Historical Redlining Is Associated with Present-Day Air Pollution Disparities in U.S. Cities

How air pollution affects cause-specific emergency hospital admissions on days with biomass combustion in Spain?

Although wildfires are growing in number, intensity and extent due to climate change, few studies have been undertaken to analyse their health impact, and fewer still to analyse the impact of variables other than particulate matter. The objective of this study is to analyse the short-term impact of NO2, PM10, PM2.5, O3 and temperature in heat waves on emergency hospital admissions in Spain on days when biomass combustion occurs. We conducted an ecological longitudinal time series study across the period 2013-2018. The dependent variables were emergency hospital admissions due to all causes (ICD-10: A00-R99), circulatory causes (ICD-10: I00-I99) and respiratory causes (ICD-10: J00-J99) in 9 representative Spanish provinces. The independent variables were daily mean air pollution concentrations measured at a provincial level. We also included daily maximum temperatures recorded at reference observatories in the respective provinces. Poisson generalised linear models were fitted for days with and without PM advections due to biomass burning smoke. We controlled for trends, seasonalities, the autoregressive nature of the series, Sundays and Public Holidays. Days with biomass burning smoke advections increased PM concentrations in all provinces and ozone in many of them, something that did not occur in equal measure in the case of NO2. Nevertheless, the principal impact on admissions was due to O3, followed by NO2, PM, and lastly, heat-wave temperatures. This pattern was observed for all three causes analysed. The role of PM was relegated to that of a third factor, and the role of temperature to an order of lesser magnitude than that of chemical pollution. To focus the health impacts of wildfires exclusively on the impact of PM concentrations would be to minimise their real impact on population health. It is therefore essential to implement integrated plans that take into account the joint effect of all atmospheric variables affected.

The Interplay of Pollution, Child Opportunity, and High Health Care Utilization in Children With Asthma in San Diego County

OBJECTIVES

This study aims to (1) compare air pollution and child opportunity between neighborhoods with and without high health care utilization (HHU) for asthma, and (2) compare health care utilization frequency by race, ethnicity, primary language, and insurance type at the patient level.

METHODS

This retrospective cohort study examined children with asthma within the Rady Children's Health System (2015-2020) who met HHU criteria [≥2 emergency department (ED) visits in 6 months or ≥2 hospitalizations in 12 mo]. Patient addresses were geocoded to census tracts, and ArcGIS was used to map CalEnviroScore 4.0 and the Child Opportunity Index. Descriptive statistics assessed health care utilization differences based on patient demographics.

RESULTS

This study included 1070 individuals. The median HHU asthma rate was 1.7 per 1000 children (interquartile range: 0.9 to 3.1) across 408 census tracts. Pollution burden was significantly higher in tracts with HHU asthma cases than those without ( P = 0.002). Census tracts with HHU asthma cases had lower Child Opportunity Index scores compared with those without ( P < 0.001). Black patients had more ED visits than white patients ( P = 0.002). Hispanic patients had more inpatient hospitalizations than non-Hispanics ( P = 0.043). Medicaid/Medi-Cal patients had more ED and inpatient encounters than those with commercial insurance ( P = 0.001).

CONCLUSIONS

We identified disparities in pollution and child opportunity among pediatric asthma patients with HHU. These differences are linked to race, ethnicity, and insurance type. These findings can guide efforts to improve child health equity.

Contemporary income inequality outweighs historic redlining in shaping intra-urban heat disparities in Los Angeles

The roots of intra-urban heat disparity in the U.S. often trace back to historical discriminatory practices, such as redlining, which categorized neighborhoods by race or ethnicity. In this study, we compare the relative impacts of historic redlining and current income inequality on thermal disparities in Los Angeles. A key innovation of our work is the use of land surface temperature data from the ECOSTRESS instrument aboard the International Space Station, enabling us to capture diurnal trends in urban thermal disparities. Our findings reveal that present-day income inequality is a stronger predictor of heat burden than the legacy of redlining. Additionally, land surface temperature disparities exhibit a seasonal hysteresis effect, intensifying during extreme heat events by 5-7 °C. Sociodemographic analysis highlights that African-American and Hispanic populations in historically and economically disadvantaged areas are often the most vulnerable. Our findings suggest that while the legacy of redlining may persist, the present-day heat disparities are not necessarily an immutable inheritance, where targeted investments and interventions can pave the way for a more thermally just future for these communities.

Electricity inaccessibility across historically redlined and present-day disadvantaged areas in New York City

BACKGROUND

Electricity is crucial in sustaining livelihoods from turning the lights on at night, keeping the refrigerator running to avoid food spoilage, and powering electricity-dependent durable medical equipment such as nebulizers. Thus, electricity inaccessibility may result in adverse outcomes. Like other environmental burdens, electricity inaccessibility may be socially patterned, with disproportionate occurrence in racially and economically marginalized communities.

OBJECTIVE

To evaluate the 2017-2019 distribution of electricity inaccessibility - defined as power outages and energy insecurity - across historical and present-day measures of community racial disadvantage in New York City (NYC).

METHODS

We measured power outages with NYC 311 outage call reports and the System Average Interruption Frequency Index (SAIFI). We calculated energy insecurity as monthly average energy use, leveraging data from the New York State Energy Research and Development Authority. These three electricity inaccessibility metrics were estimated within both historical Home Owners' Loan Corporation (HOLC) graded areas (A, 'best' through D, 'redlined') and present-day racial and economic Index of Concentrations at the Extremes (ICE) census tracts quartiles.

RESULTS

Our study covered 396 HOLC areas and 2218 census tracts in NYC. Historically A-graded areas had fewer 311 outage calls and lower SAIFI. Additionally, the rate of 311 outage calls in the present-day most disadvantaged census tracts was nearly six times that of the most privileged tracts. Persistently disadvantaged areas (i.e., both poor HOLC grade and high ICE) had more power outages than consistently advantaged areas. However, the present-day most disadvantaged census tracts still had more power outages than persistently disadvantaged areas.

IMPACT

This 2017-2019 New York City (NYC) study evaluated the distribution of three electricity inaccessibility metrics in relation to community privilege and disadvantage. Uniquely, we assessed the distribution across historically redlined areas and present-day census tracts. We defined electricity inaccessibility as power outages (311 calls and power interruptions) and energy insecurity (residential energy use). We found that 311 calls and power interruptions were more common in historically redlined areas, present-day disadvantaged census tracts, and persistently disadvantaged areas. These findings indicate proxies for historical racial discrimination, such as redlining, and modern-day community disadvantages impact the access to reliable electricity in NYC.

Unveiling trends in urinary tract cancer mortality among older adults in the United States (1999-2022): a CDC WONDER perspective

BACKGROUND

Urinary tract cancers (UTCs), including bladder cancer, remain a significant public health challenge, particularly among individuals aged 75 and older. Despite declining bladder cancer-specific mortality rates between 2015 and 2020, the broader trends in UTC mortality and associated demographic disparities remain underexplored.

METHODS

We analyzed mortality data from 1999 to 2022 using the CDC WONDER database. UTC deaths were identified using ICD- 10 codes C64 to C68. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, stratified by sex, race/ethnicity, and census regions. Joinpoint regression identified annual percent changes (APCs) to assess temporal trends.

RESULTS

From 1999 to 2022, 477,157 UTC deaths were recorded, 66% of which occurred among individuals aged 75 and older. The AAMR increased from 97.1 in 1999 to 103.5 in 2022, with a rise between 1999 and 2007 (APC: 0.63%), a decline from 2007 to 2019 (APC: - 0.33%), and a resurgence from 2019 to 2022 (APC: 2.42%). Older males exhibited higher AAMRs than females (178.7 vs. 53.6 in 2022), and Whites had the highest AAMR (108.5) among racial groups. The Western region recorded the highest AAMR (84.3) during the study period.

CONCLUSION

The resurgence in UTC mortality post- 2019 highlights emerging challenges, particularly among older males, Whites, and residents of the Western region. Targeted interventions, including improved screening and equitable healthcare access, are essential to mitigate these disparities and improve outcomes.

