- 3OHSU-PSU School of Public Health, Portland State University, Portland, OR USA
| | - Christine L Gray
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, NC USA.,4Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
| | - Kristen M Rappazzo
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, MD 58A, Research Triangle Park, NC 27711 USA
| | - Stephanie A Deflorio-Barker
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, MD 58A, Research Triangle Park, NC 27711 USA
| | - Danelle T Lobdell
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, MD 58A, Research Triangle Park, NC 27711 USA
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Gray CL, Lobdell DT, Rappazzo KM, Jian Y, Jagai JS, Messer LC, Patel AP, DeFlorio-Barker SA, Lyttle C, Solway J, Rzhetsky A. Associations between environmental quality and adult asthma prevalence in medical claims data. ENVIRONMENTAL RESEARCH 2018; 166:529-536. [PMID: 29957506 PMCID: PMC6110955 DOI: 10.1016/j.envres.2018.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. adults, we linked the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) to the MarketScan® Commercial Claims and Encounters Database. The EQI is a summary measure of five environmental domains (air, water, land, built, sociodemographic). We defined asthma as having at least 2 claims during the study period, 2003-2013. We used a Bayesian approach with non-informative priors, implementing mixed-effects regression modeling with a Poisson link function. Fixed effects variables were EQI, sex, race, and age. Random effects were counties. We modeled quintiles of the EQI comparing higher quintiles (worse quality) to lowest quintile (best quality) to estimate prevalence ratios (PR) and credible intervals (CIs). We estimated associations using the cumulative EQI and domain-specific EQIs; we assessed U.S. overall (non-stratified) as well as stratified by rural-urban continuum codes (RUCC) to assess rural/urban heterogeneity. Among the 71,577,118 U.S. adults with medical claims who could be geocoded to county of residence, 1,147,564 (1.6%) met the asthma definition. Worse environmental quality was associated with increased asthma prevalence using the non-RUCC-stratified cumulative EQI, comparing the worst to best EQI quintile (PR:1.27; 95% CI: 1.21, 1.34). Patterns varied among different EQI domains, as well as by rural/urban status. Poor environmental quality may increase asthma prevalence, but domain-specific drivers may operate differently depending on rural/urban status.
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Affiliation(s)
- Christine L Gray
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB# 7435, Chapel Hill, NC, 27599, United States; Oak Ridge Institute for Science and Education at the US Environmental Protection Agency, USEPA Human Studies Facility, 104 Mason Farm Rd, Chapel Hill, NC, 27514, United States.
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC 27711, United States.
| | - Kristen M Rappazzo
- National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC 27711, United States.
| | - Yun Jian
- Informatics Institute, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, United States.
| | - Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 2121 W. Taylor Street, Chicago, IL, 60612, United States.
| | - Lynne C Messer
- School of Public Health, Oregon Health & Sciences University-Portland State University, 840 Gaines St., Portland, OR, United States.
| | - Achal P Patel
- Oak Ridge Associated Universities at the US Environmental Protection Agency, USEPA Human Studies Facility, 104 Mason Farm Rd, Chapel Hill, NC, 27514, United States.
| | - Stephanie A DeFlorio-Barker
- National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC 27711, United States.
| | - Christopher Lyttle
- The Center for Health and the Social Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States.
| | - Julian Solway
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States; Department of Pediatrics, Committee on Molecular Medicine, University of Chicago, 5721S, Maryland Avenue, Chicago, IL 60637, United States.
| | - Andrey Rzhetsky
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States; Department of Human Genetics, University of Chicago, 920 E 58th Street, Chicago, IL 60637, United States; Department of Medicine, Institute of Genomics and Systems Biology, and Computation Institute, University of Chicago, 5801 S. Ellis Avenue, Chicago, IL 60637, United States.
