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Lopes SS, Shi A, Chen L, Li J, Meschke LL. California's Comprehensive Perinatal Services Program and birth outcomes. Front Public Health 2023; 11:1321313. [PMID: 38179565 PMCID: PMC10764413 DOI: 10.3389/fpubh.2023.1321313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction California's Medicaid (Medi-Cal) sponsors Comprehensive Perinatal Services Program (CPSP), a program with enhanced perinatal care for women (more education, nutritional supplements, and psychosocial counseling/support). Past evaluations of CPSP's effectiveness in birth outcomes were limited to pilot programs and yielded mixed results. Methods We used 2012-2016 California's statewide data about singleton live births with any receipt of prenatal care (N = 2,385,811) to examine whether Medi-Cal with CPSP enrollment was associated with lower odds of preterm birth (PTB), spontaneous PTB, and low birthweight (LBW) than non-CPSP births. With three binary variables of PTB, spontaneous PTB, and LBW as the response variables, three multilevel logistic models were used to compare the outcomes of participants enrolled in Medi-Cal with CPSP against those with private insurance, adjusting for maternal factors and county-level covariates. Results Logistic models showed that participants enrolled to Medi-Cal with CPSP [n (%) = 89,009 (3.7)] had lower odds of PTB, spontaneous PTB and LBW, respectively, as compared with those with private insurance [n (%) = 1,133,140 (47.2)]. Within the Medi-Cal sub-population, the CPSP enrollment was associated with lower odds of PTB, SPTB and LBW than Medicaid beneficiaries without CPSP [n (%) = 967,094 (40.3)]. Discussion With statewide data, these findings revealed a robust link between CPSP enrollment and better birth outcomes. Expanding access to comprehensive prenatal services could be an important strategy to improve birth outcomes.
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Affiliation(s)
- Snehal S. Lopes
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Ahan Shi
- D.W. Daniel High School, Central, SC, United States
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jian Li
- Fielding School of Public Health, Environmental Health Sciences Department and the School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Laurie L. Meschke
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
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Whitworth KW, Moussa I, Salihu HM, Chardon Fabien A, Suter M, Aagaard KM, Symanski E. Environmental justice burden and Black-White disparities in spontaneous preterm birth in Harris County, Texas. Front Reprod Health 2023; 5:1296590. [PMID: 38179111 PMCID: PMC10766384 DOI: 10.3389/frph.2023.1296590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Given limited evidence of previous studies, we evaluated the role of environmental justice (EJ) burden (i.e., a neighborhood characterized by both increased environmental burden and socioeconomic deprivation) in Black-White disparities in spontaneous preterm birth (sPTB) in Harris County, Texas and compared results that evaluated neighborhood-level socioeconomic deprivation alone. Methods We conducted a retrospective analysis using PeriBank, a database and biospecimen repository of gravidae giving birth at two hospitals in the Texas Medical Center. We included 3,703 non-Hispanic Black and 5,475 non-Hispanic white gravidae who were U.S.-born, delivered from August 2011-December 2020, and resided in Harris County, TX. We used data from the U.S. EPA EJScreen to characterize the EJ burden of participant's zip code of residence from fine particulate matter (PM2.5), ozone, and proximity to National Priorities List (NPL) sites and calculated zip-code level Area Deprivation Index (ADI). We assessed the contribution of neighborhood-level variables to the Black-White disparity in sPTB by evaluating attenuation of the odds ratio (OR) representing the effect of race in multivariable logistic regression models, controlling for individual-level characteristics. We also conducted race-stratified analyses between each neighborhood variable and sPTB. Exposure indices were treated as continuous variables; in stratified models, ORs and 95% Confidence Intervals (CIs) are presented per 10-unit increase in the neighborhood variable. Results Accounting for individual-level variables, Black gravidae had 79% higher odds of sPTB than white gravidae (OR = 1.79, 95%CI = 1.32, 2.44); the disparity was moderately attenuated when accounting for EJ burden or ADI (ORs ranged from 1.58 to 1.69). Though we observed no association between any of the EJ burden indices and sPTB among white gravidae, we found increased risks among Black gravidae, with ORs of similar magnitude for each EJ variable. For example, Black gravidae experienced 17% increased odds of sPTB associated with a 10-unit increase in the EJ burden index for PM2.5 (OR = 1.17, 95%CI = 0.97, 1.40). No racial differences were observed in the association of ADI with sPTB. Discussion Though we observed limited evidence of the contribution of living in EJ neighborhoods to the Black-White disparity in sPTB, our study suggests living in an EJ neighborhood may differentially impact Black and white gravidae.
