The associations between environmental quality and preterm birth in the United States, 2000–2005: a cross-sectional analysis

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  • Rappazzo, Kristen M
    • Other Affiliation: U.S. Environmental Protection Agency
  • Messer, Lynne C
    • Other Affiliation: Portland State University
  • Jagai, Jyotsna S
    • Other Affiliation: University of Illinois, Chicago
  • Gray, Christine L
    • Affiliation: Gillings School of Global Public Health
    • Other Affiliation: U.S. Environmental Protection Agency
  • Grabich, Shannon C
    • Affiliation: Gillings School of Global Public Health
    • Other Affiliation: U.S. Environmental Protection Agency
  • Lobdell, Danelle T
    • Other Affiliation: U.S. Environmental Protection Agency
Abstract
  • Background Many environmental factors have been independently associated with preterm birth (PTB). However, exposure is not isolated to a single environmental factor, but rather to many positive and negative factors that co-occur. The environmental quality index (EQI), a measure of cumulative environmental exposure across all US counties from 2000—2005, was used to investigate associations between ambient environment and PTB. Methods With 2000–2005 birth data from the National Center for Health Statistics for the United States (n = 24,483,348), we estimated the association between increasing quintiles of the EQI and county-level and individual-level PTB; we also considered environmental domain-specific (air, water, land, sociodemographic and built environment) and urban–rural stratifications. Results Effect estimates for the relationship between environmental quality and PTB varied by domain and by urban–rural strata but were consistent across county- and individual-level analyses. The county-level prevalence difference (PD (95 % confidence interval) for the non-stratified EQI comparing the highest quintile (poorest environmental quality) to the lowest quintile (best environmental quality) was −0.0166 (−0.0198, −0.0134). The air and sociodemographic domains had the strongest associations with PTB; PDs were 0.0196 (0.0162, 0.0229) and −0.0262 (−0.0300, −0.0224) for the air and sociodemographic domain indices, respectively. Within the most urban strata, the PD for the sociodemographic domain index was 0.0256 (0.0205, 0.0307). Odds ratios (OR) for the individual-level analysis were congruent with PDs. Conclusion We observed both strong positive and negative associations between measures of broad environmental quality and preterm birth. Associations differed by rural–urban stratum and by the five environmental domains. Our study demonstrates the use of a large scale composite environment exposure metric with preterm birth, an important indicator of population health and shows potential for future research.
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  • Article
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  • In Copyright
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  • Rappazzo et al.
Journal title
  • Environmental Health
Journal volume
  • 14
Journal issue
  • 1
Language
  • English
Bibliographic citation
  • Environmental Health. 2015 Jun 09;14(1):50
Publisher
  • BioMed Central

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