Social-Environmental Burden Is Associated with Increased Colorectal Cancer Mortality in Metropolitan Detroit

SIGNIFICANCE

Understanding the role of environmental justice in cancer survivorship could influence policy decisions, aiding intervention practices.

Examining the social distributions in neighbourhood black carbon and ultrafine particles in Montreal and Toronto, Canada

BACKGROUND

Socioeconomic inequities in outdoor ultrafine particles (UFP) and black carbon (BC) are understudied in Canada, where metropoles like Montreal and Toronto feature distinct sociodemographic diversity and urban characteristics compared to U.S. cities.

METHODS

We collected vulnerability indicators, including social, economic, household composition, and immigration status, at the dissemination area level for Montreal and Toronto using data from the 2006 and 2021 Canadian Census of Population. Areas were classified as disadvantaged, intermediate, or advantaged following K-means clustering analysis. We aggregated and calculated population-weighted average concentrations of BC and UFP, and UFP size at the dissemination area and cluster levels using high-resolution exposure surfaces, derived from year-long mobile monitoring campaigns conducted in each city during 2020-2021. Final exposure surfaces were generated by integrating predictions from land-use regression models and deep convolutional neural network models.

FINDINGS

We observed high within-city variations in aggregated air pollutant levels, with higher outdoor BC and UFP concentrations and smaller UFP sizes in areas near local sources such as major roads, railways, airports, and densely populated regions. Advantaged areas experienced the lowest median UFP concentrations in both Montreal (10,707 pt/cm3) and Toronto (10,988 pt/cm3), as well as the lowest BC concentrations (650 ng/m3) in Montreal. The highest median UFP concentrations were observed in intermediate areas in Montreal (15,709 pt/cm3) and disadvantaged areas in Toronto (12,228 pt/cm3). Conversely, the highest BC concentrations were observed in disadvantaged and intermediate areas in Montreal (805-811 ng/m3), and disadvantaged and advantaged areas in Toronto (1,228-1,252 ng/m3). Notably, high priority areas for the double burden of vulnerability and high BC and UFP concentrations were located near air pollutants local emission sources.

INTERPRETATION

Our findings highlight the importance of prioritizing exposure mitigation for populations residing near local sources and to understand contextual factors influencing inequities across cities and pollutants.

High-Resolution Geospatial Database: National Criteria-Air-Pollutant Concentrations in the Contiguous U.S., 2016-2020

Concentration estimates for ambient air pollution are used widely in fields such as environmental epidemiology, health impact assessment, urban planning, environmental equity and sustainability. This study builds on previous efforts by developing an updated high-resolution geospatial database of population-weighted annual-average concentrations for six criteria air pollutants (PM2.5, PM10, CO, NO2, SO2, O3) across the contiguous U.S. during a five-year period (2016-2020). We developed Land Use Regression (LUR) models within a partial-least-squares-universal kriging framework by incorporating several land use, geospatial and satellite-based predictor variables. The LUR models were validated using conventional and clustered cross-validation, with the former consistently showing superior performance in capturing the variability of air quality. Most models demonstrated reliable performance (e.g., mean squared error-based R 2 > 0.8, standardised root mean squared error < 0.1). We used the best modelling approach to develop estimates by Census Block, which were then population-weighted averaged at Census Block Group, Census Tract and County geographies. Our database provides valuable insights into the dynamics of air pollution, with utility for environmental risk assessment, public health, policy and urban planning.

Does the new European Union air quality directive really protect health? A nationwide case study in Spain

In October 2024, the European Union (EU) issued a Directive establishing a series of limit values, which, once transposed into national law by EU Member States, will become mandatory. This Directive is less restrictive than the WHO guideline values published in 2021. Using dose-response functions specifically calculated for every Spanish province, this study sought to ascertain how many short-term, all-cause hospital emergency admissions (ICD-9: 1-799 and ICD-10: A00-R99) were attributable to NO2, PM10 and PM2.5 concentrations across the period 2013-2018, and what the ensuing reduction in admissions would be, if the EU Directive and WHO guideline values were applied respectively. The results obtained indicate that here in Spain some 38,790 admissions per year are attributable to NO2, PM10 and PM2.5 pollution, at a total cost of €548 million. These admissions would be reduced by 478 (1.23 %) if the EU Directive were observed, and by 4496 (11.59 %) if the WHO guideline values were met. While compliance with the EU limit values would have almost no effect in terms of a decrease in attributable admissions, such an effect would indeed be seen in the event of compliance with the WHO guideline values and would entail a saving of over €63 million nationwide. This study only focused on short-term effects of PM and NO2.

Child Opportunity Index at birth and asthma with recurrent exacerbations in the US ECHO program

BACKGROUND

Environmental exposures and social determinants likely influence specific childhood asthma phenotypes.

OBJECTIVE

We hypothesized that the Child Opportunity Index (COI) at birth, measuring multiple neighborhood opportunities, influences incidence rates (IRs) for asthma with recurrent exacerbations (ARE).

METHODS

We tested for COI associations with ARE IRs in 15,877 children born between 1990 and 2018 in the ECHO (Environmental Influences on Child Health Outcomes) program. Parent-reported race and ethnicity and other demographics were assessed as effect modifiers.

RESULTS

The IRs of ARE for children born in very low COI neighborhoods was higher (IR = 10.98; 95% CI: 9.71, 12.25) than for other COI categories. Rates for non-Hispanic Black (NHB) children were significantly higher than non-Hispanic White children in every COI category. The ARE IRs for children born in very low COI neighborhoods were several-fold higher for NHB and Hispanic Black children (IR = 15.30; 95% CI: 13.10, 17.49; and IR = 18.48; 95% CI: 8.80, 28.15, respectively) when compared to White children. Adjusting for individual-level characteristics, children born in very low COI neighborhoods demonstrated an ARE IR ratio of 1.26 (95% CI: 0.99, 1.59) with a higher incidence of cases among children ages 2 to 4 years and with a parental history of asthma.

CONCLUSIONS

Rates of ARE were higher among children born in under-resourced communities, and this relationship is strongest for young minoritized children with a parental history of asthma. Higher rates for NHB even in the highest COI categories suggest that risk associated with race persists regardless of social disadvantage.

Racial disparities in maternal exposure to ambient air pollution during pregnancy and prevalence of congenital heart defects

Air pollution may be a potential cause of congenital heart defects (CHDs), but racial disparities in this association are unexplored. We conducted a statewide population-based cohort study using North Carolina birth data from 2003 to 2015 (n = 1 225 285) to investigate the relationship between air pollution and CHDs (specifically pulmonary valve atresia/stenosis, tetralogy of Fallot [TOF], and atrioventricular septal defect [AVSD]). Maternal exposure to particulate matter ≤ 2.5 μm in diameter (PM2.5) and ozone during weeks 3 to 9 of pregnancy were estimated using the Environmental Protection Agency's Downscaler Model. Single- and co-pollutant log-binomial models were created for the entire population and stratified by race to investigate disparities. Positive associations between PM2.5 and CHDs were observed. An increasing concentration-response association was found for PM2.5 and TOF in adjusted, co-pollutant models (quartile 4 prevalence ratio: 1.46; 95% CI, 1.06-2.03). Differences in the effect of PM2.5 on CHD prevalence were seen in some models stratified by race, although clear exposure-prevalence gradients were not evident. Positive associations were also seen in adjusted, co-pollutant models of ozone and AVSD. Study results suggest that prenatal PM2.5 and ozone exposure may increase the prevalence of certain CHDs. A consistent pattern of differences in association by race/ethnicity was not apparent. This article is part of a Special Collection on Environmental Epidemiology.

