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Urban-rural differences in environmental quality and associations with adverse birth outcomes
Citation:
Messer, L. C., K. Rapazzo, J. S. JAGAI, AND D. T. LOBDELL. Urban-rural differences in environmental quality and associations with adverse birth outcomes. Presented at Society for Prenatal/Perinatal Epi Research (SPER) Annual Meeeting, Minneapolis, MN, June 25 - 27, 2012.
Impact/Purpose:
We constructed an Environmental Quality Index (EQI) with data representing five domains (air, water, land, built, sociodemographic) for each United States (U.S.) county. Four categories of rural-urban continuum codes (RUCC1 (most urban) -RUCC4 (most rural)) were used to group counties for analyses.
Description:
Exposures affecting human health differ across environmental media and level of urbanicity. To address this, we constructed an Environmental Quality Index (EQI) with data representing five domains (air, water, land, built, sociodemographic) for each United States (U.S.) county. Four categories of rural-urban continuum codes (RUCC1 (most urban) -RUCC4 (most rural» were used to group counties for analyses. Using one year of birth records (2002) from the National Center for Health Statistics (3,989,704 births), fixed slope, random intercept multilevel models were constructed for three birth outcomes: preterm birth (PTB= birth at <37 weeks' completed gestation), low birth weight (LBW = birth weight <2500g) and very low birth weight (VLBW = birth weight <1500g). Models were adjusted for maternal age, education, marital status, and infant sex. Across urban-rural categories, higher EQI values (worse environmental quality) were associated with increased odds of VLBW (odds ratio (OR) for RUCC4 = 1.14; 95% confidence intervals (95%CI: 1.05, 1.24)).. Similar results were found for PTB and LBW in the two most rural RUCC categories (RUCC 3, 4). Worse environmental quality was associated with increased odds of PTB, LBW, and VLBW for white women in rural areas, but these race-stratified findings were not replicated for black or Hispanic women. Analyses with EQI quartiles confirmed higher EQI values were associated with increased odds of some adverse outcomes. Data from multiple environmental domains were successfully combined into one index representing overall county-level environmental conditions, which was associated with perinatal health. Disclaimer: This abstract does not necessarily reflect EPA policy.