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Gray CL, Messer LC, Rappazzo KM, Jagai JS, Grabich SC, Lobdell DT. The association between physical inactivity and obesity is modified by five domains of environmental quality in U.S. adults: A cross-sectional study. PLoS One 2018; 13:e0203301. [PMID: 30161196 PMCID: PMC6117021 DOI: 10.1371/journal.pone.0203301] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/18/2018] [Indexed: 01/29/2023] Open
Abstract
Physical inactivity is a primary contributor to the obesity epidemic, but may be promoted or hindered by environmental factors. To examine how cumulative environmental quality may modify the inactivity-obesity relationship, we conducted a cross-sectional study by linking county-level Behavioral Risk Factor Surveillance System data with the Environmental Quality Index (EQI), a composite measure of five environmental domains (air, water, land, built, sociodemographic) across all U.S. counties. We estimated the county-level association (N = 3,137 counties) between 2009 age-adjusted leisure-time physical inactivity (LTPIA) and 2010 age-adjusted obesity from BRFSS across EQI tertiles using multi-level linear regression, with a random intercept for state, adjusted for percent minority and rural-urban status. We modelled overall and sex-specific estimates, reporting prevalence differences (PD) and 95% confidence intervals (CI). In the overall population, the PD increased from best (PD = 0.341 (95% CI: 0.287, 0.396)) to worst (PD = 0.645 (95% CI: 0.599, 0.690)) EQI tertile. We observed similar trends in males from best (PD = 0.244 (95% CI: 0.194, 0.294)) to worst (PD = 0.601 (95% CI: 0.556, 0.647)) quality environments, and in females from best (PD = 0.446 (95% CI: 0.385, 0.507)) to worst (PD = 0.655 (95% CI: 0.607, 0.703)). We found that poor environmental quality exacerbates the LTPIA-obesity relationship. Efforts to improve obesity through LTPIA may benefit from considering this relationship.
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Affiliation(s)
- Christine L. Gray
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, USEPA Human Studies Facility, Chapel Hill, North Carolina, United States of America
| | - Lynne C. Messer
- School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, Oregon, United States of America
| | - Kristen M. Rappazzo
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, USEPA Human Studies Facility, Chapel Hill, North Carolina, United States of America
| | - Jyotsna S. Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Shannon C. Grabich
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, USEPA Human Studies Facility, Chapel Hill, North Carolina, United States of America
| | - Danelle T. Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, USEPA Human Studies Facility, Chapel Hill, North Carolina, United States of America
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Jian Y, Wu CYH, Gohlke JM. Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1143. [PMID: 28956828 PMCID: PMC5664644 DOI: 10.3390/ijerph14101143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 11/16/2022]
Abstract
Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency's Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent the cumulative environmental quality. We applied a time-stratified case-crossover design to analyze the disparities in the association between heatwaves and non-accidental deaths (NAD) among counties with different environmental qualities, in metropolitan areas in Alabama (AL), United States. Results: We found significant associations between heatwaves and NAD and a significant effect modification of this relationship by EQI. There were higher odds ratios in counties with the worst cumulative environmental qualities compared to counties with the best cumulative environmental qualities. For example, the percent change in odds ratio (mean and (95% CI)) between heatwave days and non-heatwave days was -10.3% (-26.6, 9.6) in counties with an overall EQI of 1 (the best overall environment) and 13.2% (4.9, 22.2) in counties with an overall EQI of 3 (the worst overall environment). Among the five domains, air quality had the strongest effect modification on the association. Conclusion: Our findings provide evidence that the associations between heatwaves and NAD vary among areas with different environmental qualities. These findings suggest that integration of air quality and heatwave warning systems may provide greater protection to public health.
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Affiliation(s)
- Yun Jian
- Informatics Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Connor Y H Wu
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Julia M Gohlke
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
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Jagai JS, Messer LC, Rappazzo KM, Gray CL, Grabich SC, Lobdell DT. County-level cumulative environmental quality associated with cancer incidence. Cancer 2017; 123:2901-2908. [PMID: 28480506 PMCID: PMC6121813 DOI: 10.1002/cncr.30709 10.1002/cncr.30709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 06/22/2023]
Abstract
BACKGROUND Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that occur in 5 domains. METHODS The EQI was linked to county-level annual age-adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All-site cancer and the top 3 site-specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed-slope, random intercept multilevel linear regression models. Associations were assessed with domain-specific indices and analyses were stratified by rural/urban status. RESULTS Comparing the highest quintile/poorest environmental quality with the lowest quintile/best environmental quality for overall EQI, all-site county-level cancer incidence rate was positively associated with poor environmental quality overall (IRD, 38.55; 95% CI, 29.57-47.53) and for male (IRD, 32.60; 95% CI, 16.28-48.91) and female (IRD, 30.34; 95% CI, 20.47-40.21) subjects, indicating a potential increase in cancer incidence with decreasing environmental quality. Rural/urban stratified models demonstrated positive associations comparing the highest with the lowest quintiles for all strata, except the thinly populated/rural stratum and in the metropolitan/urbanized stratum. Prostate and breast cancer demonstrated the strongest positive associations with poor environmental quality. CONCLUSION We observed strong positive associations between the EQI and all-site cancer incidence rates, and associations differed by rural/urban status and environmental domain. Research focusing on single environmental exposures in cancer development may not address the broader environmental context in which cancers develop, and future research should address cumulative environmental exposures. Cancer 2017;123:2901-8. © 2017 American Cancer Society.
