Socioeconomic and racial disparities in source-apportioned PM2.5 levels across urban areas in the contiguous US, 2010.

Fine particulate matter (PM2.5) air pollution exposure is associated with short and long-term health effects. Several studies found differences in PM2.5 exposure associated with neighborhood racial and socioeconomic composition. However, most focused on total PM2.5 mass rather than its chemical components and their sources. In this study, we describe the ZIP code characteristics that drive the disparities in exposure to PM2.5 chemical components attributed to source categories both nationally and regionally. We obtained annual mean predictions of PM2.5 and fourteen of its chemical components from spatiotemporal models and socioeconomic and racial predictor variables from the 2010 US Census, and the American Community Survey 5-year estimates. We used non-negative matrix factorization to attribute the chemical components to five source categories. We fit generalized nonlinear models to assess the associations between the neighborhood predictors and each PM2.5 source category in urban areas in the United States in 2010 (n=25,790 zip codes). We observed higher PM2.5 levels in ZIP codes with higher proportions of Black individuals and lower socioeconomic status. Racial exposure disparities were mainly attributed to Heavy Fuel, Oil and Industrial, Metal Processing Industry and Agricultural, and Motor Vehicle sources. Economic disparities were mainly attributed to Soil and Crustal Dust, Heavy Fuel Oil and Industrial, Metal Processing Industry and Agricultural, and Motor Vehicle sources. Upon further analysis through stratifying by regions within the United States, we found that the associations between ZIP code characteristics and source-attributed PM2.5 levels were generally greater in Western states. In conclusion, racial, socioeconomic, and geographic inequalities in exposure to PM2.5 and its components are driven by systematic differences in component sources that can inform air quality improvement strategies.

What Is "Socioeconomic Position (SEP)," and How Might It Modify Air Pollution-Health Associations? Cohering Findings, Identifying Challenges, and Disentangling Effects of SEP and Race in US City Settings.

PURPOSE OF REVIEW: Environmental epidemiology has long considered socioeconomic position (SEP) to be an important confounder of pollution effects on health, given that, in the USA, lower-income and minority communities are often disproportionately exposed to pollution. In recent decades, a growing literature has revealed that lower-SEP communities may also be more susceptible to pollution. Given the vast number of material and psychosocial stressors that vary by SEP, however, it is unclear which specific aspects of SEP may underlie this susceptibility. As environmental epidemiology engages more rigorously with issues of differential susceptibility, it is pertinent to define SEP more clearly, to disentangle its many aspects, and to move towards identifying causal components. Myriad stressors and exposures vary with SEP, with effects accumulating and interacting over the lifecourse. Here, we ask: In the context of environmental epidemiology, how do we meaningfully characterize"SEP"? RECENT FINDINGS: In answering this question, it is critical to acknowledge that SEP, stressors, and pollution are differentially distributed by race in US cities. These distributions have been shaped by neighborhood sorting and race-based residential segregation rooted in historical policies and processes (e.g., redlining), which have served to concentrate wealth and opportunities for education and employment in predominantly-white communities. As a result, it is now profoundly challenging to separate SEP from race in the urban US setting. Here, we cohere evidence from our recent and on-going studies aimed at disentangling synergistic health effects among SEP-related stressors and pollutants. We consider an array of SEP-linked social stressors, and discuss persistent challenges in this epidemiology, many of which are related to spatial confounding among multiple pollutants and stressors. Combining quantitative results with insights from qualitative data on neighborhood perceptions and stress (including violence and police-community relations), we offer a lens towards unpacking the complex interplay among SEP, community stressors, race, and pollution in US cities.

The intersection of pediatrics, climate change, and structural racism: Ensuring health equity through climate justice.

Understanding and intervening at the intersection of climate change and child health disparities require pediatric providers to broaden their competency with structural determinants of health - even in the clinic. The environmental effects of climate change at the community level intersect in complex ways with structural racism and social influences of health. Climate injustice is further evident in policies and practices that disproportionately affect low-income communities and communities of color through exposure to harmful pollutants from industrial plants, heavy vehicular traffic, and flooding waterways, as well as to harm from degraded civic infrastructure such as leaking water lines and unsafe bridges. To support child health, pediatric providers must recognize the environmental health harms posed to children and multiplied by climate change as well as identify opportunities to center the voices of families and communities to dismantle these inequities. In this article, three case examples demonstrate the links between structural racism, climate change and child health. We then use a healing centered engagement approach to offer specific suggestions for how pediatric providers can actively promote health and resilience, advocate for patient needs, and contribute to efforts to change structural racism in existing practices and institutions.

