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Urban-rural status affects associations between domains of environmental quality and adverse birth outcomes
Jagai, J., L. Messer, K. Rappazzo, AND D. Lobdell. Urban-rural status affects associations between domains of environmental quality and adverse birth outcomes. Presented at American Public Health Association, Boston, MA, November 02 - 06, 2013.
To assess associations between domains of environmental quality and adverse birth outcomes by urban-rural status.
The relationship between environmental conditions and human health varies by environmental domain and urbanicity. To account for multiple ambient environmental conditions, we constructed an Environmental Quality Index (EQI) for health research. We used U.S. county level data representing five environmental domains (air, water, land, built and sociodemographic) and principal components analysis to construct the EQI and domain specific indices for each county (n=3141); counties were categorized by rural-urban continuum codes (RUCC1(most urban) –RUCC4(most rural)) for analyses. Birth outcomes data for one year (2002) from National Center for Health Statistics (n=3,989,704) was associated with categorical (quintiles) EQI domain-specific RUCC-stratified indices. Fixed slope, random intercept multilevel models, adjusted for maternal age, education, marital status, and infant sex, were used to assess associations. Across urban-rural categories, poor air quality (5th quintile(Q) of air domain) was associated with increased preterm birth (PTB= birth at <37 weeks completed gestation) 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, the effect on birth outcomes was generally consistent by domain of environmental quality. The EQI quantifies the environmental burden counties face while the domain specific indices provide policy makers and planners with information regarding primary stressors in the area. This abstract does not necessarily reflect EPA policy.