Land-use and socioeconomic time-series reveal legacy of redlining on present-day gentrification within a growing United States city

Home Owners' Loan Corporation (HOLC) maps illustrated patterns of segregation in United States cites in the 1930s. As the causes and drivers of demographic and land-use segregation vary over years, these maps provide an important spatial lens in determining how patterns of segregation spatially and temporally developed during the past century. Using a high-resolution land-use time series (1937-2018) of Denver, Colorado, USA, in conjunction with 80 years of U.S. Census data, we found divergent land-use and demographics patterns across HOLC categories were both pre-existent to the establishment of HOLC mapping and continued to develop over time. Over this period, areas deemed "declining" or "hazardous" had more diverse land use compared to "desirable" areas. "Desirable" areas were dominated by one land-use type (single-family residential), while single-family residential diminished in prominence in the "declining/hazardous" areas. This divergence became more established decades after HOLC mapping, with impact to racial metrics and low-income households. We found changes in these demographic patterns also occurred between 2000 and 2019, highlighting how processes like gentrification can develop from both rapid demographic and land-use changes. This study demonstrates how the legacy of urban segregation develops over decades and can simultaneously persist in some neighborhoods while providing openings for fast-paced gentrification in others.

Short-Term Exposure to Ambient Particulate Matter Pollution and Surgical Outcomes

INTRODUCTION

Particulate matter less than 2.5 μm in diameter (PM2.5) can activate inflammatory cascades, cause oxidative damage, and induce cell death. Short-term exposures to PM2.5 have been associated with appendicitis and inflammatory bowel disease presentations, yet it is unclear if exposures may impact surgical recovery.

METHODS

We conducted a retrospective cohort study of adult, colorectal surgery patients from 2006 to 2021. Institutional American College of Surgeons National Surgical Quality Improvement Program data were linked to Environmental Protection Agency PM2.5 concentrations on the day of admission stratified into low, moderately elevated, and high exposures. The environmental justice index chronic environmental burden and social vulnerability modules accounted for chronic stressors. The outcomes included length of stay (LOS), complications, and readmissions. After appropriate bivariate tests, multivariable regression models for the primary outcomes were constructed.

RESULTS

1038 patients were included with the majority experiencing low PM2.5 (53.4%, n = 554). Patients were similar in terms of demographic, clinical, and procedural characteristics across pollution groups, with a median age of 59.6, 53.5% female, 38.3% Black, and 74.5% American Society of Anesthesiologists class 3. The unadjusted outcomes did not differ significantly across groups; however, on adjusted models, higher PM2.5 groups had longer LOS: incident rate ratio 1.12 [95% CI 1.05-1.19] and incident rate ratio 1.37 [95% CI 1.16-1.62] for moderately elevated and high PM2.5, respectively (P < 0.001).

CONCLUSIONS

This study found a novel association between surgical outcomes and short-term ambient air pollution, with higher PM2.5 on the day of admission associated with longer LOS. Notably, this is also the first surgical study to use the environmental justice index to control for social and environmental determinants of health.

Leveraging High-Resolution Satellite-Derived NO2 Estimates to Evaluate NO2 Exposure Representativeness and Socioeconomic Disparities

Research has typically estimated NO2 concentrations over several kilometers; thus, NO2 data at finer spatial resolution remain limited. This study used tropospheric NO2 data from the TROPOspheric Monitoring Instrument (TROPOMI) and traffic-related land use parameters to estimate long-term average NO2 concentrations at a spatial resolution of 500 m in South Korea from 2018 to 2022. Our satellite-land use hybrid regression model showed reasonably high predictability with a cross-validation R2 of 0.81, mean absolute error of 2.28 ppb and root mean squared error of 2.85 ppb. Leveraging these high-resolution data, we assessed the representativeness of ground monitors for population exposure by comparing population-weighted NO2 concentrations from estimated and measured data. Across 17 metropolitan cities and provinces, the ratios of population-weighted estimated to measured NO2 ranged from 0.62 to 1.12, with the ratio of 1 exhibiting the most representative monitoring networks. We further investigated disproportionate NO2 exposures based on socioeconomic status, revealing that NO2 exposures were consistently higher in local districts with higher socioeconomic status because of the unique historical backgrounds of rapid economic development and urban infrastructure design in South Korea. Using high-resolution NO2 data can lead to more comprehensive and precise exposure assessments, enhancing public health and regulatory applications.

A Scalable Calibration Method for Enhanced Accuracy in Dense Air Quality Monitoring Networks

Deployment of large numbers of low capital cost sensors to increase the spatial density of air quality measurements enables applications that build on mapping air at neighborhood scales. Effective deployment requires not only low capital costs for observations but also a simultaneous reduction in labor costs. The Berkeley Environmental Air Quality and CO2 Network (BEACO2N) is a sensor network measuring O3, CO, NO, and NO2, particulate matter (PM2.5), and CO2 at dozens of locations in cities where it is deployed. Here, we describe a low labor cost in situ field calibration for the BEACO2N O3, CO, NO, and NO2 sensors. This method identifies and leverages uniform periods in concentrations across the network for calibration. The calibration achieves high accuracy and low biases with respect to temperature, humidity, and concentration, with coefficients of determination and root mean square errors of 0.88 and 3.70 ppb for O3, 0.66 and 3.16 ppb for NO2, and 0.79 and 1.58 ppb for NO. Performance of the CO sensor is 0.90 and 33.3 ppb at a site colocated with reference measurements. The method is a crucial step toward lowering operational costs of delivering accurate measurements in dense networks employing large numbers of inexpensive air quality sensors.

The long-run effect of historical redlining practices on social vulnerability in U.S. cities

Historical redlining practices in the United States date back to the 1930s and have continued to impact cities socially, environmentally, and economically since then. This study explores current social vulnerability inequity among former HOLC (Home Owners' Loan Corporation) neighborhoods with four color-coded grades in 196 U.S. digitized cities. Social vulnerability measurements for each historical HOLC neighborhood were calculated using 2018 census tract-level social vulnerability data through areal apportionment. Kruskal-Wallis tests were employed to compare four grades of former HOLC neighborhoods regarding overall social vulnerability index (SVI), four thematic SVIs (Social economic status, Household composition and disability, Minority status and language, and Housing type and transportation), and SVIs for fifteen social vulnerability factors. After applying multiple comparison corrections, the results indicate significant differences among four HOLC grades concerning overall social vulnerability, four themes, and most of social vulnerability factors. In general, grade A (green) neighborhoods exhibit the lowest vulnerability, while grade D (red) neighborhoods have the highest vulnerability. A similar pattern of social vulnerability inequity persists even after adjusting for inter-city differences in baseline social factors using the city-normalized SVI (CSVI). This finding suggests that urban planners and policymakers should work to reduce social vulnerability inequity across neighborhoods of different grades.

Southern California ozone exposure disparities under different emissions control strategies in a low-carbon future

Environmental justice (EJ) has emerged as a critical consideration when planning new air pollution control strategies. In this study we analyze how traditional ozone (O3) control strategies for the year 2050 will affect exposure disparities, defined as departures from the population average exposure, for O3 and oxides of nitrogen (NOx) in Southern California. Future air quality fields were simulated using a chemical transport model under five emission scenarios that explore a range of traditional controls that target the largest sources of precursor emissions using a novel O3 source apportionment technique but without considering exposure disparities. We find that traditional O3 control strategies reduce O3 exposure disparities by <1.6 % and reduce NO2 exposure disparities by <9 % in Southern California. For the Black and African residents living in the urban core of Los Angeles, the relative NO2 exposure disparities increase from +23.1 % to +66.2 % and O3 exposure disparities increase from -3.3 % to +0.1 % due to NOx emissions reductions mainly in outlying regions and the NOx-rich environment in the urban core. Additional analysis shows that complete elimination of NOx emissions from Los Angeles International Airport (LAX) would reduce the NO2 exposure disparities by up to 50 %, but there is currently no practical method to achieve this goal. The results of the current study highlight the challenge of simultaneously attaining O3 standards and reducing exposure disparities for O3 and NO2 in cities with NOx-rich urban cores. Reducing emissions by region may be a solution to this challenge.

