Mercedes A. Bravo

Segregation measures over time likely mask the movement of Latinos into predominantly non-Hispanic Black (NHB) areas. Due to systematic disinvestment, the co-location of NHB and Latinos may correlate with environmental and social stressors. We construct a combined racial isolation (RI) measure for Blacks and Latinos for the 72 246 contiguous U.S. census tracts. We compare trends (1990-2015) in RI of NHB individuals and RI of NHB and Hispanic individuals (RI-NHB + H). We estimate correlations between RI-NHB + H and CDC Environmental Justice Index (EJI) components. We assess associations between EJI, RI-NHB + H, and birthweight percentiles using North Carolina detailed birth records (n = 504 363; 2015-2019). Between 1990-2015, RI-NHB + H and RI-NHB increased in most (88.7%) and the majority (69.1%) of U.S. census tracts, respectively. The largest local, spatial correlations between RI-NHB + H and EJI occurred in the southeast, southwest, and parts of the west coast, where both are high. For NHB and NHW mothers, the association between EJI and birthweight percentiles was increasingly negative at higher levels of RI-NHB + H. Among Hispanic mothers, the association was negative at mid RI levels, but not at high RI levels. Our results underscore the changing nature of segregation in the U.S. and illuminate cumulative impacts experienced by NHB and Latino populations on reproductive health.

Fluoride is increasingly discussed as a geogenic risk factor for chronic kidney disease of uncertain etiology (CKDu); an epidemic of kidney disease is affecting hot tropical farming communities worldwide. Emerging evidence continues to support the association between high-fluoride exposure and kidney injury, particularly in regions with high fluoride levels. However, while fluoride’s geogenic nature leads to prolonged exposure through water and food sources, the direct impact on kidney health remains incompletely understood. This review explores the relationship between fluoride exposure and adverse kidney health outcomes, especially in the context of CKDu, synthesizing findings from epidemiological studies conducted worldwide. While a broad range of studies show widespread dental fluorosis prevalence in regions with high environmental fluoride levels in Sri Lanka, India, China, and Mexico, such correlation was not evident for CKDu and environmental fluoride levels. Notably, the spatial distribution patterns of CKDu and exposure risk through high fluoride levels in drinking water exhibit some inconsistencies, suggesting fluoride alone may not be the sole driver of CKDu. This review underscores the kidney health risks of fluoride exposure while emphasizing the need for further studies that consider multiple interacting factors beyond fluoride exposure in examination of environmental triggers of CKDu.

Background Studies show associations between air pollution exposure and coronavirus 2019 (COVID19) hospitalizations, but have not substantially explored regional differences. In this study, we estimate associations between shorter-term exposure to fine particulate matter (PM_2.5) and hospitalization among individuals with SARS-CoV-2 infection. Methods This study utilized data from 72,385 patients (78,504 hospitalizations) with a hospital-confirmed SARS-CoV-2 infection between January 1, 2020 and December 31, 2020. Daily PM_2.5 concentrations from ground-based monitors were averaged to generate 2, 5, and 21-day average exposures prior to hospitalization. We used a time-stratified case-crossover approach to estimate associations between PM_2.5 and COVID19-related hospitalizations in 57 Core Based Statistical Areas (CBSAs) across the United States (US). We subsequently conducted nationwide and region-specific random effects meta-analysis. Results In the random effects meta-analysis, a 1 µg/m³ increase in 2, 5, and 21-day average PM_2.5 are associated with a 0.61% (95% Confidence Interval [CI] = 0.12, 1.11); 0.91% (CI = 0.15, 1.67); and 0.04% (CI = −2.70, 2.85) increase in COVID19-related hospitalization risk, respectively. We observe substantial heterogeneity in the associations by region with the largest adverse associations in the South. Conclusions Higher concentrations of PM_2.5 are associated with higher risk of COVID19-related hospitalizations. Given the geographic heterogeneity observed, studies exploring factors, such as PM_2.5 exposure, that could explain differences in COVID19 risks may help to understand the COVID19 pandemic and aid in preparing for future ones.

Residential instability and neighborhood conditions may shape children’s health and development, but it is unclear whether all residential moves are equally destabilizing, and the extent to which moving to neighborhoods with different conditions can improve children’s outcomes. Most studies estimating causal effects of these factors on children’s health or development use smaller, geographically constrained, urban cohorts. In a racially/ethnically and socioeconomically diverse statewide cohort including urban and rural communities, we investigate effects of residential instability, neighborhood deprivation, and their intersection on childhood educational outcomes. We construct a statewide dataset that links North Carolina birth records (2002–2005) with lead testing data (2003–2015) and 4th grade standardized test scores (2013–2016). A composite census tract-level neighborhood deprivation index (NDI) is linked with individuals based on residence at birth, lead testing, and 4th grade. Outcomes of interest are 4th grade test scores in reading and mathematics. We use multinomial propensity scores to estimate effects of residential instability and neighborhood deprivation on test scores. Children who moved between only high deprivation neighborhoods had lower reading test scores (-0.29 [95% CI: -0.59, -0.015]) compared to children who resided in high deprivation neighborhoods but did not move. Children who resided in a high deprivation neighborhood at birth and subsequently moved to a low deprivation neighborhood(s) had higher test scores compared to those who moved between only high deprivation neighborhoods (1.59 [0.90, 2.28]). Additionally, children who move from high to low deprivation neighborhoods earlier had larger improvements. Being residentially stable, even while residing in a high deprivation neighborhood, is associated with improved educational outcomes. However, there is also a larger positive effect of moving from high to low deprivation neighborhoods. Our findings have important implications, particularly given the increasing segregation of neighborhoods by socioeconomic status and the housing affordability crisis in the United States. Partnerships between housing programs, early childhood education and services, and health care providers, which address evictions and broader issues, may help address health inequalities rooted in childhood exposures and experiences.

There is a profound need to identify modifiable risk factors to screen and prevent pancreatic cancer. Air pollution, including fine particulate matter (PM_2.5), is increasingly recognized as a risk factor for cancer. We conducted a case-control study using data from the electronic health record (EHR) of Duke University Health System, 15-year residential history, NASA satellite fine particulate matter (PM_2.5) and neighborhood socioeconomic data. Using deterministic and probabilistic linkage algorithms, we linked residential history and EHR data to quantify long term PM_2.5 exposure. Logistic regression models quantified the association between a one interquartile range (IQR) increase in PM_2.5 concentration and pancreatic cancer risk. The study included 203 cases and 5027 controls (median age of 59 years, 62% female, 26% Black). Individuals with pancreatic cancer had higher average annual exposure (9.4 μg/m³) as compared to IQR increase in average annual PM_2.5 was associated with greater odds of pancreatic cancer (OR=1.20; 95% CI: 1.00-1.44). These findings highlight the link between elevated PM_2.5 exposure and increased pancreatic cancer risk. They may inform screening strategies for high-risk populations and guide air pollution policies to mitigate exposure.