Socioeconomic disparities in incidents at toxic sites during Hurricane Harvey.

BACKGROUND: Hurricane Harvey facilitated exposure to various toxic substances and floodwater throughout the greater Houston metropolitan area. Although disparities exist in this exposure and vulnerable populations can bear a disproportionate impact, no research has integrated disparities in exposure to toxic incidents following Hurricane Harvey. OBJECTIVE: The objective of this study was to analyze the relationship between flooding, socioeconomic status (SES), and toxic site incidents. METHODS: Data on toxic site locations, reported releases, and flood water depths during Hurricane Harvey in the greater Houston area were compiled from multiple sources. A multivariable logistic regression was performed to predict the odds of a toxic site release by flooding at the site, SES and racial composition of the census tract. RESULTS: 83 out of 1403 toxic sites (5.9%) had reported releases during Hurricane Harvey. The proportion of toxic sites with reported incidents across increasing SES index quintiles were 8.35, 7.67, 5.14, 4.55, and 0.51, respectively. The odds of an incident were lower in the highest SES quintile areas (ORadj = 0.06, 95% CI: 0.01-0.42) compared to the lowest SES quintile. Flooding was similar at toxic sites with and without incidents, and was distributed similarly and highest at toxic sites located in lower SES quintiles. SIGNIFICANCE: Despite similar flooding across toxic sites during Hurricane Harvey, areas with lower SES were more likely to have a toxic release during the storm, after accounting for number of toxic sites. Improving quality of maintenance, safety protocols, number of storm-resilient facilities may minimize this disproportionate exposure and its subsequent adverse outcomes among socioeconomically vulnerable populations.

Climatic and Environmental Correlates of Dry Eye Disease Severity: A Report From the Dry Eye Assessment and Management (DREAM) Study.

Purpose: Correlate climate, weather parameters, and environmental exposures with the severity of symptoms and signs of dry eye disease (DED) in Dry Eye Assessment and Management (DREAM) study participants. Methods: Participants from five distinct climates completed the Ocular Surface Disease Index (OSDI) and were examined for corneal and conjunctival staining, tear breakup time (TBUT), and Schirmer's testing at baseline, 3, 6, and 12 months. Climate, weather parameters, and pollutants including ozone (O3), carbon monoxide (CO), nitrous oxides (NO2, NOx, NOy), sulfur dioxide (SO2), particulate matter, and optical depth were obtained from governmental databases. Multivariate analysis and partial correlation coefficients (ρ) were used to assess associations, adjusted for age, sex, and the presence of Sjögren disease. Results: Among 535 participants, 81% were female and mean age was 58 years. Participants from the Mediterranean climate demonstrated better corneal fluorescein staining, better TBUT, and higher Schirmer's test scores throughout the calendar year (each P < 0.0001). Greater corneal fluorescein staining was associated with lower humidity (P < 0.0038). TBUT measurements positively correlated with temperature, humidity, and dewpoint and inversely correlated with NO2 levels (P < 0.0038). Paradoxically, some airborne pollutants were associated with less severe signs of dry eye (P < 0.0038). Windspeed was not correlated with signs of DED, and OSDI scores did not correlate with individual environmental exposures. Conclusions: Dry eye signs differed between climates and local humidity levels. With the exception of NO2, airborne pollutants were not associated with detrimental dry eye features. Translational Relevance: These results support limiting dry air exposure for patients with DED.

Geocoding Error, Spatial Uncertainty, and Implications for Exposure Assessment and Environmental Epidemiology.

Although environmental epidemiology studies often rely on geocoding procedures in the process of assigning spatial exposure estimates, geocoding methods are not commonly reported, nor are consequent errors in exposure assignment explored. Geocoding methods differ in accuracy, however, and, given the increasing refinement of available exposure models for air pollution and other exposures, geocoding error may account for an increasingly larger proportion of exposure misclassification. We used residential addresses from a reasonably large, dense dataset of asthma emergency department visits from all New York City hospitals (n = 21,183; 26.9 addresses/km2), and geocoded each using three methods (Address Point, Street Segment, Parcel Centroid). We compared missingness and spatial patterning therein, quantified distance and directional errors, and quantified impacts on pollution exposure estimates and assignment to Census areas for sociodemographic characterization. Parcel Centroids had the highest overall missingness rate (38.1%, Address Point = 9.6%, Street Segment = 6.1%), and spatial clustering in missingness was significant for all methods, though its spatial patterns differed. Street Segment geocodes had the largest mean distance error (µ = 29.2 (SD = 26.2) m; vs. µ = 15.9 (SD = 17.7) m for Parcel Centroids), and the strongest spatial patterns therein. We found substantial over- and under-estimation of pollution exposures, with greater error for higher pollutant concentrations, but minimal impact on Census area assignment. Finally, we developed surfaces of spatial patterns in errors in order to identify locations in the study area where exposures may be over-/under-estimated. Our observations provide insights towards refining geocoding methods for epidemiology, and suggest methods for quantifying and interpreting geocoding error with respect to exposure misclassification, towards understanding potential impacts on health effect estimates.