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Affiliation(s)
- K. W. Whitworth
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - I. Moussa
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - H. M. Salihu
- Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - A. Chardon Fabien
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - M. Suter
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - K. M. Aagaard
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - E. Symanski
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
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Gearhart-Serna LM, Mills BA, Hsu H, Fayanju OM, Hoffman K, Devi GR. Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity. Sci Rep 2023; 13:20301. [PMID: 37985794 PMCID: PMC10662118 DOI: 10.1038/s41598-023-45693-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
Individual environmental contaminants have been associated with breast cancer; however, evaluations of multiple exposures simultaneously are limited. Herein, we evaluated associations between breast cancer summary stages and the Environmental Quality Index (EQI), which includes a range of environmental factors across five domains. The EQI (2000-2005) was linked to county-level age-standardized incidence rates (SIRs) obtained from the North Carolina Central Cancer Registry (2010-2014). Incidence rates and SIRs of total, in situ, localized, regional, and distant breast cancers were evaluated stratified by rural-urban status. In counties with poor environmental quality compared to those with good environmental quality, total breast cancer incidence was higher by 10.82 cases per 100,000 persons (95% CI 2.04, 19.60, p = 0.02). This association was most pronounced for localized breast cancer (β = 5.59, 95% CI 0.59, 10.58, p = 0.03). Higher incidence of early-stage disease (carcinoma in situ β = 5.25, 95% CI 2.34, 8.16, p = 0.00 and localized breast cancer β = 6.98, 95% CI 2.24, 11.73, p = 0.00) and total breast cancer (β = 11.44, 95% CI 3.01, 19.87, p = 0.01) occurred in counties with poor land quality, especially urban counties. Our analyses indicate significant associations between environmental quality and breast cancer incidence, which differ by breast cancer stage and urbanicity, identifying a critical need to assess cumulative environmental exposures in the context of cancer stage.
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Affiliation(s)
- Larisa M Gearhart-Serna
- Department of Surgery, Duke University School of Medicine, DUMC Box 2606 Med Ctr, Durham, NC, 27710, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
- Nicholas School of the Environment, Duke University, Durham, NC, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
| | - Brittany A Mills
- Department of Surgery, Duke University School of Medicine, DUMC Box 2606 Med Ctr, Durham, NC, 27710, USA
| | - Hillary Hsu
- Department of Surgery, Duke University School of Medicine, DUMC Box 2606 Med Ctr, Durham, NC, 27710, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Oluwadamilola M Fayanju
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Gayathri R Devi
- Department of Surgery, Duke University School of Medicine, DUMC Box 2606 Med Ctr, Durham, NC, 27710, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hurbain P, Liu Y, Strickland MJ, Li D. A cross-sectional analysis of associations between environmental indices and asthma in U.S. counties from 2003 to 2012. J Expo Sci Environ Epidemiol 2022; 32:320-332. [PMID: 33895778 PMCID: PMC8542056 DOI: 10.1038/s41370-021-00326-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/20/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND To capture the impacts of environmental stressors, environmental indices like the Air Quality Index, Toxic Release Inventory, and Environmental Quality Index have been used to investigate the environmental quality and its association with public health issues. However, past studies often rely on relatively small sample sizes, and they have typically not adjusted for important individual-level disease risk factors. OBJECTIVE We aim to estimate associations between existing environmental indices and asthma prevalence over a large population and multiple years. METHODS Based on data availability, we assessed the predictive capability of these indices for prevalent asthma across U.S. counties from 2003 to 2012. We gathered asthma data from the U.S. CDC Behavioral Risk Factor Surveillance System by county and used multivariable weighted logistic regression models to estimate the associations between the environmental indices and asthma, adjusting for individual factors such as smoking, income level, and obesity. RESULTS Environmental indices showed little to no correlation with one another and with prevalent asthma over time. Associations of environmental indices with prevalent asthma were very weak; whereas individual factors were more substantially associated with prevalent asthma. SIGNIFICANCE Our study suggests that an improved environmental index is needed to predict population-level asthma prevalence.