Historical Redlining and Community-Reported Housing Quality: A Spatial Analysis

Historical redlining, a racially discriminatory practice implemented by the US government in the 1930s, has been associated with present-day environmental outcomes. However, there is limited research examining the relationship between historical redlining and contemporary housing quality. The objective of the present study was to investigate the relationship between historical redlining and contemporary housing quality in Atlanta, Georgia. Spatial patterns of housing code violation complaints from 2015 to 2019 were examined using point-pattern and spatial cluster analyses. We used Bayesian hierarchical models, accounting for spatial autocorrelation, to estimate associations between historical redlining and housing complaints, after adjusting for contemporary neighborhood characteristics, such as poverty, median structure age, vacant and renter-occupied properties, and residential racial segregation. A total of 48,626 housing code violation complaints were reported during the study period, including 6531 complaints deemed "hazardous." Historical redlining was a statistically significant predictor of housing complaints. We observed a 167% increased risk (IRR = 2.67, 95% confidence interval = 1.49, 4.77) of housing complaints for historically redlined neighborhoods compared to neighborhoods historically graded as "best" or "still desirable," after adjusting for neighborhood characteristics. Redlined neighborhoods also had an increased risk of "hazardous" housing complaints (IRR = 1.94, 95% confidence interval = 1.11, 3.40), after adjusting for contemporary neighborhood characteristics. Historically redlined neighborhoods exhibited disproportionately higher rates of housing code violation complaints. Spatial analysis of housing code violation complaints can provide insights into housing quality and inform interventions targeted at addressing the environmental legacy of structural racism.

Critical Steps To Address Climate, Health, And Equity

Climate change poses an unprecedented threat to human health and well-being in the United States. In this article, part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, we outline key strategies to address climate change, health, and equity, using a public health approach. We focus on three critical areas: transitioning to clean energy sources, upgrading health infrastructure, and scaling public health and health care resilience. Priorities for action must be coupled with further research to ensure the equitable implementation of climate solutions, create effective communication strategies, and build public support and momentum. Addressing the climate crisis requires urgent, coordinated action across sectors. With concerted effort, the health sector can play a vital role in mitigating climate change and protecting the population's health.

Hurricanes and Health Equity: A Review of Structural Determinants of Vulnerability for Climate and Health Research

PURPOSE OF REVIEW

Understanding hurricane vulnerability is crucial for targeting and identifying climate adaptation measures. However, vulnerability assessments often focus on proximal factors, which may obscure underlying drivers of health inequities. We sought to describe the literature characterizing hurricane vulnerability in the U.S., from 2000 to 2022. We abstracted the approaches and factors in each hurricane vulnerability assessment study, and developed a conceptual framework to guide data collection on structural determinants of climate vulnerability.

RECENT FINDINGS

The review included a total of 121 studies. The majority pre-specified vulnerable populations, while 40% empirically derived vulnerability. Downstream factors pertaining to demographics, spatial analysis, and health status were most commonly used to assess vulnerability to hurricanes. Only five studies reported structural vulnerabilities, including racism, governance, institutions, and infrastructure deficiencies, which form the basis of our conceptual framework. Most hurricane vulnerability studies do not consider upstream factors of health inequities. We developed a conceptual framework and provided example data measures for structural determinants to incorporate into climate and health research, facilitating the development of more effective interventions to address root causes.

Growing Evidence for the Role of Air Pollution in Breast Cancer Development

In the article that accompanies this editorial, Wu et al., observed that residential exposure to fine particulate matter was associated with higher breast cancer incidence using prospective data from over 58,000 California women in the Multiethnic Cohort Study. These findings, together with a meta-analysis of findings from cohort studies included in the manuscript, highlight the importance of environmental contributors to breast cancer risk.

Interactive effects between extreme temperatures and PM2.5 on cause-specific mortality in thirteen U.S. states

The extent and robustness of the interaction between exposures to heat and ambient PM2.5 is unclear and little is known of the interaction between exposures to cold and ambient PM2.5. Clarifying these interactions, if any, is crucial due to the omnipresence of PM2.5 in the atmosphere and increasing scope and frequency of extreme temperature events. To investigate both of these interactions, we merged 6 073 575 individual-level mortality records from thirteen states spanning seventeen years with 1 km daily PM2.5 predictions from sophisticated prediction model and 1 km meteorology from Daymet V4. A time-stratified, bidirectional case-crossover design was used to control for confounding by individual-level, long-term and cyclic weekly characteristics. We fitted conditional logistic regressions with an interaction term between PM2.5 and extreme temperature events to investigate the potential interactive effects on mortality. Ambient PM2.5 exposure has the greatest effect on mortality by all internal causes in the 2 d moving average exposure window. Additionally, we found consistently synergistic interactions between a 10 μg m-3 increase in the 2 d moving average of PM2.5 and extreme heat with interaction odds ratios of 1.013 (95% CI: 1.000, 1.026), 1.024 (95% CI: 1.002, 1.046), and 1.033 (95% CI: 0.991, 1.077) for deaths by all internal causes, circulatory causes, and respiratory causes, respectively, which represent 75%, 156%, and 214% increases in the coefficient estimates for PM2.5 on those days. We also found evidence of interactions on the additive scale with corresponding relative excess risks due to interaction (RERIs) of 0.013 (95% CI: 0.003, 0.021), 0.020 (95% CI: 0.008, 0.031), and 0.017 (95% CI: -0.015, 0.036). Interactions with other PM2.5 exposure windows were more pronounced. For extreme cold, our results were suggestive of an antagonistic relationship. These results suggest that ambient PM2.5 interacts synergistically with exposure to extreme heat, yielding greater risks for mortality than only either exposure alone.

Contaminant Exposure Profiles Demonstrate Similar Physiological Effects Across Environments Despite Unique Profile Composition in Formosa, Argentina, and Connecticut, USA

OBJECTIVE

Exposure to environmental contaminants is globally universal. However, communities vary in the specific combination of contaminants to which they are exposed, potentially contributing to variation in human health and creating "locally situated biologies." We investigated how environmental exposures differ across environments by comparing exposure profiles between two contexts that differ markedly across political, economic, and sociocultural factors-Namqom, Formosa, Argentina, and New Haven, Connecticut, United States.

METHODS

We collected infant urine, maternal urine, and human milk samples from mother-infant dyads in Formosa (n = 13) and New Haven (n = 21). We used untargeted liquid chromatography with high-resolution mass spectrometry (LC-HRMS) to annotate environmental contaminants and endogenous metabolites in these samples, and we analyzed the data using exposome-wide association studies (EWAS) followed by pathway enrichment.

RESULTS

We found statistically significant differences between the chemical exposure profiles of the Argentinian and US mothers, mostly involving pesticides; however, we observed similarities in the infant urine and human milk environmental contaminant profiles, suggesting that the maternal body may buffer infant exposure through human milk. We also found that infants and mothers were exposed to contaminants that were associated with alterations in amino acid and carbohydrate metabolism. Infants additionally showed alterations in vitamin metabolism, including vitamins B1, B3, and B6.

CONCLUSIONS

Differences in chemical exposure profiles may be related to structural factors. Despite variation in the composition of exposure profiles between the two study sites, environmental contaminant exposure was associated with similar patterns in human physiology when we considered contaminants comprehensively rather than individually, with implications for metabolic and cardiovascular disease risk as well as infant cognitive development.

Race, historical redlining, and contemporary transportation noise disparities in the United States

BACKGROUND

Legacies of discriminatory federal housing practices-e.g., racialized property appraisal by the Home Owners' Loan Corporation (HOLC) and institutionalized redlining by the Federal Housing Administration-include disparate present-day environmental health outcomes. Noise pollution is health-harming, but just one study has associated contemporary noise with redlining in some HOLC-mapped United States (US) cities, while two national studies found associations between greater neighborhood-level people of color composition and increased noise. No studies have examined noise pollution exposure disparities across all HOLC-mapped cities or based on the intersection of race/ethnicity and redlining.

OBJECTIVE

We address three objectives: (1) Assess disparities in fine-scale, per person transportation noise exposures by historical redlining status across all HOLC-mapped cities. (2) Quantify disparities in noise exposures by race/ethnicity nationwide. (3) Explore interactions between redlining status and race/ethnicity in noise exposures.

METHODS

We analyzed three data sources: (1) complete digital HOLC maps of ordered investment risk grades (A-D), (2) fine-scale (30 m) estimates of transportation noise levels (year-2020), and (3) sociodemographic characteristics of individuals in year-2020 census blocks.