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Affiliation(s)
- JS Jagai
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago, Chicago, IL, USA
| | - LC Messer
- School of Community Health; College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - KM Rappazzo
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, NC, USA
| | - CL Gray
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, NC, USA
| | - SC Grabich
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, NC, USA
| | - DT Lobdell
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, NC, USA
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Jagai JS, Messer LC, Rappazzo KM, Gray CL, Grabich SC, Lobdell DT. County-level cumulative environmental quality associated with cancer incidence. Cancer 2017; 123:2901-2908. [PMID: 28480506 DOI: 10.1002/cncr.30709] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that occur in 5 domains. METHODS The EQI was linked to county-level annual age-adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All-site cancer and the top 3 site-specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed-slope, random intercept multilevel linear regression models. Associations were assessed with domain-specific indices and analyses were stratified by rural/urban status. RESULTS Comparing the highest quintile/poorest environmental quality with the lowest quintile/best environmental quality for overall EQI, all-site county-level cancer incidence rate was positively associated with poor environmental quality overall (IRD, 38.55; 95% CI, 29.57-47.53) and for male (IRD, 32.60; 95% CI, 16.28-48.91) and female (IRD, 30.34; 95% CI, 20.47-40.21) subjects, indicating a potential increase in cancer incidence with decreasing environmental quality. Rural/urban stratified models demonstrated positive associations comparing the highest with the lowest quintiles for all strata, except the thinly populated/rural stratum and in the metropolitan/urbanized stratum. Prostate and breast cancer demonstrated the strongest positive associations with poor environmental quality. CONCLUSION We observed strong positive associations between the EQI and all-site cancer incidence rates, and associations differed by rural/urban status and environmental domain. Research focusing on single environmental exposures in cancer development may not address the broader environmental context in which cancers develop, and future research should address cumulative environmental exposures. Cancer 2017;123:2901-8. © 2017 American Cancer Society.
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Affiliation(s)
- Jyotsna S Jagai
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Lynne C Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon
| | - Kristen M Rappazzo
- US Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, North Carolina
| | - Christine L Gray
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Oak Ridge Institute for Science and Education, US Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, North Carolina
| | - Shannon C Grabich
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Oak Ridge Institute for Science and Education, US Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, North Carolina
| | - Danelle T Lobdell
- US Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Chapel Hill, North Carolina
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13
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Jian Y, Messer LC, Jagai JS, Rappazzo KM, Gray CL, Grabich SC, Lobdell DT. Associations between Environmental Quality and Mortality in the Contiguous United States, 2000-2005. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:355-362. [PMID: 27713110 PMCID: PMC5332172 DOI: 10.1289/ehp119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/28/2016] [Accepted: 08/23/2016] [Indexed: 05/08/2023]
Abstract
BACKGROUND Assessing cumulative effects of the multiple environmental factors influencing mortality remains a challenging task. OBJECTIVES This study aimed to examine the associations between cumulative environmental quality and all-cause and leading cause-specific (heart disease, cancer, and stroke) mortality rates. METHODS We used the overall Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent environmental exposure. Associations between the EQI and mortality rates (CDC WONDER) for counties in the contiguous United States (n = 3,109) were investigated using multiple linear regression models and random intercept and random slope hierarchical models. Urbanicity, climate, and a combination of the two were used to explore the spatial patterns in the associations. RESULTS We found 1 standard deviation increase in the overall EQI (worse environment) was associated with a mean 3.22% (95% CI: 2.80%, 3.64%) increase in all-cause mortality, a 0.54% (95% CI: -0.17%, 1.25%) increase in heart disease mortality, a 2.71% (95% CI: 2.21%, 3.22%) increase in cancer mortality, and a 2.25% (95% CI: 1.11%, 3.39%) increase in stroke mortality. Among the environmental domains, the associations ranged from -1.27% (95% CI: -1.70%, -0.84%) to 3.37% (95% CI: 2.90%, 3.84%) for all-cause mortality, -2.62% (95% CI: -3.52%, -1.73%) to 4.50% (95% CI: 3.73%, 5.27%) for heart disease mortality, -0.88% (95% CI: -2.12%, 0.36%) to 3.72% (95% CI: 2.38%, 5.06%) for stroke mortality, and -0.68% (95% CI: -1.19%, -0.18%) to 3.01% (95% CI: 2.46%, 3.56%) for cancer mortality. Air had the largest associations with all-cause, heart disease, and cancer mortality, whereas the sociodemographic index had the largest association with stroke mortality. Across the urbanicity gradient, no consistent trend was found. Across climate regions, the associations ranged from 2.29% (95% CI: 1.87%, 2.72%) to 5.30% (95% CI: 4.30%, 6.30%) for overall EQI, and larger associations were generally found in dry areas for both overall EQI and domain indices. CONCLUSIONS These results suggest that poor environmental quality, particularly poor air quality, was associated with increased mortality and that associations vary by urbanicity and climate region. Citation: Jian Y, Messer LC, Jagai JS, Rappazzo KM, Gray CL, Grabich SC, Lobdell DT. 2017. Associations between environmental quality and mortality in the contiguous United States, 2000-2005. Environ Health Perspect 125:355-362; http://dx.doi.org/10.1289/EHP119.
