Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

BACKGROUND: Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. METHODS: Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. RESULTS: Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. CONCLUSIONS: Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

Reduced Urban Heat Island intensity under warmer conditions.

The Urban Heat Island (UHI), the tendency for urban areas to be hotter than rural regions, represents a significant health concern in summer as urban populations are exposed to elevated temperatures. A number of studies suggest that the UHI increases during warmer conditions, however there has been no investigation of this for a large ensemble of cities. Here we compare urban and rural temperatures in 54 US cities for 2000-2015 and show that the intensity of the urban heat island, measured here as the differences in daily-minimum or daily-maximum temperatures between urban and rural stations or ΔT, in fact tends to decrease with increasing temperature in most cities (38/54). This holds when investigating daily variability, heat extremes, and variability across climate zones and is primarily driven by changes in rural areas. We relate this change to large-scale or synoptic weather conditions, and find that the lowest ΔT nights occur during moist weather conditions. We also find that warming cities have not experienced an increasing urban heat island effect.

Temperature and heat in informal settlements in Nairobi.

Nairobi, Kenya exhibits a wide variety of micro-climates and heterogeneous surfaces. Paved roads and high-rise buildings interspersed with low vegetation typify the central business district, while large neighborhoods of informal settlements or "slums" are characterized by dense, tin housing, little vegetation, and limited access to public utilities and services. To investigate how heat varies within Nairobi, we deployed a high density observation network in 2015/2016 to examine summertime temperature and humidity. We show how temperature, humidity and heat index differ in several informal settlements, including in Kibera, the largest slum neighborhood in Africa, and find that temperature and a thermal comfort index known colloquially as the heat index regularly exceed measurements at the Dagoretti observation station by several degrees Celsius. These temperatures are within the range of temperatures previously associated with mortality increases of several percent in youth and elderly populations in informal settlements. We relate these changes to surface properties such as satellite-derived albedo, vegetation indices, and elevation.