RESULTS

We find an approximately monotonic association for excess transportation noise with HOLC grade, marked by a pronounced exposure increase (17.4 dBA or 3× loudness) between contemporary residents of grade A (highest-graded) and D (lowest-graded) neighborhoods, a pattern consistent across HOLC-mapped cities. People of color experience ~7 dBA greater (2× louder) excess transportation noise exposures than White people nationwide, a pattern consistent across US counties. Noise exposure disparities are larger by HOLC grade than by race/ethnicity. However, contemporary racial/ethnic noise exposure disparities persist within each HOLC grade at levels approximating those disparities existing in ungraded areas, indicating that historical redlining is one of multiple discriminatory practices shaping contemporary national soundscape injustices.

SIGNIFICANCE

Findings illustrate how historical redlining and broader racialized inequalities in US society have shaped environmental injustices nationwide.

IMPACT STATEMENT

Excessive noise exposures harm human health. Communities of color in the United States experience disparate noise exposures, although previous studies are limited by reliance upon aggregated data. They are also disproportionately concentrated in historically redlined areas. Legacies of redlining include persistent racial and economic inequalities and environmental health disparities. Here, we conduct the first complete national examination of contemporary noise pollution disparities with respect to historical redlining and race/ethnicity. Findings advance understanding of the historical roots and enduring salience of race-based disparities in noise pollution exposures and can inform efforts to address these disparities through noise pollution policy-making.

Redlining in New York City: impacts on particulate matter exposure during pregnancy and birth outcomes

BACKGROUND

Evidence suggests historical redlining shaped the built environment and health outcomes in urban areas. Only a handful of studies have examined redlining's association with air pollution and adverse birth outcomes in New York City (NYC). Additionally, no NYC-specific studies have examined the impact of redlining on birth weight.

METHODS

This longitudinal cohort study analysed data from the National Institute of Health Environmental Influences on Child Health Outcomes Programme to investigate the extent to which maternal residence in a historically redlined neighbourhood is associated with fine particulate matter (PM2.5) exposure during pregnancy using multivariable regression models. Additionally, we examined how maternal residence in a historically redlined neighbourhood during pregnancy influenced birth weight z-score, preterm birth and low birth weight.

RESULTS

Our air pollution model showed that living in a historically redlined census tract or an ungraded census tract was associated with increased PM2.5 exposure during pregnancy. We also found living in a historically redlined census tract or an ungraded census tract was associated with a lower birth weight z-score. This finding remained significant when controlling for individual and census tract-level race, ethnicity and income. When we controlled PM2.5 in our models assessing the relationship between redlining grade and birth outcome, our results did not change.

DISCUSSION

Our study supports the literature linking redlining to contemporary outcomes. However, our research in ungraded tracts suggests redlining alone is insufficient to fully explain inequality in birth outcomes and PM2.5 levels today.

Inequitable Spatial and Temporal Patterns in the Distribution of Multiple Environmental Risks and Benefits in Metro Vancouver

The urban environment impacts residents' health and well-being in many ways. Environmental benefits and risks may be interactively and inequitably distributed across different populations in cities, and these patterns may change over time. Here, we assess the spatial distribution of environmental risks and benefits in pairs, considering synergies and trade-offs, in an illustrative metropolitan area (Metro Vancouver) in Canada in the years 2006 and 2016. We classify census dissemination areas as sweet, sour, risky, or medium spots based on relative exposures for six environmental combinations: Walkability and NO2; heat stress and NO2; vegetation coverage and NO2; vegetation coverage and heat stress; walkability and accessibility to natural recreational areas; and heat stress and accessibility to natural recreational areas. We evaluate whether different population groups are disproportionately exposed to lower environmental quality based on linear regressions and other metrics. We find that while performance for individual environmental variables improved over the decade, considering their combinations, sweet spots became sweeter and sour spots became sourer. Residents with high material and social deprivation and visible minorities were disproportionately exposed to lower environmental quality in both years for most of the environmental combinations. Further, we find that these inequities were not improving over time for all groups: for instance, South Asian residents in the region faced higher disproportionate burdens or diminished access to benefits in 2016, as compared to 2006. Given these findings, we suggest considerations of cumulative exposure in prioritizing areas for intervention, targeting the sour and risky spots persistently experienced by overburdened populations.

The Legacy of Redlining: Increasing Childhood Asthma Disparities through Neighborhood Poverty

Rationale: Identifying the root causes of racial disparities in childhood asthma is critical for health equity. Objectives: To determine whether the racist policy of redlining in the 1930s led to present-day disparities in childhood asthma by increasing community-level poverty and decreasing neighborhood socioeconomic position (SEP). Methods: We categorized census tracts at the birth address of participants from the Children's Respiratory and Environmental Workgroup birth cohort consortium into categories A, B, C, and D as defined by the Home Owners Loan Corporation, with D being the highest perceived risk. Surrogates of present-day neighborhood-level SEP were determined for each tract, including the percentage of low-income households, the CDC's Social Vulnerability Index, and other tract-level variables. We performed causal mediation analysis, which, under the assumption of no unmeasured confounding, estimates the direct and mediated pathways by which redlining may cause asthma disparities through tract-level mediators adjusting for individual-level covariates. Measurements and Main Results: Of 4,849 children, the cumulative incidence of asthma through age 11 was 26.6%, and 13.2% resided in census tracts with a Home Owners Loan Corporation grade of D. In mediation analyses, residing in Grade-D tracts (adjusted odds ratio = 1.03 [95% confidence interval = 1.01, 1.05]) was significantly associated with childhood asthma, with 79% of this increased risk mediated by percentage of low-income households; results were similar for the Social Vulnerability Index and other tract-level variables. Conclusions: The historical structural racist policy of redlining led to present-day asthma disparities in part through decreased neighborhood SEP. Policies aimed at reversing the effects of structural racism should be considered to create more just, equitable, and healthy communities.

Inhaling Poor Health: The Impact of Air Pollution on Cardiovascular Kidney Metabolic Syndrome

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

Impact of COVID-19 pandemic on greenhouse gas and criteria air pollutant emissions from the San Pedro Bay Ports and future policy implications

The Ports of Los Angeles and Long Beach, collectively known as the San Pedro Bay Ports, serve as vital gateways for freight movement in the United States. The COVID-19 pandemic and other influencing factors disrupted freight movement and led to unprecedented cargo surge, vessel congestion, and increased air pollution and greenhouse gas emissions from seaport and connected freight system operations beginning in June 2020. In this study, we conducted the first comprehensive monthly assessment of the excess particulate matter, oxides of nitrogen (NOx), and carbon dioxide (CO2) emissions due to the heightened congestion and freight transport activity from ocean-going vessels (OGVs), trucks, locomotives, and cargo handling equipment (CHE) supporting seaport operations. Excess emissions peaked in October 2021 at 23 tons of NOx per day and 2001 tons of CO2 per day. The strategic queuing system implemented in November 2021 significantly reduced the number of anchored and loitering OGVs and their emissions near the ports, even during continued high cargo throughput until Summer 2022. Looking forward, we analyzed projected emissions benefits of adopted California Air Resources Board regulations requiring cleaner and zero-emission trucks, locomotives, and CHE over the next decade. If a repeated port congestion event were to occur in 2035, NOx emissions from land-based freight transport should be lessened by more than 80%. Our study underscores the potential emissions impacts of disruptions to the freight transport network and the critical need to continue reducing its emissions in California and beyond.

Multidimensional structural racism and estimated cancer risk from traffic-related air pollution

BACKGROUND

Traffic-related air pollutants have been associated with a variety of adverse human health impacts, including cancers. In the United States, numerous studies have documented racial inequities in neighborhood exposures to traffic-related air pollution. Emerging evidence suggests that structural racism may influence neighborhood exposures to air pollutants. However, existing research has largely focused on residential racial segregation, one indicator of structural racism. This study developed a multidimensional measure of structural racism to examine the relationship between structural racism and estimated cancer risk from air pollutants in Georgia.

METHODS

Carcinogenic air toxics data were obtained from the US Environmental Protection Agency's 2019 Air Toxics Screening Assessment and sociodemographic data from the American Community Survey. Guided by stakeholder input, county-level data on residential segregation, education, employment, incarceration, economic status, political participation, and homeownership were used to create a multidimensional county-level structural racism index. Relative risks (RRs) were estimated for associations between structural racism and elevated (top 10% in Georgia) estimated cancer risk from air toxics.