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Affiliation(s)
- Yun Jian
- Oak Ridge Institute for Science and Education, National Health and Environmental Effects Research Laboratory (NHEERL), U.S. Environmental Protection Agency (EPA), Chapel Hill, North Carolina, USA
| | - Lynne C. Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon, USA
| | - Jyotsna S. Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Chicago, Illinois, USA
| | | | - Christine L. Gray
- Oak Ridge Institute for Science and Education, National Health and Environmental Effects Research Laboratory (NHEERL), U.S. Environmental Protection Agency (EPA), Chapel Hill, North Carolina, USA
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Danelle T. Lobdell
- NHEERL, U.S. EPA, Chapel Hill, North Carolina, USA
- Address correspondence to D.T. Lobdell, U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, MD 58A, Research Triangle Park, NC 27711 USA. Telephone: (919) 843-4434. E-mail:
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14
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Grabich SC, Rappazzo KM, Gray CL, Jagai JS, Jian Y, Messer LC, Lobdell DT. Additive Interaction between Heterogeneous Environmental Quality Domains (Air, Water, Land, Sociodemographic, and Built Environment) on Preterm Birth. Front Public Health 2016; 4:232. [PMID: 27822465 PMCID: PMC5076290 DOI: 10.3389/fpubh.2016.00232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Environmental exposures often occur in tandem; however, epidemiological research often focuses on singular exposures. Statistical interactions among broad, well-characterized environmental domains have not yet been evaluated in association with health. We address this gap by conducting a county-level cross-sectional analysis of interactions between Environmental Quality Index (EQI) domain indices on preterm birth in the Unites States from 2000 to 2005. METHODS The EQI, a county-level index constructed for the 2000-2005 time period, was constructed from five domain-specific indices (air, water, land, built, and sociodemographic) using principal component analyses. County-level preterm birth rates (n = 3141) were estimated using live births from the National Center for Health Statistics. Linear regression was used to estimate prevalence differences (PDs) and 95% confidence intervals (CIs) comparing worse environmental quality to the better quality for each model for (a) each individual domain main effect, (b) the interaction contrast, and (c) the two main effects plus interaction effect (i.e., the "net effect") to show departure from additivity for the all U.S. counties. Analyses were also performed for subgroupings by four urban/rural strata. RESULTS We found the suggestion of antagonistic interactions but no synergism, along with several purely additive (i.e., no interaction) associations. In the non-stratified model, we observed antagonistic interactions, between the sociodemographic/air domains [net effect (i.e., the association, including main effects and interaction effects) PD: -0.004 (95% CI: -0.007, 0.000), interaction contrast: -0.013 (95% CI: -0.020, -0.007)] and built/air domains [net effect PD: 0.008 (95% CI 0.004, 0.011), interaction contrast: -0.008 (95% CI: -0.015, -0.002)]. Most interactions were between the air domain and other respective domains. Interactions differed by urbanicity, with more interactions observed in non-metropolitan regions. CONCLUSION Observed antagonistic associations may indicate that those living in areas with multiple detrimental domains may have other interfering factors reducing the burden of environmental exposure. This study is the first to explore interactions across different environmental domains and demonstrates the utility of the EQI to examine the relationship between environmental domain interactions and human health. While we did observe some departures from additivity, many observed effects were additive. This study demonstrated that interactions between environmental domains should be considered in future analyses.
