Citation:

Krajewski, A., K. Rappazzo, P. Langlois, L. Messer, AND D. Lobdell. Associations between cumulative environmental quality and ten selected birth defects in Texas. Birth Defects Research. John Wiley & Sons, Inc., Hoboken, NJ, 113(2):161-172, (2020). https://doi.org/10.1002/bdr2.1788

Impact/Purpose:

This study addresses research questions under Sustainable and Healthy Communities (Product 10.2.9 Environmental Quality Index (EQI) – development of census tract, community, rural, Tribal and examine cumulative health impacts for vulnerable groups). The Center for Public Health and Environmental Assessment in the Public Health and Environmental Systems Division, Epidemiology Branch has developed a measure that estimates overall environmental quality at the county level across the U.S. spanning the years 2006-2010 called the Environmental Quality Index (EQI). This work is being conducted for the purpose of learning more about how various environmental factors contribute in concert to health disparities in low-income, underrepresented minority and vulnerable populations, and to better estimate the total environmental and social context to which humans are exposed.

Description:

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 ten 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 ten 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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