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Luben TJ, Wilkie AA, Krajewski AK, Njie F, Park K, Zelasky S, Rappazzo KM. Short-term exposure to air pollution and infant mortality: A systematic review and meta-analysis. Sci Total Environ 2023; 898:165522. [PMID: 37459995 DOI: 10.1016/j.scitotenv.2023.165522] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND AIM Infant mortality is a widely reported indicator of population health and a leading public health concern. In this systematic review and meta-analysis, we review the available literature for epidemiologic evidence of the association between short-term air pollution exposure and infant mortality. METHODS Relevant publications were identified through PubMed and Web of Science databases using comprehensive search terms and screened using predefined inclusion/exclusion criteria. We extracted data from included studies and applied a systematic rubric for evaluating study quality across domains including participant selection, outcome, exposure, confounding, analysis, selective reporting, sensitivity, and overall quality. We performed meta-analyses, using both fixed and random-effect methods, and estimated pooled odds ratios (ORs) and 95 % confidence intervals (95%CI) for pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), coarse particulate matter (PM10), fine particulate matter (PM2.5), ozone (O3), carbon monoxide (CO)) and infant mortality, neonatal mortality, or postneonatal mortality. RESULTS Our search returned 549 studies. We excluded 490 studies in the abstract screening phase and an additional 37 studies in the full text screening phase, leaving 22 studies for inclusion. Among these 22 studies, 14 included effect estimates for PM10, 13 for O3, 11 for both NO2 and CO, 8 for SO2, and 3 for PM2.5. We did not calculate a pooled OR for PM2.5 due to the limited number of studies available and demonstrated heterogeneity in the effect estimates. The pooled ORs (95%CI) with the greatest magnitudes were for a 10-ppb increase in SO2 or NO2 concentration in the days before death (1.07 [95%CI: 1.02, 1.12], 1.04 [95%CI: 1.01, 1.08], respectively). The pooled OR for PM10 was 1.02 (95%CI: 1.00, 1.03), and the pooled ORs for CO and O3 were 1.01 (95%CI: 1.00, 1.02) and 0.99 (95%CI: 0.97, 1.01). CONCLUSIONS Increased exposure to SO2, NO2, PM10, or CO is associated with infant mortality across studies.
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Affiliation(s)
- Thomas J Luben
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, RTP, NC, USA.
| | - Adrien A Wilkie
- Oak Ridge Institute for Science and Education (ORISE) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Alison K Krajewski
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, RTP, NC, USA
| | - Fanny Njie
- Oak Ridge Associated Universities (ORAU) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Kevin Park
- Oak Ridge Associated Universities (ORAU) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Sarah Zelasky
- Oak Ridge Associated Universities (ORAU) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, RTP, 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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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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Krajewski AK, Jimenez MP, Rappazzo KM, Lobdell DT, Jagai JS. Aggregated cumulative county arsenic in drinking water and associations with bladder, colorectal, and kidney cancers, accounting for population served. J Expo Sci Environ Epidemiol 2021; 31:979-989. [PMID: 33692484 PMCID: PMC8862296 DOI: 10.1038/s41370-021-00314-8] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Many studies neglect to account for variation in population served by community water systems (CWSs) when aggregating CWS-level contaminant concentrations to county level. OBJECTIVE In an ecological epidemiologic analysis, we explored two methods-unweighted and weighted (proportion of CWS population served by county population)-to account for population served by CWS in association between arsenic and three cancers to determine the impact of population served on aggregated measures of exposure. METHODS CWS arsenic concentration data for 19 states were obtained from Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Network for 2000-10, aggregated to county level, and linked to county-level cancer data for 2011-5 from National Cancer Institute and CDC State Cancer Profiles. Negative binomial regression models estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI) between county-level bladder, colorectal, and kidney cancers and quartiles of aggregated cumulative county-level arsenic concentration (ppb-years). RESULTS We observed positive associations between the highest quartile of exposure, compared to the lowest, of aggregated cumulative county-level arsenic concentration (ppb-year) for bladder [weighted aRR: 1.89(1.53, 2.35)], colorectal [1.64(1.33, 2.01)], and kidney [1.69(1.37, 2.09)] cancers. We observed stronger associations utilizing the weighted exposure assessment method. However, inferences from this study are limited due to the ecologic nature of the analyses and different analytic study designs are needed to assess the utility that the weighted by CWS population served metric has for exposure assessment. SIGNIFICANCE Weighting by CWS population served accounts for some potential exposure assignment error in epidemiologic analysis.