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Affiliation(s)
- Shannon C Grabich
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park , Chapel Hill, NC , USA
| | - Kristen M Rappazzo
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park , Chapel Hill, NC , USA
| | - Christine L Gray
- National Health and Environmental Effects Research Laboratory, Oak Ridge Institute for Science and Education, U.S. Environmental Protection Agency, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago , Chicago, IL , USA
| | - Yun Jian
- National Health and Environmental Effects Research Laboratory, Oak Ridge Institute for Science and Education, U.S. Environmental Protection Agency , Chapel Hill, NC , USA
| | - Lynne C Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University , Portland, OR , USA
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park , Chapel Hill, NC , USA
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15
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Atta CAM, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, Rajapakse T, Kaplan GG, Metcalfe A. Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis. Am J Public Health 2016; 106:e24-34. [PMID: 26562127 PMCID: PMC4695937 DOI: 10.2105/ajph.2015.302902] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Birth defects remain a significant source of worldwide morbidity and mortality. Strong scientific evidence shows that folic acid fortification of a region's food supply leads to a decrease in spina bifida (a birth defect of the spine). Still, many countries around the world have yet to approve mandatory fortification through government legislation. OBJECTIVES We sought to perform a systematic review and meta-analysis of period prevalence of spina bifida by folic acid fortification status, geographic region, and study population. SEARCH METHODS An expert research librarian used terms related to neural tube defects and epidemiology from primary research from 1985 to 2010 to search in EMBASE and MEDLINE. We searched the reference lists of included articles and key review articles identified by experts. SELECTION CRITERIA Inclusion criteria included studies in English or French reporting on prevalence published between January 1985 and December 2010 that (1) were primary research, (2) were population-based, and (3) reported a point or period prevalence estimate of spina bifida (i.e., prevalence estimate with confidence intervals or case numerator and population denominator). Two independent reviewers screened titles and abstracts for eligible articles, then 2 authors screened full texts in duplicate for final inclusion. Disagreements were resolved through consensus or a third party. DATA COLLECTION AND ANALYSIS We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, abstracting data related to case ascertainment, study population, folic acid fortification status, geographic region, and prevalence estimate independently and in duplicate. We extracted overall data and any subgroups reported by age, gender, time period, or type of spina bifida. We classified each period prevalence estimate as "mandatory" or "voluntary" folic acid fortification according to each country's folic acid fortification status at the time data were collected (as determined by a well-recognized fortification monitoring body, Food Fortification Initiative). We determined study quality on the basis of sample representativeness, standardization of data collection and birth defect assessment, and statistical analyses. We analyzed study-level period prevalence estimates by using a random effects model (α level of < 0.05) for all meta-analyses. We stratified pooled period prevalence estimates by birth population, fortification status, and continent. RESULTS Of 4078 studies identified, we included 179 studies in the systematic review and 123 in a meta-analysis. In studies of live births (LBs) alone, period prevalences of spina bifida were (1) lower in geographical regions with mandatory (33.86 per 100,000 LBs) versus voluntary (48.35 per 100,000 LBs) folic acid fortification, and (2) lower in studies of LBs, stillbirths, and terminations of pregnancy in regions with mandatory (35.22 per 100,000 LBs) versus voluntary (52.29 per 100,000 LBs) fortification. In LBs, stillbirths, and terminations of pregnancy studies, the lowest pooled prevalence estimate was in North America (38.70 per 100,000). Case ascertainment, surveillance methods, and reporting varied across these population-based studies. CONCLUSIONS Mandatory legislation enforcing folic acid fortification of the food supply lags behind the evidence, particularly in Asian and European countries. This extensive literature review shows that spina bifida is significantly more common in world regions without government legislation regulating full-coverage folic acid fortification of the food supply (i.e., Asia, Europe) and that mandatory folic acid fortification resulted in a lower prevalence of spina bifida regardless of the type of birth cohort. African data were scarce, but needed, as many African nations are beginning to adopt folic acid legislation.
