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County-level environmental quality and associations with individual - and county-level preterm birth
Citation:
Messer, L., K. Rappazzo, J. Jagai, AND D. Lobdell. County-level environmental quality and associations with individual - and county-level preterm birth. Presented at Society for Epidemiologic Research, Boston, MA, June 18 - 21, 2013.
Impact/Purpose:
Human health is influenced by simultaneous exposure to stressors and amenities, but research usually considers single exposures. We constructed a county-level Environmental Quality Index (EQI)and linked with birth outcome data in two different models and compared the models.The EQI quantifies environmental burden faced by counties while domain specific indices inform policy makers about the primary stressors in the county. These environments appear linked to both individual and county-level outcomes.
Description:
Human health is influenced by simultaneous exposure to stressors and amenities, but research usually considers single exposures. We constructed a county-level Environmental Quality Index (EQI) using principal components analysis with data from five domains (air, water, land, built, sociodemographic). With data from the National Center for Health Statistics (2002; n=3,989,704), we report associations among rural-urban stratified, domain-specific and overall indices for preterm birth (PTB) odds to mothers in the United States. Race-stratified linear regression estimated prevalence differences (PD(95% confidence interval(CI))) in county-level rates of PTB (n=3141) for quintiles of index exposure. Fixed slope, random intercept multilevel logistic models estimated odds ratios (OR(95%CI)) for index quintiles and individual PTB. Results differed by domain, racial group, and urbanicity. Increasing quintiles of the air index were associated with increased ORs and PDs for PTB(e.g., 5th quintile OR=1.21(1.16, 1.27); PD=0.020(0.013, 0.026) versus 1st quintile). In the most urban counties, an inverse relationship between the sociodemographic domain index and PTB (e.g., 5th quintile, OR=0.70(0.66, 0.74); PD=-0.041(-0.048, -0.034)) was observed but in the 3 less urban strata positive associations were noted (suburban strata 5th quintile, OR=1.29(1.19, 1.40); PD=0.028(0.020, 0.037)). Generally, results for county-and individual-level analysis followed similar patterns, but not consistently so. The EQI, land, water, and built indices had mixed results with PTB for both county-and individual-level analyses. This work allows us to consider both associations with cases and with rates of PTB. The EQI quantifies environmental burden faced by counties while domain specific indices inform policy makers about the primary stressors in the county. These environments appear linked to both individual and county-level outcomes. This abstract does not reflect EPA policy.