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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, NC, USA.
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Research Triangle Park, NC, USA.
| | - Monica P Jimenez
- Oak Ridge Associated Universities (ORAU) Student Services Contractor at US EPA, Research Triangle Park, NC, USA
| | - Kristen M Rappazzo
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Research Triangle Park, NC, USA
| | - Danelle T Lobdell
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Research Triangle Park, NC, USA
| | - Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, School of Public Health, Chicago, IL, USA
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Jagai JS, Krajewski AK, Price KN, Lobdell DT, Sargis RM. Diabetes control is associated with environmental quality in the USA. Endocr Connect 2021; 10:1018-1026. [PMID: 34343109 PMCID: PMC8428089 DOI: 10.1530/ec-21-0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 12/15/2022]
Abstract
Environmental parameters, including built and sociodemographic environments, can impact diabetes control (DC). Epidemiological studies have associated specific environmental factors with DC; however, the impact of multidimensional environmental status has not been assessed. The Environmental Quality Index (EQI), a comprehensive quantitative metric capturing five environmental domains, was considered as an exposure. Age-adjusted rates of DC prevalence for each county in the United States were used as an outcome. DC was defined as the proportion of adults aged 20+ years with a previous diabetes diagnosis who currently do not have high fasting blood glucose (≥126 mg/dL) or elevated HbA1c (≥6.5). We conducted county-level analyses of DC prevalence rates for the years 2004-2012 in association with EQI for 2006-2010 and domain-specific indices using random intercept multilevel linear regression models clustered by state and controlled for county-level rates of obesity and physical inactivity. Analyses were stratified by rural-urban strata, and results are reported as prevalence rate differences (PRD) with 95% CIs comparing highest quintile/worst environmental quality to lowest quintile/best environmental quality. The association of DC with cumulative environmental quality was negative after control for all counties (PRD -0.32, 95% CI: -0.38, -0.27); suggesting that rates of DC worsen as environmental quality declines. While overall environmental quality exerts effects on DC that vary across the rural-urban spectrum, poor sociodemographic, and built environmental factors are associated with decreased DC nationally. These data suggest improvements in environmental quality mediated by larger-scale policy and practice interventions may improve glycemic control and reduce the morbidity and mortality arising from hyperglycemia.
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Affiliation(s)
- Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
- Correspondence should be addressed to J S Jagai:
| | - Alison K Krajewski
- Oak Ridge Institute for Science and Education, U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment, Public Health and Environmental Systems Division, Chapel Hill, North Carolina, USA
- U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Kyla N Price
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Danelle T Lobdell
- U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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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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Jagai JS, Krajewski AK, Shaikh S, Lobdell DT, Sargis RM. Association between environmental quality and diabetes in the USA. J Diabetes Investig 2020; 11:315-324. [PMID: 31579986 PMCID: PMC7078099 DOI: 10.1111/jdi.13152] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/08/2019] [Accepted: 09/19/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION Caloric excess and physical inactivity fail to fully account for the rise of diabetes prevalence. Individual environmental pollutants can disrupt glucose homeostasis and promote metabolic dysfunction. However, the impact of cumulative exposures on diabetes risk is unknown. MATERIALS AND METHODS The Environmental Quality Index, a county-level index composed of five domains, was developed to capture the multifactorial ambient environmental exposures. The Environmental Quality Index was linked to county-level annual age-adjusted population-based estimates of diabetes prevalence rates. Prevalence differences (PD, annual difference per 100,000 persons) and 95% confidence intervals (CI) were estimated using random intercept mixed effects linear regression models. Associations were assessed for overall environmental quality and domain-specific indices, and all analyses were stratified by four rural-urban strata. RESULTS Comparing counties in the highest quintile/poorest environmental quality to those in the lowest quintile/best environmental quality, counties with poor environmental quality demonstrated lower total diabetes prevalence rates. Associations varied by rural-urban strata; overall better environmental quality was associated with lower total diabetes prevalence rates in the less urbanized and thinly populated strata. When considering all counties, good sociodemographic environments were associated with lower total diabetes prevalence rates (prevalence difference 2.77, 95% confidence interval 2.71-2.83), suggesting that counties with poor sociodemographic environments have an annual prevalence rate 2.77 per 100,000 persons higher than counties with good sociodemographic environments. CONCLUSIONS Increasing attention has focused on environmental exposures as contributors to diabetes pathogenesis, and the present findings suggest that comprehensive approaches to diabetes prevention must include interventions to improve environmental quality.