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Affiliation(s)
- Callie A M Atta
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Kirsten M Fiest
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Alexandra D Frolkis
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Nathalie Jette
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Tamara Pringsheim
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Christine St Germaine-Smith
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Thilinie Rajapakse
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Gilaad G Kaplan
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
| | - Amy Metcalfe
- Callie A. M. Atta, Kirsten M. Fiest, Nathalie Jette, Tamara Pringsheim, and Christine St Germaine-Smith are with the Department of Clinical Neurosciences, University of Calgary, Alberta. Kirsten M. Fiest and Nathalie Jette are also with Hotchkiss Brain Institute, University of Calgary. Tamara Pringsheim and Thilinie Rajapakse are with the Department of Paediatrics, University of Calgary. Kirsten M. Fiest, Alexandra D. Frolkis, Nathalie Jette, Tamara Pringsheim, and Gilaad G. Kaplan are with Department of Community Health Sciences, University of Calgary. Amy Metcalfe is with the Department of Obstetrics and Gynecology, University of Calgary
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16
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Rappazzo KM, Messer LC, Jagai JS, Gray CL, Grabich SC, Lobdell DT. The associations between environmental quality and preterm birth in the United States, 2000-2005: a cross-sectional analysis. Environ Health 2015; 14:50. [PMID: 26051702 PMCID: PMC4464856 DOI: 10.1186/s12940-015-0038-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/29/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Many environmental factors have been independently associated with preterm birth (PTB). However, exposure is not isolated to a single environmental factor, but rather to many positive and negative factors that co-occur. The environmental quality index (EQI), a measure of cumulative environmental exposure across all US counties from 2000-2005, was used to investigate associations between ambient environment and PTB. METHODS With 2000-2005 birth data from the National Center for Health Statistics for the United States (n = 24,483,348), we estimated the association between increasing quintiles of the EQI and county-level and individual-level PTB; we also considered environmental domain-specific (air, water, land, sociodemographic and built environment) and urban-rural stratifications. RESULTS Effect estimates for the relationship between environmental quality and PTB varied by domain and by urban-rural strata but were consistent across county- and individual-level analyses. The county-level prevalence difference (PD (95% confidence interval) for the non-stratified EQI comparing the highest quintile (poorest environmental quality) to the lowest quintile (best environmental quality) was -0.0166 (-0.0198, -0.0134). The air and sociodemographic domains had the strongest associations with PTB; PDs were 0.0196 (0.0162, 0.0229) and -0.0262 (-0.0300, -0.0224) for the air and sociodemographic domain indices, respectively. Within the most urban strata, the PD for the sociodemographic domain index was 0.0256 (0.0205, 0.0307). Odds ratios (OR) for the individual-level analysis were congruent with PDs. CONCLUSION We observed both strong positive and negative associations between measures of broad environmental quality and preterm birth. Associations differed by rural-urban stratum and by the five environmental domains. Our study demonstrates the use of a large scale composite environment exposure metric with preterm birth, an important indicator of population health and shows potential for future research.
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Affiliation(s)
- Kristen M Rappazzo
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA.
| | - Lynne C Messer
- School of Community Health; College of Urban and Public Affairs, Portland State University, Portland, OR, USA.
| | - Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Chicago, IL, USA.
| | - Christine L Gray
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
| | - Shannon C Grabich
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
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Golalipour MJ, Qorbani M, Mirfazeli A, Mobasheri E. Risk factors of neural tube defects in northern iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e7940. [PMID: 25068063 PMCID: PMC4102996 DOI: 10.5812/ircmj.7940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/24/2014] [Accepted: 04/05/2014] [Indexed: 11/16/2022]
Abstract
Background: Neural tube defects (NTDs) including spina bifida and anencephaly are the second most common birth defects with 2.8 per 1000 births in northern Iran. Objectives: This study was conducted to determine the risk factors of neural tube defects in Gorgan, north of Iran. Patients and Methods: This hospital-based, case-control study was carried out on all NTD-affected pregnancies (n = 59) during February 2007 - August 2010, and 160 healthy pregnancies were selected via convenient sampling method in three hospitals in Gorgan, north of Iran. Risk factors including maternal body mass index (BMI), season of birth, gender of the newborn, mother’s age, ethnicity, consanguineous marriage, folic acid consumption, nutrition, habitat, and education, were assessed through interviews with mothers. Univariate and multivariate logistic regression analyses were used to estimate the risks by odds ratios (ORs) and 95% confidence intervals. Results: The multivariate analysis showed that maternal BMI (normal/underweight OR: 0.23, overweight/underweight OR: 0.15, obese/underweight OR: 0.13) and maternal ethnicity (Fars/Sistani OR: 3.49) and maternal nutrition (good/poor OR: 0.46) were significantly correlated with NTDs in the newborns. Conclusions: This study showed that maternal ethnicity, insufficient nutrition, and BMI, were the main risk factors of NTDs in northern Iran.
