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Domains of environmental quality are differentially associated with adverse birth outcomes by levels of urban-rural status
Citation:
Messer, L., K. Rappazzo, J. Jagai, AND D. Lobdell. Domains of environmental quality are differentially associated with adverse birth outcomes by levels of urban-rural status. Presented at Society for Pediatric and Preinatal Epidemiologic Research, Boston, MA, June 17 - 18, 2013.
Impact/Purpose:
To assess associations between domains of environmental quality and adverse birth outcomes by levels of urban-rural status.
Description:
Human health is affected by exposures operating from multiple domains across level of urbanicity. To accommodate this, we constructed an environmental quality index(EQI) using data from five domains (air, water, land, built, sociodemographic) for each United States (U.S.) county; counties were categorized by rural-urban continuum codes(RUCC1(most urban) – RUCC4(most rural)) for analyses. Using one year (2002) of National Center for Health Statistics birth records (n=3,989,704), fixed slope, random intercept multilevel models were constructed for preterm birth (PTB= birth at <37 weeks completed gestation). Categorical(quintiles) EQI domain-specific RUCC-stratified models were adjusted for maternal age, education, marital status, and infant sex. Across urban-rural categories, poor air quality (5th quintile(Q) of the air domain) was associated with increased PTB odds (odds ratio (OR) for RUCC1-Q5 = 1.18; 95% confidence intervals (95%CI: 1.11, 1.26)) while exposure to more farmland (5th Q land domain) was associated with lower odds of PTB in all but the most rural RUCC strata (RUCC2-Q5 OR= 0.87; 95% CI: 0.81, 0.93). In all but the most urban strata (RUCC1), exposure to poorer sociodemographic conditions (Q5) was also associated with increased PTB odds (RUCC3-Q5 OR=1.34; 95% CI: 1.25, 1.43). Associations with water and built environment domains were inconsistent across rural-urban status. Similar results were found for very PTB, low birth weight (BW) and very low BW outcomes. While some variability was noted by urban-rural residence, consistency of perinatal effect was noted for some domains of environmental quality. This abstract does not necessarily reflect EPA policy.