RESULTS

Multilevel analyses revealed a significant association between multidimensional structural racism and exposure to carcinogenic traffic-related air pollutants. Neighborhoods in the highest quartile of structural racism exhibited an elevated cancer risk from traffic-related air pollutants (RR, 7.84; 95% CI, 5.11-12.05) compared to neighborhoods with lower levels of structural racism.

CONCLUSIONS

Multidimensional structural racism was associated with estimated cancer risk from traffic-related air pollution in Georgia. Findings can inform future studies and policy interventions that address racial inequalities in exposure to traffic-related air pollution.

Home and school pollutant exposure, respiratory outcomes, and influence of historical redlining

BACKGROUND

The discriminatory and racist policy of historical redlining in the United States during the 1930s played a role in perpetuating contemporary environmental health disparities.

OBJECTIVE

Our objectives were to determine associations between home and school pollutant exposure (fine particulate matter [PM2.5], NO2) and respiratory outcomes (Composite Asthma Severity Index, lung function) among school-aged children with asthma and examine whether associations differed between children who resided and/or attended school in historically redlined compared to non-redlined neighborhoods.

METHODS

Children ages 6 to 17 with moderate-to-severe asthma (N = 240) from 9 US cities were included. Combined home and school exposure to PM2.5 and NO2 was calculated based on geospatially assessed monthly averaged outdoor pollutant concentrations. Repeated measures of Composite Asthma Severity Index and lung function were collected.

RESULTS

Overall, 37.5% of children resided and/or attended schools in historically redlined neighborhoods. Children in historically redlined neighborhoods had greater exposure to NO2 (median: 15.4 vs 12.1 parts per billion) and closer distance to a highway (median: 0.86 vs 1.23 km), compared to those in non-redlined neighborhoods (P < .01). Overall, PM2.5 was not associated with asthma severity or lung function. However, among children in redlined neighborhoods, higher PM2.5 was associated with worse asthma severity (P < .005). No association was observed between pollutants and lung function or asthma severity among children in non-redlined neighborhoods (P > .005).

CONCLUSIONS

Our findings highlight the significance of historical redlining and current environmental health disparities among school-aged children with asthma, specifically, the environmental injustice of PM2.5 exposure and its associations with respiratory health.

Society for Birth Defects Research and Prevention Symposium: Health Disparities Within Communities of Color

BACKGROUND

High-risk pregnancies and birth defects are often greater within communities of color where resources for a healthy pregnancy are generally lacking. Infant and maternal mortality, preterm birth, and instances of increased developmental and physical defects are related to environmental exposures (e.g., pesticides, lead in water, wildfire smoke), dietary additives, and lack of access to adequate healthcare. More frequently people of color and other under-served groups, are affected by historical inequality and unconscious bias. Compounding these disparities, research into these issues and efforts to address them are poorly supported.

METHODS

The speakers in this symposium presented evidence for health disparities within communities of color to foster research aimed at identifying toxic levels of potentially hazardous dietary chemicals, or exposures in the pediatric population can focus on addressing the current inadequacy of translating scientific findings into enforceable policies.

RESULTS

The disparities discussed within this symposium highlighted key areas in desperate need of policy reform. In the United States, regulatory exposure levels have been established for lead exposures but frequently exceed these limits without mitigation. Neural tube defects can be prevented by a simple dietary solution such as fortification of staple foods with folic acid. Recent literature on gender as a social determinant of health has determined women suffer more negative health consequences due to social attitudes.

CONCLUSIONS

Ultimately, this symposium provided an understanding of the experience of disadvantaged and marginalized persons during pregnancy, illustrated the disparities that exist in reproductive health, and described the need to address and prevent them.

Connecting Past to Present: Does Historical Redlining Affect Current Life Expectancy?

INTRODUCTION

Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes.

METHODS

In this paper, we used structural equation modeling to uncover relationships between current and historical redlining practices and modern-day life expectancy, exploring two levels of potential mediating factors: (1) racial segregation and structural racism; and (2) mediating health outcomes. We analyzed data from 11,661 census tracts throughout the United States using historical redlining data from 1940, modern redlining data from 2010 to 2017, racial segregation and structural racism indices from 2010 to 2019, health outcome data from 2021 to 2022, and life expectancy data from 2010 to 2015. Historical redlining was measured using Home Owners' Loan Corporation (HOLC) ratings, which ranged from 1.0 for favorable neighborhoods ("greenlined") to 4.0 for unfavorable ("redlined") neighborhoods. Modern-day redlining was measured using Home Mortgage Disclosure Act (HMDA) data, which were transformed into four quartiles, ranging from level 1 (low mortgage rejection rates) to level 4 (high mortgage rejection rates).

RESULTS

We found a significant relationship between historic redlining and current life expectancy, with average life expectancy decreasing steadily from 80.7 years in HOLC 1 tracts to 75.7 years in HOLC 4 tracts, a differential of 5.0 years between the greenlined and redlined tracts. We also found a significant relationship between modern-day redlining and current life expectancy, with average life expectancy decreasing steadily from 79.9 years in HMDA 1 tracts to 73.5 years in HMDA 4 tracts, a differential of 6.4 years. In the structural equation model, historical redlining had a total effect of decreasing life expectancy by 1.18 years for each increase of one in the HOLC rating. Modern-day redlining had a total effect of decreasing life expectancy by 1.89 years for each increase of one in the HMDA quartile.

CONCLUSION

This paper provides new evidence that the legacy of redlining is not relegated to the history books but rather is a present and pressing public health issue today.

EV-miRNA associated with environmental air pollution exposures in the MADRES cohort

Air pollution is a hazardous contaminant, exposure to which has substantial consequences for health during critical periods, such as pregnancy. MicroRNA (miRNA) is an epigenetic mechanism that modulates transcriptome responses to the environment and has been found to change in reaction to air pollution exposure. The data are limited regarding extracellular-vesicle (EV) miRNA variation associated with air pollution exposure during pregnancy and in susceptible populations who may be disproportionately exposed. This study aimed to identify EV-miRNA expression associated with ambient, residential exposure to PM2.5, PM10, NO2, O3 and with traffic-related NOx in 461 participants of the MADRES cohort, a low income, predominantly Hispanic pregnancy cohort based in Los Angeles, CA. This study used residence-based modeled air pollution data as well as Nanostring panels for EVmiRNA extracted with Qiagen exoRNeasy kits to evaluate 483 miRNA in plasma in early and late pregnancy. Average air pollution exposures were considered separately for 1-day, 1-week, and 8-week windows before blood collection in both early and late pregnancy. This study identified 63 and 66 EV-miRNA significantly associated with PM2.5 and PM10, respectively, and 2 miRNA associated with traffic-related NOX (False Discovery Rate-adjusted P-value < .05). Of 103 unique EV-miRNA associated with PM, 92% were associated with lung conditions according to HMDD (Human miRNA Disease Database) evidence. In particular, EV-miRNA previously identified with air pollution exposure also associated with PM2.5 and PM10 in this study were: miR-126, miR-16-5p, miR-187-3p, miR200b-3p, miR486-3p, and miR-582-3p. There were no significant differences in average exposures in early vs late pregnancy. Significant EV-miRNAs were only identified in late pregnancy with an 8-week exposure window, suggesting a vulnerable timeframe of exposure, rather than an acute response. These results describe a wide array of EV-miRNA for which expression is affected by PM exposure and may be in part mediating the biological response to ambient air pollution, with potential for health implications in pregnant women and their children.