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Affiliation(s)
- Mohammad Jafar Golalipour
- Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding Author: Mohammad Jafar Golalipour, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, P. O. Box: 49175-1141, Gorgan, IR Iran. Tel/Fax: +98-1714425165, E-mail:
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, IR Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Arezo Mirfazeli
- Department of Pediatrics, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Elham Mobasheri
- Department of Obstetrics and Gynecology, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
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18
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Messer LC, Jagai JS, Rappazzo KM, Lobdell DT. Construction of an environmental quality index for public health research. Environ Health 2014; 13:39. [PMID: 24886426 PMCID: PMC4046025 DOI: 10.1186/1476-069x-13-39 10.1186/1476-069x-13-39/tables/14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/01/2014] [Indexed: 06/22/2023]
Abstract
BACKGROUND A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. METHODS The EQI was developed in four parts: domain identification; data source acquisition; variable construction; and data reduction. Five environmental domains (air, water, land, built and sociodemographic) were recognized. Within each domain, data sources were identified; each was temporally (years 2000-2005) and geographically (county) restricted. Variables were constructed for each domain and assessed for missingness, collinearity, and normality. Domain-specific data reduction was accomplished using principal components analysis (PCA), resulting in domain-specific indices. Domain-specific indices were then combined into an overall EQI using PCA. In each PCA procedure, the first principal component was retained. Both domain-specific indices and overall EQI were stratified by four rural-urban continuum codes (RUCC). Higher values for each index were set to correspond to areas with poorer environmental quality. RESULTS Concentrations of included variables differed across rural-urban strata, as did within-domain variable loadings, and domain index loadings for the EQI. In general, higher values of the air and sociodemographic indices were found in the more metropolitan areas and the most thinly populated areas have the lowest values of each of the domain indices. The less-urbanized counties (RUCC 3) demonstrated the greatest heterogeneity and range of EQI scores (-4.76, 3.57) while the thinly populated strata (RUCC 4) contained counties with the most positive scores (EQI score ranges from -5.86, 2.52). CONCLUSION The EQI holds promise for improving our characterization of the overall environment for public health. The EQI describes the non-residential ambient county-level conditions to which residents are exposed and domain-specific EQI loadings indicate which of the environmental domains account for the largest portion of the variability in the EQI environment. The EQI was constructed for all counties in the United States, incorporating a variety of data to provide a broad picture of environmental conditions. We undertook a reproducible approach that primarily utilized publically-available data sources.
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Affiliation(s)
- Lynne C Messer
- School of Community Health; College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - Jyotsna S Jagai
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago, Chicago, IL, USA
| | - Kristen M Rappazzo
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Oak Ridge Institute for Science and Education, National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, Oak Ridge, NC, USA
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA
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19
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Messer LC, Jagai JS, Rappazzo KM, Lobdell DT. Construction of an environmental quality index for public health research. Environ Health 2014; 13:39. [PMID: 24886426 PMCID: PMC4046025 DOI: 10.1186/1476-069x-13-39] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/01/2014] [Indexed: 05/24/2023]
Abstract
BACKGROUND A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. METHODS The EQI was developed in four parts: domain identification; data source acquisition; variable construction; and data reduction. Five environmental domains (air, water, land, built and sociodemographic) were recognized. Within each domain, data sources were identified; each was temporally (years 2000-2005) and geographically (county) restricted. Variables were constructed for each domain and assessed for missingness, collinearity, and normality. Domain-specific data reduction was accomplished using principal components analysis (PCA), resulting in domain-specific indices. Domain-specific indices were then combined into an overall EQI using PCA. In each PCA procedure, the first principal component was retained. Both domain-specific indices and overall EQI were stratified by four rural-urban continuum codes (RUCC). Higher values for each index were set to correspond to areas with poorer environmental quality. RESULTS Concentrations of included variables differed across rural-urban strata, as did within-domain variable loadings, and domain index loadings for the EQI. In general, higher values of the air and sociodemographic indices were found in the more metropolitan areas and the most thinly populated areas have the lowest values of each of the domain indices. The less-urbanized counties (RUCC 3) demonstrated the greatest heterogeneity and range of EQI scores (-4.76, 3.57) while the thinly populated strata (RUCC 4) contained counties with the most positive scores (EQI score ranges from -5.86, 2.52). CONCLUSION The EQI holds promise for improving our characterization of the overall environment for public health. The EQI describes the non-residential ambient county-level conditions to which residents are exposed and domain-specific EQI loadings indicate which of the environmental domains account for the largest portion of the variability in the EQI environment. The EQI was constructed for all counties in the United States, incorporating a variety of data to provide a broad picture of environmental conditions. We undertook a reproducible approach that primarily utilized publically-available data sources.