Violent crime and socioeconomic deprivation in shaping asthma-related pollution susceptibility: a case-crossover design.

BACKGROUND: The objective of this study was to quantify and compare the relative influence of community violent crime and socioeconomic deprivation in modifying associations between ozone and emergency department (ED) visits for asthma among children. METHODS: We used a spatiotemporal case-crossover analysis for all New York City EDs for the months May-September from 2005 to 2011 from a statewide administrative ED dataset. The data included 11 719 asthmatic children aged 5-18 years, and the main outcome measure was percentage of excess risk of asthma ED visit based on Cox regression analysis. RESULTS: Stronger ozone-asthma associations were observed for both elevated crime and deprivation (eg, on lag day 2, we found 20.0% (95% CI 10.2% to 30.6 %) and 21.0% (10.5% to 32.5%) increased risk per 10 ppb ozone, for communities in the highest vs lowest quartiles of violent crime and deprivation, respectively). However, in varied models accounting for both modifiers, only violence retained significance. CONCLUSIONS: The results suggest stronger spatiotemporal ozone-asthma associations in communities of higher violent crime or deprivation. Notably, violence was the more consistent and significant modifier, potentially mediating a substantial portion of socioeconomic position-related susceptibility.

Building New York State Centers of Excellence in Children's Environmental Health: A Replicable Model in a Time of Uncertainty.

Public health programs may be seriously affected in periods of federal retrenchment. During these times, state-based strategies provide an alternate pathway for advancing public health.A 12-year campaign to secure state support for a network of Centers of Excellence in Children's Environmental Health (CEH) promoting health of children across New York State is described. It was driven by rising rates of asthma, birth defects, developmental disorders, and other noncommunicable diseases in children; growing evidence associating hazardous environmental exposures with these conditions; and recognition that federal resources in CEH are insufficient.Critical campaign elements were (1) formation of a statewide coalition of academic health centers, health care providers, public health officials, community advocates, and other stakeholders; (2) bipartisan collaborations with legislative champions and government leaders; (3) assessment of the burden of developmental disorders and noncommunicable diseases associated with environmental exposures among children; (4) maps documenting the presence of environmental hazards in every county statewide; (5) iterative charting of a changing political landscape; and (6) persistence. The 2017 award of a 5-year, $10 million contract to establish Centers of Excellence in CEH demonstrates the value of this statewide strategy.

Exploring the Health and Spatial Equity Implications of the New York City Bike Share System.

INTRODUCTION: This paper examines spatial equity and estimates the health impact of Citi Bike, New York City's (NYC) bike share system. We discuss how further system expansion and utilization by residents in high-poverty communities of color could affect the potential benefit of the largest bicycle share system in the United States. METHODS: First, we compared the Citi Bike station distribution by census tract poverty during the system's 2013 launch and after the 2015 geographic expansion. Second, we applied the World Health Organization's Health Economic Assessment Tool (HEAT) to estimate the benefit of cycling associated with annual Citi Bike members for two 12-month time periods and analyzed change of the benefit over time. RESULTS: The results showed that the greatest proportion of Citi Bike stations were located in low-poverty (wealthier) NYC census tracts (41% per period), and there were no significant changes in station distribution during expansion. HEAT estimated an increase from two to three premature deaths prevented and an increased annual economic benefit from $18,800,000 to $28,300,000 associated with Citi Bike use. CONCLUSION: In conclusion, although Citi Bike stations are not equitably located, the estimated annual health benefits are substantial and have increased over time. Our findings underscore the potential for even greater benefits with increased spatial access in higher-poverty neighborhoods and communities of color. Our findings highlight the importance of the built environment in shaping health and the need for a health equity lens to consider the social and political processes that perpetuate inequities.

Association between particulate air pollution exposure during pregnancy and postpartum maternal psychological functioning.

