Spatiotemporal analysis of adverse birth outcomes in Central Appalachia

项目摘要 在阿巴拉契亚中部（包括西弗吉尼亚州、肯塔基州、田纳西州的部分地区），存在着显著且日益扩大的健康差距 和弗吉尼亚州）与美国其他地区相比，但针对导致这些问题的环境因素的研究 缺乏健康差异。阿巴拉契亚中部提供了一个独特的机会， 与资源开采相关的风险。大型露天煤矿的煤炭生产占主导地位 在20世纪90年代至21世纪初的资源开采方法，现在正在减少其他资源开采方法 增加我们假设中环空气及水污染所引致的健康风险会增加， 阿巴拉契亚居民生活在靠近活跃的地表地雷。这里提出的研究 扩展了我们在阿巴拉契亚社区的初步工作，评估对健康风险和水的看法 质量，填补了文献中的关键数据空白，超越了县级生态研究， 暴露与健康结果。我们建议：1）时空特征的流域和流域 与1990年至2015年之间的地表采矿相关的边界，以及2）确定 不利的生育结果和怀孕期间生活在活跃的地表地雷边界内。使用自然 实验设计，我们将建立一个回顾性的纵向队列怀孕导致活产 1990年至2015年期间，在空气和流域边界内外的地面地雷数量， 地理编码的出生记录。我们提出了创新的方法来定义精细的空间（30米）和时间（每月） 通过结合卫星衍生数据集来估计土地利用， 变化，航空运输建模和流域划定。在露天采矿的大气区和流域内， 个别怀孕将被分类为发生前，期间，或后活跃的表面采矿。使用 扩展的差异的差异的方法，所提出的研究将提高推理和精度 通过减少与未测量的混杂因素和不利因素的长期趋势相关的偏倚， 出生结果。拟议的研究将有助于确定健康差异的因果基础， 阿巴拉契亚中部社区，最终导致研究，政策和实践的改进， 可以推广到阿巴拉契亚中部以外的其他地区，在那里露天采矿是普遍的。

PROJECT SUMMARY Significant and increasing health disparities exist in Central Appalachia (encompassing parts of WV, KY, TN and VA) compared to other U.S. regions, yet research addressing environmental factors contributing to these health disparities is lacking. Central Appalachia offers a unique opportunity to examine environmental exposures associated with resource extraction. Coal production from large surface mines was the dominant resource extraction method in the 1990s-2000s and is now decreasing as other resource extraction methods increase. We hypothesize that health risks associated with air and water pollution are increased in Central Appalachian residents living within close proximity to active surface mines. The research proposed here extends our preliminary work in Appalachian communities assessing perceptions of health risks and water quality and fills a critical data gap in the literature, moving beyond county-level ecological studies to link exposure with health outcomes. We propose to: 1) spatiotemporally characterize airshed and watershed boundaries associated with surface mining between 1990 and 2015, and 2) determine associations between adverse birth outcomes and living within active surface mine boundaries during pregnancy. Using a natural experiment design, we will build a retrospective longitudinal cohort of pregnancies resulting in live births between 1990 and 2015 within and outside of air and watershed boundaries of surface mines based on geocoded birth records. We propose innovative methods for defining fine spatial (30m) and temporal (monthly) resolution air and watershed exposure boundaries by combining satellite derived datasets to estimate land use change, air transport modeling, and watershed delineation. Within surface mining airsheds and watersheds, individual pregnancies will be categorized as occurring pre-, during, or post- active surface mining. Using an extension of a difference in differences approach, the proposed research will improve inference and precision in effect estimates by reducing bias associated with unmeasured confounding and secular trends in adverse birth outcomes. The proposed research will aid in defining the causal underpinnings of health disparities in Central Appalachian communities, ultimately leading to research, policy and practice improvements that may be generalizable to other areas beyond Central Appalachia where surface mining is prevalent.