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Affiliation(s)
- Patrick Hurbain
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | | | - Dingsheng Li
- School of Community Health Sciences, University of Nevada, Reno, NV, USA.
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Nance D, Rappazzo KM, Jensen ET, Hoffman K, Cotton CC, Krajewski AK, Turner KO, Genta RM, Lobdell DT, Dellon ES. Increased risk of eosinophilic esophagitis with poor environmental quality as measured by the Environmental Quality Index. Dis Esophagus 2021; 34:6307361. [PMID: 34155508 DOI: 10.1093/dote/doab041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/21/2021] [Accepted: 05/30/2021] [Indexed: 12/11/2022]
Abstract
Geographic differences in eosinophilic esophagitis (EoE) prevalence suggest the possibility that environmental exposures contribute to EoE pathogenesis. We aimed to examine the association between environmental quality and risk of EoE, using the Environmental Quality Index (EQI), which provides quantification of environmental quality in five domains: air, land, water, built, and sociodemographic for all counties in the United States. To do this, we performed a case-control study in a large pathology database. EoE cases were defined by ≥15 eosinophils per high-power field with other pathologic diagnoses excluded; controls did not have EoE. The pathology data were geocoded and linked with the EQI by county of residence. Logistic regression was used to estimate odds ratio (OR and 95% confidence interval [CI]) of EoE with overall EQI and for each domain, after adjusting for sex, age, and proportion minority race or ethnicity at the county level (higher EQI score indicates worse environmental quality). Of 29,802 EoE cases and 593,329 controls analyzed, odds of EoE were highest in the worst quintile of EQI (OR 1.25; 95% CI: 1.04-1.50), which was largely explained by poor scores in the water domain (OR: 1.33; 1.17-1.50). Conversely, odds of EoE were reduced with higher scores in the air domain (OR: 0.87, 0.74-1.03) and land domain (OR 0.87; 0.76-0.99). Poor EQI, mostly reflected by poor water quality, was associated with increased odds of EoE, while poor air and land quality were inversely associated with EoE. Additional work to identify specific water pollutants that may have an etiologic role in EoE may be warranted.
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Affiliation(s)
- D Nance
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - K M Rappazzo
- United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, Durham, NC, USA
| | - E T Jensen
- Department of Epidemiology and Prevention, Wake Forest University Public Health Sciences, Winston-Salem, NC, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - K Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - C C Cotton
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - A K Krajewski
- United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, Durham, NC, USA
| | - K O Turner
- Inform Diagnostics, Irving, TX, USA.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R M Genta
- Inform Diagnostics, Irving, TX, USA.,Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - D T Lobdell
- United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, Durham, NC, USA
| | - E S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Dunlop AL, Essalmi AG, Alvalos L, Breton C, Camargo CA, Cowell WJ, Dabelea D, Dager SR, Duarte C, Elliott A, Fichorova R, Gern J, Hedderson MM, Thepaksorn EH, Huddleston K, Karagas MR, Kleinman K, Leve L, Li X, Li Y, Litonjua A, Ludena-Rodriguez Y, Madan JC, Nino JM, McEvoy C, O’Connor TG, Padula AM, Paneth N, Perera F, Sathyanarayana S, Schmidt RJ, Schultz RT, Snowden J, Stanford JB, Trasande L, Volk HE, Wheaton W, Wright RJ, McGrath M. Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts. PLoS One 2021; 16:e0245064. [PMID: 33418560 PMCID: PMC7794036 DOI: 10.1371/journal.pone.0245064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate's degree, vocational or technical training [reference category]; bachelor's degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor's degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor's degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.
