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Area-level socioeconomic deprivation, nitrogen dioxide exposure, and term birth weight in New York City.

ABSTRACT: Numerous studies have linked air pollution with adverse birth outcomes, but relatively few have examined differential associations across the socioeconomic gradient. To evaluate interaction effects of gestational nitrogen dioxide (NO2) and area-level socioeconomic deprivation on fetal growth, we used: (1) highly spatially-resolved air pollution data from the New York City Community Air Survey (NYCCAS); and (2) spatially-stratified principle component analysis of census variables previously associated with birth outcomes to define area-level deprivation. New York City (NYC) hospital birth records for years 2008-2010 were restricted to full-term, singleton births to non-smoking mothers (n=243,853). We used generalized additive mixed models to examine the potentially non-linear interaction of nitrogen dioxide (NO2) and deprivation categories on birth weight (and estimated linear associations, for comparison), adjusting for individual-level socio-demographic characteristics and sensitivity testing adjustment for co-pollutant exposures. Estimated NO2 exposures were highest, and most varying, among mothers residing in the most-affluent census tracts, and lowest among mothers residing in mid-range deprivation tracts. In non-linear models, we found an inverse association between NO2 and birth weight in the least-deprived and most-deprived areas (p-values<0.001 and 0.05, respectively) but no association in the mid-range of deprivation (p=0.8). Likewise, in linear models, a 10 ppb increase in NO2 was associated with a decrease in birth weight among mothers in the least-deprived and most-deprived areas of -16.2g (95% CI: -21.9 to -10.5) and -11.0 g (95% CI: -22.8 to 0.9), respectively, and a non-significant change in the mid-range areas [?=0.5 g (95% CI: -7.7 to 8.7)]. Linear slopes in the most- and least-deprived quartiles differed from the mid-range (reference group) (p-values<0.001 and 0.09, respectively). The complex patterning in air pollution exposure and deprivation in NYC, however, precludes simple interpretation of interactive effects on birth weight, and highlights the importance of considering differential distributions of air pollution concentrations, and potential differences in susceptibility, across deprivation levels.

SUBMITTER: Shmool JL

PROVIDER: S-EPMC4715366 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Area-level socioeconomic deprivation, nitrogen dioxide exposure, and term birth weight in New York City.

Shmool Jessie L C JL Bobb Jennifer F JF Ito Kazuhiko K Elston Beth B Savitz David A DA Ross Zev Z Matte Thomas D TD Johnson Sarah S Dominici Francesca F Clougherty Jane E JE

Environmental research 20151001

Numerous studies have linked air pollution with adverse birth outcomes, but relatively few have examined differential associations across the socioeconomic gradient. To evaluate interaction effects of gestational nitrogen dioxide (NO2) and area-level socioeconomic deprivation on fetal growth, we used: (1) highly spatially-resolved air pollution data from the New York City Community Air Survey (NYCCAS); and (2) spatially-stratified principle component analysis of census variables previously assoc ...[more]

PMID: 26318257

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Project description:ImportanceDiabetes management operates under a complex interrelationship between behavioral, social, and economic factors that affect a patient's ability to self-manage and access care.ObjectiveTo examine the association between 2 complementary area-based metrics, area deprivation index (ADI) score and rurality, and optimal diabetes care.Design, setting, and participantsThis cross-sectional study analyzed the electronic health records of patients who were receiving care at any of the 75 Mayo Clinic or Mayo Clinic Health System primary care practices in Minnesota, Iowa, and Wisconsin in 2019. Participants were adults with diabetes aged 18 to 75 years. All data were abstracted and analyzed between June 1 and November 30, 2020.Main outcomes and measuresThe primary outcome was the attainment of all 5 components of the D5 metric of optimal diabetes care: glycemic control (hemoglobin A1c <8.0%), blood pressure (BP) control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), lipid control (use of statin therapy according to recommended guidelines), aspirin use (for patients with ischemic vascular disease), and no tobacco use. The proportion of patients receiving optimal diabetes care was calculated as a function of block group-level ADI score (a composite measure of 17 US Census indicators) and zip code-level rurality (calculated using Rural-Urban Commuting Area codes). Odds of achieving the D5 metric and its components were assessed using logistic regression that was adjusted for demographic characteristics, coronary artery disease history, and primary care team specialty.ResultsAmong the 31 934 patients included in the study (mean [SD] age, 59 [11.7] years; 17 645 men [55.3%]), 13 138 (41.1%) achieved the D5 metric of optimal diabetes care. Overall, 4090 patients (12.8%) resided in the least deprived quintile (quintile 1) of block groups and 1614 (5.1%) lived in the most deprived quintile (quintile 5), while 9193 patients (28.8%) lived in rural areas and 2299 (7.2%) in highly rural areas. The odds of meeting the D5 metric were lower for individuals residing in quintile 5 vs quintile 1 block groups (odds ratio [OR], 0.72; 95% CI, 0.67-0.78). Patients residing in rural (OR, 0.84; 95% CI, 0.73-0.97) and highly rural (OR, 0.81; 95% CI, 0.72-0.91) zip codes were also less likely to attain the D5 metric compared with those in urban areas.Conclusions and relevanceThis cross-sectional study found that patients living in more deprived and rural areas were significantly less likely to attain high-quality diabetes care compared with those living in less deprived and urban areas. The results call for geographically targeted population health management efforts by health systems, public health agencies, and payers.

Project description:BackgroundSocioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland.MethodsThe 2010-2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations.ResultsAmong men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010-2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index).ConclusionsSignificant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.

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Dataset Information

Area-level socioeconomic deprivation, nitrogen dioxide exposure, and term birth weight in New York City.

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Area-level socioeconomic deprivation, nitrogen dioxide exposure, and term birth weight in New York City.

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