The association of short-term increases in ambient PM2.5 and temperature exposures with stillbirth: racial/ethnic disparities among Medicaid recipients

Racial/ethnic disparities in the association between short-term (eg, days, weeks), ambient fine particulate matter (PM2.5) and temperature exposures and stillbirth in the United States have been understudied. A time-stratified, case-crossover design using a distributed lag nonlinear model (0- to 6-day lag) was used to estimate stillbirth odds due to short-term increases in average daily PM2.5 and temperature exposures among 118 632 Medicaid recipients from 2000 to 2014. Disparities by maternal race/ethnicity (Black, White, Hispanic, Asian, American Indian) and zip code-level socioeconomic status (SES) were assessed. In the temperature-adjusted model, a 10 μg m-3 increase in PM2.5 concentration was marginally associated with increased stillbirth odds at lag 1 (0.68%; 95% CI, -0.04% to 1.40%) and lag 2 (0.52%; 95% CI, -0.03 to 1.06) but not lag 0-6 (2.80%; 95% CI, -0.81 to 6.45). An association between daily PM2.5 concentrations and stillbirth odds was found among Black individuals at the cumulative lag (0-6 days: 9.26% 95% CI, 3.12%-15.77%) but not among other races or ethnicities. A stronger association between PM2.5 concentrations and stillbirth odds existed among Black individuals living in zip codes with the lowest median household income (lag 0-6: 14.13%; 95% CI, 4.64%-25.79%). Short-term temperature increases were not associated with stillbirth risk among any race/ethnicity. Black Medicaid enrollees, and especially those living in lower SES areas, may be more vulnerable to stillbirth due to short-term increases in PM2.5 exposure. This article is part of a Special Collection on Environmental Epidemiology.

Historical redlining, neighborhood disadvantage, and reports of child maltreatment in a large urban county

BACKGROUND

Child protective services (CPS) reports are spatially concentrated in disadvantaged neighborhoods and Black children are more likely than White children to reside in these neighborhoods. Entrenched patterns of racial residential segregation reflect the lasting impact of historical redlining - a racist practice spearheaded by the federally sponsored Home Owners' Loan Corporation (HOLC) in the 1930s that assigned worst risk grades to minoritized neighborhoods. Research has established links between historically redlined areas and the present-day wellbeing of children and families; however, little is known about the relationship between historical redlining and CPS report rates in neighborhoods.

OBJECTIVE

Using census tracts as a proxy for neighborhood, this study examines the relationship between historical redlining and the number of CPS reports within neighborhoods.

PARTICIPANTS, SETTING, AND METHOD

This study combines data on HOLC risk grades and sociodemographic data from the American Community Survey with the aggregate number of CPS reports per census tract in Los Angeles County, CA (n = 1137).

RESULTS

We used Bayesian conditionally autoregressive models to examine the relationship between historical redlining score (A = 1, B = 2, C = 3, D = 4) and the number of CPS reports within neighborhoods. In the unadjusted model, each unit increase in redlining score is associated with a 21.6 % higher number of CPS reports (95 % CI; 1.140, 1.228). In adjusted models that included concentrated disadvantage, each unit increase in redlining score is associated with a 7.3 % higher number of CPS reports (95 % CI; 1.021, 1.136).

CONCLUSION

Housing policy reforms through a racial equity lens should be considered as a part of a national strategy to prevent child maltreatment.

An elevated rate of whole-genome duplications in cancers from Black patients

In the United States, Black individuals have higher rates of cancer mortality than any other racial group. Here, we examine chromosome copy number changes in cancers from more than 1800 self-reported Black patients. We find that tumors from self-reported Black patients are significantly more likely to exhibit whole-genome duplications (WGDs), a genomic event that enhances metastasis and aggressive disease, compared to tumors from self-reported white patients. This increase in WGD frequency is observed across multiple cancer types, including breast, endometrial, and lung cancer, and is associated with shorter patient survival. We further demonstrate that combustion byproducts are capable of inducing WGDs in cell culture, and cancers from self-reported Black patients exhibit mutational signatures consistent with exposure to these carcinogens. In total, these findings identify a type of genomic alteration that is associated with environmental exposures and that may influence racial disparities in cancer outcomes.

Methodologic Strategies for Quantifying Associations of Historical and Contemporary Mortgage Discrimination on Population Health Equity: A Systematic Review

BACKGROUND

Mortgage discrimination refers to the systematic withholding of home mortgages from minoritized groups. In recent years, there has been an increase in empirical research investigating associations of historical and contemporary mortgage discrimination on contemporary  outcomes. Investigators have used a variety of measurement methods and approaches, which may have implications for results and interpretation.

PURPOSE

We conducted a systematic review of peer-reviewed literature that has quantified links between both historical and current mortgage discrimination with contemporary adverse environmental, social, and health outcomes. Our goals were to document the methodology used to measure and assign mortgage discrimination, to assess implications for results and interpretation, and to make recommendations for future work.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, literature searches were conducted in September 2022 using terms that combined concepts of mortgage discrimination, health, and neighborhood environment.

RESULTS

In total, 45 papers fit the eligibility criteria. In these, researchers investigated associations between mortgage discrimination and: (1) health outcomes (N = 28); (2) environmental and social exposures including heat, air pollution, greenspace, soil lead levels, and crime (N = 12); and (3) built environment features, including presence of retail alcohol, fast food, and tobacco stores (N = 5). Eleven included studies used Home Mortgage Discrimination Act (HMDA) data to identify racialized bias in mortgage discrimination or redlining, and 34 used Homeowner Loan Corporation (HOLC) maps. The construction and parametrization of mortgage discrimination or redlining and the spatial assignment of HOLC grades to contemporary addresses or neighborhoods varied substantially across studies.

CONCLUSIONS

Results from our review suggest the need for careful consideration of optimal methods to analyze mortgage discrimination such as HOLC spatial assignment or HMDA index parametrization, contemplation of covariates, and place-based knowledge of the study location.

Air Quality Sensor Experts Convene: Current Quality Assurance Considerations for Credible Data

Air sensors can provide valuable non-regulatory and supplemental data as they can be affordably deployed in large numbers and stationed in remote areas far away from regulatory air monitoring stations. Air sensors have inherent limitations that are critical to understand before collecting and interpreting the data. Many of these limitations are mechanistic in nature, which will require technological advances. However, there are documented quality assurance (QA) methods to promote data quality. These include laboratory and field evaluation to quantitatively assess performance, the application of corrections to improve precision and accuracy, and active management of the condition or state of health of deployed air quality sensors. This paper summarizes perspectives presented at the U.S. Environmental Protection Agency's 2023 Air Sensors Quality Assurance Workshop (https://www.epa.gov/air-sensor-toolbox/quality-assurance-air-sensors#QAworkshop) by stakeholders (e.g., manufacturers, researchers, air agencies) and identifies the most pressing needs. These include QA protocols, streamlined data processing, improved total volatile organic compound (TVOC) data interpretation, development of speciated VOC sensors, and increased documentation of hardware and data handling. Community members using air sensors need training and resources, timely data, accessible QA approaches, and shared responsibility with other stakeholders. In addition to identifying the vital next steps, this work provides a set of common QA and QC actions aimed at improving and homogenizing air sensor QA that will allow stakeholders with varying fields and levels of expertise to effectively leverage air sensor data to protect human health.

PM2.5 exposure disparities persist despite strict vehicle emissions controls in California

As policymakers increasingly focus on environmental justice, a key question is whether emissions reductions aimed at addressing air quality or climate change can also ameliorate persistent air pollution exposure disparities. We examine evidence from California's aggressive vehicle emissions control policy from 2000 to 2019. We find a 65% reduction in modeled statewide average exposure to PM2.5 from on-road vehicles, yet for people of color and overburdened community residents, relative exposure disparities increased. Light-duty vehicle emissions are the main driver of the exposure and exposure disparity, although smaller contributions from heavy-duty vehicles especially affect some overburdened groups. Our findings suggest that a continued trend of emissions reductions will likely reduce concentrations and absolute disparity but may not reduce relative disparities without greater attention to the systemic factors leading to this disparity.

Advocacy and Health Equity: The Role of the Pediatric Pulmonologist

Pediatric pulmonologists have the expertise to be advocates in many areas that affect the respiratory health of children. This article provides an overview of selected advocacy topics related to health equity and provides key examples that can improve child respiratory health in the clinical encounter and beyond.