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Affiliation(s)
- Anne L. Dunlop
- Woodruff Health Sciences Center, School of Medicine and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Alicynne Glazier Essalmi
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Lyndsay Alvalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Carlos A. Camargo
- Department of Epidemiology Harvard University, Cambridge, Massachusetts, United States of America
| | - Whitney J. Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Stephen R. Dager
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Amy Elliott
- Avera Research Institute Center for Pediatric & Community Research, Sioux Falls, South Dakota, United States of America
| | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - James Gern
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Elizabeth Hom Thepaksorn
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Kathi Huddleston
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Leslie Leve
- Prevention Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Yijun Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Augusto Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Yunin Ludena-Rodriguez
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Juliette C. Madan
- Department of Epidemiology Geisel School of Medicine at Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, United States of America
| | - Julio Mateus Nino
- Obstetrics and Gynecology, Maternal and Fetal Medicine, Atrium Health, Charlotte, North Carolina, United States of America
| | - Cynthia McEvoy
- Division of Neonatal, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Thomas G. O’Connor
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Frederica Perera
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington & Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Rebecca J. Schmidt
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Robert T. Schultz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessica Snowden
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, Arkansas, United States of America
| | - Joseph B. Stanford
- Department of Family Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Heather E. Volk
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - William Wheaton
- Science and Technology Program, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Monica McGrath
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Abstract
PURPOSE OF REVIEW Pregnant women are exposed to numerous synthetic chemicals (e.g., pesticides, phthalates, polychlorinated biphenyls) in their daily lives as well as a range of non-chemical stressors, including poverty, depression, discrimination, and stressful life events. Although many studies have examined individual exposures to chemical and non-chemical stressors in relation to child health outcomes, very few studies have considered these exposures together. Here, we review the recent epidemiologic literature on the joint impact of chemical and non-chemical stressors on child outcomes. RECENT FINDINGS Considerable co-exposure to chemical and non-chemical stressors occurs in vulnerable populations. Non-chemical stressors may modify the impact of chemical exposures on children's health, typically exacerbating their negative impact, but associations differ considerably by the chemicals and populations of interest. Additional research is urgently needed to better understand the cumulative risks of multiple stressors on children's health and the underlying physiological mechanisms.
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Affiliation(s)
- Emily S Barrett
- Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, 170 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
| | - Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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10
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Huang H, Woodruff TJ, Baer RJ, Bangia K, August LM, Jellife-Palowski LL, Padula AM, Sirota M. Investigation of association between environmental and socioeconomic factors and preterm birth in California. Environ Int 2018; 121:1066-1078. [PMID: 30075861 PMCID: PMC6638551 DOI: 10.1016/j.envint.2018.07.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 05/29/2023]
Abstract
BACKGROUND Preterm birth (PTB),2 defined as birth at gestational age <37 weeks, is a major public health concern. Infants born prematurely, comprising of about 10% of the US newborns, have elevated risks of neonatal mortality and a wide array of health problems. Although numerous clinical, genetic, environmental and socioeconomic factors have been implicated in PTB, very few studies investigate the impacts of multiple pollutants and social factors on PTB using large scale datasets. OBJECTIVES To evaluate association between environmental and socioeconomic factors and PTB in California. METHODS We linked the birth cohort file maintained by the California Office of Statewide Health Planning and Development from 2009 to 2012 years across 1.8 million births and the CalEnviroScreen 3.0 dataset from California Communities Environmental Health Screening Tool at the census tract level for 56 California counties. CalEnviroScreen contains 7 exposure and 5 environmental effects variables that constitute the Pollution Burden variable, and 5 socioeconomic variables. We evaluated relationships between environmental exposures and the risk of PTB using hierarchical clustering analyses and GIS-based visualization. We also used logistic regression to evaluate the relationship between specific pollutant and exposure indicators and PTB, accounted for socio-demographic determinants such as maternal race/ethnicity, maternal age, maternal education and payment of delivery costs. RESULTS There exists geographic variability in PTB for groups of counties with similar environmental and social exposure profiles. We found an association between Pollution Burden, particulate matter ≤2.5 μm (PM2.5), and Drinking Water Scores and PTB (adjusted odds ratios were 1.03 (95% Confidence Interval (CI): 1.01, 1.04), 1.03 (95% CI: 1.02,1.04), and 1.04 (95% CI: 1.03,1.05), respectively). Additional findings suggest that certain drinking water contaminants such as arsenic and nitrate are associated with PTB in California. CONCLUSIONS CalEnviroScreen data combined with birth records offer great opportunity for revealing novel exposures and evaluating cumulative exposures related to PTB by providing useful environmental and social information. Certain drinking water contaminants such as arsenic and nitrate are potentially associated with PTB in California and should be investigated further. Small association signals may involve sizeable population impacts.
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Affiliation(s)
- Hongtai Huang
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA; Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Rebecca J Baer
- Department of Pediatrics, University of California, San Diego, CA, USA; California Preterm Birth Initiative, University of California, San Francisco, CA, USA
| | - Komal Bangia
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, CA, USA
| | - Laura M August
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, CA, USA
| | - Laura L Jellife-Palowski
- California Preterm Birth Initiative, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Amy M Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA; Department of Pediatrics, University of California, San Francisco, CA, USA.