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Affiliation(s)
- Lynne C Messer
- School of Community Health; College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - Jyotsna S Jagai
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago, Chicago, IL, USA
| | - Kristen M Rappazzo
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Oak Ridge Institute for Science and Education, National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, Oak Ridge, NC, USA
| | - Danelle T Lobdell
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA
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20
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Sacks JD, Rappold AG, Davis JA, Richardson DB, Waller AE, Luben TJ. Influence of urbanicity and county characteristics on the association between ozone and asthma emergency department visits in North Carolina. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:506-12. [PMID: 24569869 PMCID: PMC4014762 DOI: 10.1289/ehp.1306940] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 02/22/2014] [Indexed: 05/17/2023]
Abstract
BACKGROUND Air pollution epidemiologic studies, often conducted in large metropolitan areas because of proximity to regulatory monitors, are limited in their ability to examine potential associations between air pollution exposures and health effects in rural locations. METHODS Using a time-stratified case-crossover framework, we examined associations between asthma emergency department (ED) visits in North Carolina (2006-2008), collected by a surveillance system, and short-term ozone (O3) exposures using predicted concentrations from the Community Multiscale Air Quality (CMAQ) model. We estimated associations by county groupings based on four urbanicity classifications (representative of county size and urban proximity) and county health. RESULTS O3 was associated with asthma ED visits in all-year and warm season (April-October) analyses [odds ratio (OR) = 1.019; 95% CI: 0.998, 1.040; OR = 1.020; 95% CI: 0.997, 1.044, respectively, for a 20-ppb increase in lag 0-2 days O3]. The association was strongest in Less Urbanized counties, with no evidence of a positive association in Rural counties. Associations were similar when adjusted for fine particulate matter in copollutant models. Associations were stronger for children (5-17 years of age) compared with other age groups, and for individuals living in counties identified with poorer health status compared with counties that had the highest health rankings, although estimated associations for these subgroups had larger uncertainty. CONCLUSIONS Associations between short-term O3 exposures and asthma ED visits differed by overall county health and urbanicity, with stronger associations in Less Urbanized counties, and no positive association in Rural counties. Results also suggest that children are at increased risk of O3-related respiratory effects.
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Affiliation(s)
- Jason D Sacks
- National Center for Environmental Assessment, Office of Research and Development, and
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21
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Delmelle EM, Cassell CH, Dony C, Radcliff E, Tanner JP, Siffel C, Kirby RS. Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2013; 97:673-84. [PMID: 23996978 PMCID: PMC4507419 DOI: 10.1002/bdra.23168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with birth defects may face significant geographic barriers accessing medical care and specialized services. Using a Geographic Information Systems-based approach, one-way travel time and distance to access medical care for children born with spina bifida was estimated. METHODS Using 2007 road information from the Florida Department of Transportation, we built a topological network of Florida roads. Live-born Florida infants with spina bifida during 1998 to 2007 were identified by the Florida Birth Defects Registry and linked to hospital discharge records. Maternal residence at delivery and hospitalization locations were identified during the first year of life. RESULTS Of 668 infants with spina bifida, 8.1% (n = 54) could not be linked to inpatient data, resulting in 614 infants. Of those 614 infants, 99.7% (n = 612) of the maternal residential addresses at delivery were successfully geocoded. Infants with spina bifida living in rural areas in Florida experienced travel times almost twice as high compared with those living in urban areas. When aggregated at county levels, one-way network travel times exhibited statistically significant spatial autocorrelation, indicating that families living in some clusters of counties experienced substantially greater travel times compared with families living in other areas of Florida. CONCLUSION This analysis demonstrates the usefulness of linking birth defects registry and hospital discharge data to examine geographic differences in access to medical care. Geographic Information Systems methods are important in evaluating accessibility and geographic barriers to care and could be used among children with special health care needs, including children with birth defects.
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Affiliation(s)
- Eric M. Delmelle
- Department of Geography and Earth Sciences and Center for Applied GI Science, College of Liberal Arts and Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Cynthia H. Cassell
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Coline Dony
- Department of Geography and Earth Sciences and Center for Applied GI Science, College of Liberal Arts and Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Elizabeth Radcliff
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Jean Paul Tanner
- Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Csaba Siffel
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Russell S. Kirby
- Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
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