METHODS: We studied associations between prenatal exposure to particulate matter with diameter ≤ 2.5 µm (PM2.5) and postpartum psychological functioning in a lower income, ethnically mixed sample of urban US women enrolled in a pregnancy cohort study. Analyses included 557 mothers who delivered at ≥37 weeks gestation. Daily estimates of residential PM2.5 over gestation were derived using a satellite-based spatio-temporally resolved model. Outcomes included the Edinburgh Postnatal Depression Scale (EPDS) score from 6 or 12 months postpartum and subscale scores for anhedonia, depressive and anxiety symptoms. Associations were also examined within racial/ethnic groups. Distributed lag models (DLMs) were implemented to identify windows of vulnerability during pregnancy. RESULTS: Most mothers had less than a high school education (64%) and were primarily Hispanic (55%) and Black (29%). In the overall sample, a DLM adjusted for age, race, education, prenatal smoking, and season of delivery, we found significant associations between higher PM2.5 exposure in the second trimester and increased anhedonia subscale scores postpartum. In race stratified analyses, mid-pregnancy PM2.5 exposure was significantly associated with increased total EPDS scores as well as higher anhedonia and depressive symptom subscale scores among Black women. CONCLUSIONS: Increased PM2.5 exposure in mid-pregnancy was associated with increased depressive and anhedonia symptoms, particularly in Black women.

Climate Change and Schools: Environmental Hazards and Resiliency.

The changing climate is creating additional challenges in maintaining a healthy school environment in the United States (U.S.) where over 50 million people, mostly children, spend approximately a third of their waking hours. Chronic low prioritization of funds and resources to support environmental health in schools and lack of clear regulatory oversight in the U.S. undergird the new risks from climate change. We illustrate the extent of risk and the variation in vulnerability by geographic region, in the context of sparse systematically collected and comparable data particularly about school infrastructure. Additionally, we frame different resilience building initiatives, focusing on interventions that target root causes, or social determinants of health. Disaster response and recovery are also framed as resilience building efforts. Examples from U.S. Federal Region 2 (New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands) and nationally are used to illustrate these concepts. We conclude that better surveillance, more research, and increased federal and state oversight of environmental factors in schools (specific to climate risks) is necessary, as exposures result in short- and long term negative health effects and climate change risks will increase over time.

The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012.

BACKGROUND: Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits. METHODS: Nine clinically-relevant spring tree pollen genera (elm, poplar, maple, birch, beech, ash, sycamore/London planetree, oak, and hickory) measured in Armonk, NY, were analyzed for their associations with over-the-counter allergy medication sales and daily asthma syndrome ED visits from patients' chief complaints or diagnosis codes in New York City during March 1st through June 10th, 2002-2012. Multi-day impacts of pollen on the outcomes (0-3 days and 0-7 days for the medication sales and ED visits, respectively) were estimated using a distributed lag Poisson time-series model adjusting for temporal trends, day-of-week, weather, and air pollution. For asthma syndrome ED visits, age groups were also analyzed. Year-to-year variation in the average peak dates and the 10th-to-90th percentile duration between pollen and the outcomes were also examined with Spearman's rank correlation. RESULTS: Mid-spring pollen types (maple, birch, beech, ash, oak, and sycamore/London planetree) showed the strongest significant associations with both outcomes, with cumulative rate ratios up to 2.0 per 0-to-98th percentile pollen increase (e.g., 1.9 [95% CI: 1.7, 2.1] and 1.7 [95% CI: 1.5, 1.9] for the medication sales and ED visits, respectively, for ash). Lagged associations were longer for asthma syndrome ED visits than for the medication sales. Associations were strongest in children (ages 5-17; e.g., a cumulative rate ratio of 2.6 [95% CI: 2.1, 3.1] per 0-to-98th percentile increase in ash). The average peak dates and durations of some of these mid-spring pollen types were also associated with those of the outcomes. CONCLUSIONS: Tree pollen peaking in mid-spring exhibit substantive impacts on allergy, and asthma exacerbations, particularly in children. Given the narrow time window of these pollen peak occurrences, public health and clinical approaches to anticipate and reduce allergy/asthma exacerbation should be developed.

Health impact assessments for environmental restoration: the case of Caño Martín Peña.

