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Associations between environmental quality and infant mortality in the United States, 2000–2005

Journal Article · · Archives of Public Health
 [1];  [2];  [3];  [4];  [5];  [5];  [5]
  1. US Environmental Protection Agency (EPA), Chapel Hill, NC (United States). Oak Ridge Inst. for Science and Education (ORISE); DOE/OSTI
  2. Univ. of Illinois, Chicago, IL (United States). School of Public Health, Div. of Environmental and Occupational Health Sciences
  3. Portland State Univ., OR (United States). OHSU-PSU School of Public Health
  4. US Environmental Protection Agency (EPA), Chapel Hill, NC (United States). Oak Ridge Inst. for Science and Education (ORISE); Univ. of North Carolina, Chapel Hill, NC (United States). Gillings School of Global Public Health, Dept. of Epidemiology
  5. US Environmental Protection Agency (EPA), Research Triangle Park, NC (United States). National Health and Environmental Effects Research Lab.
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Background: 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 to 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; 144,741 deaths). 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.
Research Organization:
Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States)
Sponsoring Organization:
USDOE
Grant/Contract Number:
SC0014664
OSTI ID:
1627038
Journal Information:
Archives of Public Health, Journal Name: Archives of Public Health Journal Issue: 1 Vol. 76; ISSN 2049-3258
Publisher:
BioMed CentralCopyright Statement
Country of Publication:
United States
Language:
English

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Figures / Tables (5)

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60 APPLIED LIFE SCIENCES
Air quality
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Infant mortality
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Multiple environmental exposures
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Environmental & Occupational Health
Sociodemographic environment
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