Perinatal & Pediatric
Association between Environmental Quality Index and Congenital Heart Defects in Arkansas Jenil Patel* Lydia Famuyide Famuyide Famuyide University of Arkansas for Medical Sciences
Introduction: Congenital heart defects (CHDs) occur in 1% of live births in the United States (US) and are the leading cause of death from birth defects. While prior studies have largely focused on isolated environmental exposures, fewer have examined the cumulative influence of multiple environmental domains. This study evaluated whether county-level cumulative environmental quality is associated with the prevalence of CHDs in Arkansas.
Methods: We conducted a retrospective cohort study using births occurring from 2006-2010, linking CHD cases identified through the Arkansas Reproductive Health Monitoring System to county-level Environmental Quality Index (EQI) measures. The overall EQI and five domain-specific indices (air, water, land, sociodemographic, and built environment) were categorized into quartiles. Crude and adjusted prevalence ratios (PR) and 95% Cis were estimated using Poisson regression with cluster-robust standard errors, adjusting for maternal age, smoking during pregnancy, race/ethnicity, rural-urban continuum codes, and maternal education.
Results: Overall environmental quality was not significant associated with CHD prevalence after adjustment (Adjusted PR: 0.85; 95% CI: 0.71, 1.01). No significant associations were observed for the air, land, water, built and sociodemographic domains in the adjusted models. In crude analyses, worse land domain environmental quality was associated with a lower prevalence of CHDs (Crude PR: 0.81; 95% CI: 0.68, 0.97), though this association was attenuated after adjustment.
Conclusion: County-level cumulative environmental quality, as measured by the EQI, was not independently associated with overall CHD prevalence in Arkansas after appropriate adjustment for key maternal and contextual factors. Ongoing analyses will examine associations between EQI domains and specific CHD phenotypes, which may be differentially sensitive to environmental conditions and could be obscured in analyses of CHDs as a heterogenous group.