BACKGROUND: Health Impact Assessment (HIA) is a methodology for predicting the effects of a proposed policy or plan on health. A proposed environmental restoration and development plan presented an opportunity for an HIA in an environmental justice community surrounding the Martín Peña channel in San Juan, Puerto Rico. The HIA focused on the dredging of the channel, debris removal, road, sewer, and storm water infrastructure improvements, housing demolition, and resident relocation. OBJECTIVE: The aim of this study was to determine the potential effects of the proposed plan on the community's health to inform the funding decision by the Puerto Rican legislature. As the first HIA in Puerto Rico, a secondary objective was to build HIA capacity in Puerto Rico. METHODS: This HIA used community training, literature reviews, existing local studies, focus groups, interviews, and disease surveillance data to assess baseline health, determine expected effects, and build capacity. FINDINGS: The Martín Peña community is experiencing deteriorating environmental conditions. Flooding and negative environmental exposures, such as mold, limits to physical activity, stress, chemical toxicants, pathogenic bacteria, and pests, are worsening. The higher rates of diseases, such as asthma and diarrhea, in the community compared with elsewhere in Puerto Rico appear to be largely attributable to these factors. Overall, the proposed plan is expected to improve many of these health disparities but the successful implementation depends on continued community acceptance and participation, particularly with the relocation process. Recommendations are for full financing and several mitigation efforts to avoid negative and preserve beneficial health consequences. CONCLUSIONS: As the first HIA in Puerto Rico, this assessment provided specific recommendations to benefit the health of the community affected by an environmental restoration and development plan and also capacity building for a larger audience in Puerto Rico. This approach could be generalized to other Latino environmental justice communities in Puerto Rico and abroad.

Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs.

There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fine-particulate matter are sufficiently protective of children's health.

The effects of outdoor air pollutants on the costs of pediatric asthma hospitalizations in the United States, 1999 to 2007.

BACKGROUND: Acute exposure to outdoor air pollutants has been associated with increased pediatric asthma morbidity. However, the impact of subchronic exposures is largely unknown. OBJECTIVE: To examine the association between subchronic exposure to 6 outdoor air pollutants (PM2.5, PM10, ozone, nitrogen oxides, sulfur oxides, carbon monoxide) and pediatric asthma hospitalization length of stay, charges, and costs. METHODS: We linked pediatric asthma hospitalization discharge data from a nationally representative dataset, the 1999-2007 Nationwide Inpatient Sample, with outdoor air pollution data from the Environmental Protection Agency. Hospitals with no air quality data within 10 miles were excluded. Our predictor was the average concentration of 6 pollutants near the hospital during the month of admission. We conducted bivariate analyses using Spearman correlations and multivariable analyses using Poisson regression for length of stay and linear regression for log-transformed charges and costs, controlling for patient demographics, hospital characteristics, and month of admission. RESULTS: In unadjusted analyses, all 6 pollutants had minimal correlation with the 3 outcomes (ρ<0.1, P<0.001). In multivariable analyses, a 1-unit (µg/m) increase in monthly PM2.5 led to a $123 increase in charges (95% confidence interval $40-249) and a $47 increase in costs (95% confidence interval $15-93). No other pollutants were significant predictors of charges or costs or length of stay. CONCLUSION: Subchronic PM2.5 exposure is associated with increased costs for pediatric asthma hospitalizations. Policy changes to reduce outdoor subchronic pollutant exposure may lead to improved asthma outcomes and substantial savings in healthcare spending.

Global climate change and children's health: threats and strategies for prevention.

BACKGROUND: Global climate change will have multiple effects on human health. Vulnerable populations-children, the elderly, and the poor-will be disproportionately affected. OBJECTIVE: We reviewed projected impacts of climate change on children's health, the pathways involved in these effects, and prevention strategies. DATA SOURCES: We assessed primary studies, review articles, and organizational reports. DATA SYNTHESIS: Climate change is increasing the global burden of disease and in the year 2000 was responsible for > 150,000 deaths worldwide. Of this disease burden, 88% fell upon children. Documented health effects include changing ranges of vector-borne diseases such as malaria and dengue; increased diarrheal and respiratory disease; increased morbidity and mortality from extreme weather; changed exposures to toxic chemicals; worsened poverty; food and physical insecurity; and threats to human habitation. Heat-related health effects for which research is emerging include diminished school performance, increased rates of pregnancy complications, and renal effects. Stark variation in these outcomes is evident by geographic region and socioeconomic status, and these impacts will exacerbate health disparities. Prevention strategies to reduce health impacts of climate change include reduction of greenhouse gas emissions and adaptation through multiple public health interventions. CONCLUSIONS: Further quantification of the effects of climate change on children's health is needed globally and also at regional and local levels through enhanced monitoring of children's environmental health and by tracking selected indicators. Climate change preparedness strategies need to be incorporated into public health programs.