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11
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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. Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Nielsen CC, Amrhein CG, Osornio-Vargas AR. Mapping outdoor habitat and abnormally small newborns to develop an ambient health hazard index. Int J Health Geogr 2017; 16:43. [PMID: 29183340 PMCID: PMC5704543 DOI: 10.1186/s12942-017-0117-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/21/2017] [Indexed: 01/19/2023] Open
Abstract
Background The geography of where pregnant mothers live is important for understanding outdoor environmental habitat that may result in adverse birth outcomes. We investigated whether more babies were born small for gestational age or low birth weight at term to mothers living in environments with a higher accumulation of outdoor hazards. Methods Live singleton births from the Alberta Perinatal Health Program, 2006–2012, were classified according to birth outcome, and used in a double kernel density estimation to determine ratios of each outcome per total births. Individual and overlay indices of spatial models of 136 air emissions and 18 land variables were correlated with the small for gestational age and low birth weight at term, for the entire province and sub-provincially. Results There were 24 air substances and land sources correlated with both small for gestational age and low birth weight at term density ratios. On the provincial scale, there were 13 air substances and 2 land factors; sub-provincial analysis found 8 additional air substances and 1 land source. Conclusion This study used a combination of multiple outdoor variables over a large geographic area in an objective model, which may be repeated over time or in other study areas. The air substance-weighted index best identified where mothers having abnormally small newborns lived within areas of potential outdoor hazards. However, individual air substances and the weighted index provide complementary information.
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Affiliation(s)
- Charlene C Nielsen
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Canada.,Department of Pediatrics, University of Alberta, 3-591 ECHA, 11,405 87th Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Carl G Amrhein
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Canada
| | - Alvaro R Osornio-Vargas
- Department of Pediatrics, University of Alberta, 3-591 ECHA, 11,405 87th Avenue, Edmonton, AB, T6G 1C9, Canada.
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13
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Abstract
BACKGROUND Particulate matter (PM) has been documented to contribute to preterm delivery. However, few studies have investigated the relationships between individual constituents of fine PM (PM2.5 ) and preterm delivery, and factors that may modify their associations. METHODS In this study, we examined the associations between several prenatal exposure metrics to PM2.5 and 23 constituents of PM2.5 and preterm delivery in California from 2000 to 2006. In a retrospective cohort study including 231 637 births, we conducted logistic regression analyses adjusting for maternal, infant, temporal, geographic, and neighbourhood characteristics. RESULTS We observed increased risk for preterm delivery with full-gestational exposure for several PM2.5 constituents. Per interquartile range increase, ammonium (21.2%, 95% confidence interval (CI) 17.1, 25.4), nitrate (18.1%, 95% CI 14.9, 21.4) and bromine (16.7%, 95% CI 13.2, 20.3) had some of the largest increased risks. Alternatively, some PM2.5 constituents were inversely associated with preterm delivery, including chlorine (-8.2%, 95% CI -10.3, -6.0), sodium (-13.2%, 95% CI -15.2, -11.3), sodium ion (-11.9%, 95% CI -14.1, -9.6) and vanadium (-19.2%, 95% CI -25.3, -12.6). Greater associations between PM2.5 constituents and preterm delivery were observed for Blacks and Asians, older mothers, and those with some college education compared to their reference groups, as well as for births with gestational ages from 32 to 34 weeks. CONCLUSIONS PM2.5 constituents ammonium, nitrate and bromine, often linked to traffic and biomass combustion, were most associated with increased risk of preterm delivery in California. Certain demographic subgroups may be particularly impacted.
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Affiliation(s)
- Rupa Basu
- Air and Climate Epidemiology Section, California Office of Environmental Health Hazard Assessment, Oakland, CA
| | - Dharshani Pearson
- Air and Climate Epidemiology Section, California Office of Environmental Health Hazard Assessment, Oakland, CA
| | - Keita Ebisu
- Air and Climate Epidemiology Section, California Office of Environmental Health Hazard Assessment, Oakland, CA
| | - Brian Malig
- Air and Climate Epidemiology Section, California Office of Environmental Health Hazard Assessment, Oakland, CA
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15
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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. Environ Health Perspect 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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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