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Affiliation(s)
- Jyotsna S Jagai
- School of Public HealthDivision of Environmental and Occupational Health SciencesUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Alison K Krajewski
- Oak Ridge Institute for Science and EducationNational Health and Environmental Effects Research LaboratoryEnvironmental Public Health DivisionU.S. Environmental Protection AgencyChapel HillNorth CarolinaUSA
| | - Sabina Shaikh
- Program on Global Environment and Public Policy StudiesUniversity of ChicagoChicagoIllinoisUSA
| | - Danelle T Lobdell
- National Health and Environmental Effects Research LaboratoryEnvironmental Public Health DivisionU.S. Environmental Protection AgencyChapel HillNorth CarolinaUSA
| | - Robert M Sargis
- Department of MedicineDivision of Endocrinology, Diabetes, and MetabolismUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Jagai JS, Krajewski AK, Jimenez MP, Murphy MS, Leibowitz SG, Lobdell DT. Watershed integrity and associations with gastrointestinal illness in the United States. J Water Health 2019; 17:978-988. [PMID: 31850904 PMCID: PMC10439500 DOI: 10.2166/wh.2019.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 06/10/2023]
Abstract
Gastrointestinal (GI) illnesses are associated with various environmental factors, such as water quality, stormwater runoff, agricultural runoff, sewer overflows, and wastewater treatment plant effluents. However, rather than assessing an individual factor alone, two indices incorporating a combination of ecological and environmental stressors were created to represent (1) overall watershed integrity, Index of Watershed Integrity (IWI) and (2) catchment integrity, Index of Catchment Integrity (ICI). These indices could provide a more comprehensive understanding of how watershed/catchment integrity potentially impact the rates of GI illness, compared to assessing an individual stressor alone. We utilized the IWI and ICI, as well as agricultural and urban land uses, to assess associations at the county level with the rates of GI illness in a population of adults over 65 years of age. Our findings demonstrated that both watershed and catchment integrity are associated with reduced hospitalizations for any GI outcomes, though association varied by urbanicity. We believe that improved versions of the IWI and ICI may potentially be useful indicators for public health analyses in other circumstances, particularly when considering rural areas or to capture the complex stressors impacting the ecological health of a watershed.
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Affiliation(s)
- Jyotsna S Jagai
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois, Chicago, IL, USA E-mail:
| | - Alison K Krajewski
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Health and Environment Effects Research Laboratory, Research Triangle Park, NC, USA
| | - Monica P Jimenez
- Oak Ridge Associated Universities Student Services Contractor at the U.S. Environmental Protection Agency, National Health and Environment Effects Research Laboratory, Research Triangle Park, NC, USA
| | | | - Scott G Leibowitz
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Western Ecology Division, Corvallis, OR, USA
| | - Danelle T Lobdell
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, Chapel Hill, NC, USA
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Abstract
CONTEXT Since 2009, poisonings have been the leading cause of fatal injuries in the United States (US) and remain a continuing public health issue. Because of the varying definitions for what constitutes a poisoning case, there are inconsistencies in the annual number of cases reported among national health surveys. OBJECTIVES The main objective of this study was to describe poisonings treated in Illinois hospitals by type of exposure, as well as to detail demographic characteristics, acute outcomes, and general cost estimates for those exposed to poisoning. We also compared a broad definition for poisoning used in our analysis with the definitions used by four national health surveys in order to assess the adequacy of various definitions in capturing poisonings for surveillance. MATERIAL AND METHODS We conducted a comprehensive analysis of outpatients and inpatients treated in Illinois hospitals in 2010 using the Illinois hospital database. Age-adjusted incidence rates were calculated. RESULTS In Illinois, 425,491 patients were treated in hospitals for poisoning in 2010, of whom 222,339 were inpatients. The age-adjusted incidence rate was 3,189 per 100,000 persons, with an average length of stay among inpatients of 5.5 days. The cumulative hospital charges were $7.9 billion. DISCUSSION AND CONCLUSION The definitions used in national surveys miss 60-90% of poisoning cases. Poisoning is the leading cause of fatal injuries in the U.S., but as this study shows broadening the definition for poisoning may provide a more accurate representation of the direct and indirect effects of poisoning in the US.
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Affiliation(s)
- Alison K Krajewski
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois , Chicago, IL , USA
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