Household air pollution disparities between socioeconomic groups in Chicago

Purpose: To assess household air pollution levels in urban Chicago households and examine how socioeconomic factors influence these levels. Methods: We deployed wireless air monitoring devices to 244 households in a diverse population in Chicago to continuously record household fine particulate matter (PM2.5) concentration. We calculated hourly average PM2.5 concentration in a 24-hour cycle. Four factors-race, household income, area deprivation, and exposure to smoking-were considered in this study. Results: A total of 93085 h of exposure data were recorded. The average household PM2.5 concentration was 43.8 μg m-3. We observed a significant difference in the average household PM2.5 concentrations between Black/African American and non-Black/African American households (46.3 versus 31.6 μg m-3), between high-income and low-income households (18.2 versus 52.5 μg m-3), and between smoking and non-smoking households (69.7 versus 29.0 μg m-3). However, no significant difference was observed between households in less and more deprived areas (43.7 versus 43.0 μg m-3). Implications: Household air pollution levels in Chicago households are much higher than the recommended level, challenging the hypothesis that household air quality is adequate for populations in high income nations. Our results indicate that it is the personal characteristics of participants, rather than the macro environments, that lead to observed differences in household air pollution.

Racial and ethnic disparities in health risk from industrial surface water pollution in the United States, 2011-2021

Industrial chemical pollution is released into surface water at a large scale annually in the United States. However, geographic variation and racial disparities in potential exposure are poorly understood at a national scale. Using county-level Risk-Screening Environmental Indicators data for 2011-2021 and American Community Survey data, this study analyzes the spatial and temporal distribution of health risk from modeled water releases using a Gamma hurdle model. Several racial disparities in presence of risk and amount of risk were identified, particular for Black or African American and Asian populations. At least 200 million U.S. residents live in a county where health risk from this pollution is present. Exposure reduction in high-risk areas may improve health for the broader population while also reducing inequities.

NPCC4: New York City climate risk information 2022-observations and projections

New York City (NYC) faces many challenges in the coming decades due to climate change and its interactions with social vulnerabilities and uneven urban development patterns and processes. This New York City Panel on Climate Change (NPCC) report contributes to the Panel's mandate to advise the city on climate change and provide timely climate risk information that can inform flexible and equitable adaptation pathways that enhance resilience to climate change. This report presents up-to-date scientific information as well as updated sea level rise projections of record. We also present a new methodology related to climate extremes and describe new methods for developing the next generation of climate projections for the New York metropolitan region. Future work by the Panel should compare the temperature and precipitation projections presented in this report with a subset of models to determine the potential impact and relevance of the "hot model" problem. NPCC4 expects to establish new projections-of-record for precipitation and temperature in 2024 based on this comparison and additional analysis. Nevertheless, the temperature and precipitation projections presented in this report may be useful for NYC stakeholders in the interim as they rely on the newest generation of global climate models.

Synergy of Urban Heat, Pollution, and Social Vulnerability in One of America's Most Rapidly Growing Cities: Houston, We Have a Problem

During the first two decades of the twenty-first century, we analyze the expansion of urban land cover, urban heat island (UHI), and urban pollution island (UPI) in the Houston Metropolitan Area (HMA) using land cover classifications derived from Landsat and land/aerosol products from NASA's Moderate Resolution Imaging Spectroradiometer. Our approach involves both direct utilization and fusion with in situ observations for a comprehensive characterization. We also examined how social vulnerability within the HMA changed during the study period and whether the synergy of UHI, UPI, and social vulnerability enhances environmental inequalities. We found that urban land cover within the HMA increased by 1,345.09 km2 and is accompanied by a 171.92 (73.93) % expansion of the daytime (nighttime) UHI. While the UPI experienced an overall reduction in particulate pollution, the magnitude of change is smaller compared to the surroundings. Further, the UPI showed localized enhancement in particulate pollution caused by increases in vehicular traffic. Our analysis found that the social vulnerability of the HMA urban regions increased during the study period. Overall, we found that the urban growth during the first two decades of the twenty-first century resulted in a synergy of UHI, UPI, and social vulnerability, causing an increase in environmental inequalities within the HMA.

Community-Engaged Research and the Use of Open Access ToxVal/ToxRef In Vivo Databases and New Approach Methodologies (NAM) to Address Human Health Risks From Environmental Contaminants

BACKGROUND

The paper analyzes opportunities for integrating Open access resources (Abstract Sifter, US EPA and NTP Toxicity Value and Toxicity Reference [ToxVal/ToxRefDB]) and New Approach Methodologies (NAM) integration into Community Engaged Research (CEnR).

METHODS

CompTox Chemicals Dashboard and Integrated Chemical Environment with in vivo ToxVal/ToxRef and NAMs (in vitro) databases are presented in three case studies to show how these resources could be used in Pilot Projects involving Community Engaged Research (CEnR) from the University of California, Davis, Environmental Health Sciences Center.

RESULTS

Case #1 developed a novel assay methodology for testing pesticide toxicity. Case #2 involved detection of water contaminants from wildfire ash and Case #3 involved contaminants on Tribal Lands. Abstract Sifter/ToxVal/ToxRefDB regulatory data and NAMs could be used to screen/prioritize risks from exposure to metals, PAHs and PFAS from wildfire ash leached into water and to investigate activities of environmental toxins (e.g., pesticides) on Tribal lands. Open access NAMs and computational tools can apply to detection of sensitive biological activities in potential or known adverse outcome pathways to predict points of departure (POD) for comparison with regulatory values for hazard identification. Open access Systematic Empirical Evaluation of Models or biomonitoring exposures are available for human subpopulations and can be used to determine bioactivity (POD) to exposure ratio to facilitate mitigation.

CONCLUSIONS

These resources help prioritize chemical toxicity and facilitate regulatory decisions and health protective policies that can aid stakeholders in deciding on needed research. Insights into exposure risks can aid environmental justice and health equity advocates.

Local exposure misclassification in national models: relationships with urban infrastructure and demographics

BACKGROUND

National-scale linear regression-based modeling may mischaracterize localized patterns, including hyperlocal peaks and neighborhood- to regional-scale gradients. For studies focused on within-city differences, this mischaracterization poses a risk of exposure misclassification, affecting epidemiological and environmental justice conclusions.

OBJECTIVE

Characterize the difference between intraurban pollution patterns predicted by national-scale land use regression modeling and observation-based estimates within a localized domain and examine the relationship between that difference and urban infrastructure and demographics.

METHODS

We compare highly resolved (0.01 km2) observations of NO2 mixing ratio and ultrafine particle (UFP) count obtained via mobile monitoring with national model predictions in thirteen neighborhoods in the San Francisco Bay Area. Grid cell-level divergence between modeled and observed concentrations is termed "localized difference." We use a flexible machine learning modeling technique, Bayesian Additive Regression Trees, to investigate potentially nonlinear relationships between discrepancy between localized difference and known local emission sources as well as census block group racial/ethnic composition.

RESULTS

We find that observed local pollution extremes are not represented by land use regression predictions and that observed UFP count significantly exceeds regression predictions. Machine learning models show significant nonlinear relationships among localized differences between predictions and observations and the density of several types of pollution-related infrastructure (roadways, commercial and industrial operations). In addition, localized difference was greater in areas with higher population density and a lower share of white non-Hispanic residents, indicating that exposure misclassification by national models differs among subpopulations.

IMPACT

Comparing national-scale pollution predictions with hyperlocal observations in the San Francisco Bay Area, we find greater discrepancies near major roadways and food service locations and systematic underestimation of concentrations in neighborhoods with a lower share of non-Hispanic white residents. These findings carry implications for using national-scale models in intraurban epidemiological and environmental justice applications and establish the potential utility of supplementing large-scale estimates with publicly available urban infrastructure and pollution source information.

Outdoor Air Pollution and Pediatric Respiratory Disease

Outdoor air pollution is ubiquitous, and no safe level of exposure has been identified for the most common air pollutants such as ozone and particle pollution. Children are uniquely more susceptible to the harms of outdoor air pollution, which can cause and exacerbate respiratory disease. Although challenging to identify the effects of outdoor air pollution on individual patients, understanding the basics of outdoor air pollution is essential for pediatric respiratory health care providers. This review covers basic information regarding outdoor air pollution, unique considerations for children, mechanisms for increased susceptibility, and association with incident and exacerbation of respiratory disease in children.