Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, US.
Division of Infectious Disease Readiness and Innovation, National Center on Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop: H24-3, Atlanta, GA, 30329, US.
Matern Child Health J. 2024 Dec;28(12):2026-2036. doi: 10.1007/s10995-024-04003-4. Epub 2024 Oct 8.
Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States.
This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability.
Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5 μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed.
We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.
怀孕期间暴露于不利的环境条件下，如极端高温和空气污染，与死胎风险增加有关，死胎定义为妊娠 20 周及以后的胎儿死亡，但尚无研究探讨其与社会脆弱性的关系。我们在美国检查了县一级的死产率、死产的环境风险因素和社会脆弱性之间的关联。
这项生态研究将三个全国性数据集（国家生命统计系统）中的县一级数据与环境条件（北美陆地数据同化系统和环境保护署）以及社会脆弱性（疾病控制和预防中心/毒物和疾病登记处社会脆弱性指数）联系起来。对变量进行泊松和负二项式模型拟合，并产生比率比来估计死产率、环境风险因素和社会脆弱性之间的关联。
社会脆弱性与死产率、年平均极端高温天数和直径≤2.5 μm 的环境颗粒物浓度（PM2.5）呈正相关。臭氧和 PM2.5 各自超过监管标准的天数与死产率或社会脆弱性无关。发现平均年 PM2.5 浓度与死产率之间存在正相关；没有观察到环境风险因素与死产率之间的其他显著关联。
我们发现社会脆弱性与死产率之间以及社会脆弱性与死产的环境风险因素之间存在关联。进一步的研究可以更好地了解社会脆弱性如何影响环境暴露与死产风险之间的关系。
