Citation:

Patel, A., J. Jagai, L. Messer, C. Gray, K. Rappazzo, S. DeflorioBarker, AND D. Lobdell. Associations between environmental quality and infant mortality in the United States, 2000-2005. Archives of Public Health. BioMed Central Ltd, London, Uk, 76(60):1, (2018). https://doi.org/10.1186/s13690-018-0306-0

Impact/Purpose:

This study addresses research questions under Sustainable and Healthy Communities (Project 2.64 Indicators, Indices & Report on the Environment and Project 2.62 Community Public Health & Well-Being). The National Health Environmental Effects Research Laboratory in the Environmental Public Health Division, Epidemiology Branch is currently engaged in research aimed at developing a measure that estimates overall environmental quality at the county level across the U.S. spanning the years 2000 – 2005 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:

The United States (U.S.) suffers from high infant mortality (IM) rates and there are significant racial/ethnic differences in these rates. Prior studies on the environment and infant mortality are generally limited to singular exposures. We utilize the Environmental Quality Index (EQI), a measure of cumulative environmental exposure (across air, water, land, sociodemographic, and land domains) for U.S. counties from 2000-2005, to investigate associations between ambient environment and IM across maternal race/ethnicity. Methods We linked 2000-2005 infant data from the U.S. Centers for Disease Control and Prevention to the EQI (n=22,702,529; 144,741deaths). We utilized multi-level regression to estimate associations between quartiles of county-level EQI and IM. We also considered associations between quartiles of county level domain specific indices with IM. We controlled for rural-urban status (RUCC1: urban, metropolitan; RUCC2: urban, non-metropolitan; RUCC3: less urbanized; RUCC4: thinly populated), maternal age, maternal education, marital status, infant sex, and stratified on race/ethnicity. Additionally, we estimated associations for linear combinations of environmental quality and rural-urban status. Results We found a mix of positive, negative, and null associations and our findings varied across domain and race/ethnicity. Poorer overall environmental quality was associated with decreased odds among Non-Hispanic whites (OR and 95% CI: EQIQ4 (ref. EQIQ1): 0.84[0.80,0.89]). For Non-Hispanic blacks and Hispanics, some increased odds were observed. Poorer air quality was monotonically associated with increased odds among Non-Hispanic whites (airQ4 (ref. airQ1): 1.05[0.99,1.11]) and blacks (airQ4 (ref. airQ1): 1.09 [0.9,1.31]). Rural status was associated with increased IM odds among Hispanics (RUCC4-Q4:1.36[1.04,1.78]; RUCC1-Q4: 1.04[0.92,1.16], ref. for both RUCC1-Q1). Conclusions This study is the first to report on associations between ambient environmental quality and IM across the United States. It corroborates prior research suggesting an association between air pollution and IM and identifies residence in thinly populated (rural) areas as a potential risk factor towards IM amongst Hispanics. Some of the counterintuitive findings highlight the need for additional research into potentially differential drivers of environmental quality across the rural-urban continuum, especially with regards to the sociodemographic environment.

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