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Austin A.,Injury Epidemiology and Surveillance Unit | Herrick H.,State Center for Health Statistics | Proescholdbell S.,Injury Epidemiology and Surveillance Unit
American Journal of Public Health

Objectives. We explored the association of sexual orientation with poor adult health outcomes before and after adjustment for exposure to adverse childhood experiences (ACEs). Methods. Data were from the 2012 North Carolina, 2011 Washington, and 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding health risks, perceived poor health, and chronic conditions by sexual orientation and 8 categories of ACEs. There were 711 lesbian, gay, and bisexual (LGB) respondents and 29 690 heterosexual respondents. Results. LGB individuals had a higher prevalence of all ACEs than heterosexuals, with odds ratios ranging from 1.4 to 3.1. After adjustment for cumulative exposure to ACEs, sexual orientation was no longer associated with poor physical health, current smoking, and binge drinking. Associations with poor mental health, activity limitation, HIV risk behaviors, current asthma, depression, and disability remained, but were attenuated. Conclusions. The higher prevalence of ACEs among LGB individuals may account for some of their excess risk for poor adult health outcomes. Source

Root E.D.,University of Colorado at Boulder | Meyer R.E.,State Center for Health Statistics | Meyer R.E.,University of North Carolina at Chapel Hill | Emch M.,University of North Carolina at Chapel Hill
Social Science and Medicine

This study examines associations between area-level socioeconomic factors and the birth defect gastroschisis in order to further our understanding of the etiology of this condition. Specifically, this study explores how measuring socioeconomic conditions at different geographic scales affect the results of statistical models. A population-based case-control study of resident live births was conducted using data from the North Carolina Birth Defect Monitoring Program and the North Carolina composite linked birth files from 1998 through 2004. Neighborhood conditions potentially related to gastroschisis (poverty, unemployment, education, and racial composition) were measured using Census 2000 data and aggregated to several geographic scales. The Brown-Forsythe test of homogeneity of variance was used to select the neighborhood size by examining the effect of neighborhood size on variation in gastroschisis rates. To examine our assumptions about neighborhood size and neighborhood effects on gastroschisis, we estimated a series of logistic regression and multilevel logistic regression models. The Brown-Forsythe test suggested an optimal neighborhood size with a circular radius of approximately 2500 m, which was supported by the statistical analysis. Results indicate a weak association between living in a neighborhood characterized by high poverty and unemployment and an elevated risk of a gastroschisis-affected pregnancy after adjusting for individual-level risk factors. Cross-level interactions indicate that women in low poverty neighborhoods who do not rely on Medicaid have a significantly lower risk of gastroschisis. The choice of neighborhood scale influences model results suggesting that socioeconomic processes may influence health outcomes variably at different scales. © 2010 Elsevier Ltd. Source

Vinikoor-Imler L.C.,U.S. Environmental Protection Agency | Davis J.A.,U.S. Environmental Protection Agency | Meyer R.E.,State Center for Health Statistics | Luben T.J.,U.S. Environmental Protection Agency
Birth Defects Research Part A - Clinical and Molecular Teratology

BACKGROUND: Few studies have examined the potential relationship between air pollution and birth defects. The objective of this study was to investigate whether maternal exposure to particulate matter (PM2.5) and ozone (O3) during pregnancy is associated with birth defects among women living throughout North Carolina. METHODS: Information on maternal and infant characteristics was obtained from North Carolina birth certificates and health service data (2003-2005) and linked with information on birth defects from the North Carolina Birth Defects Monitoring Program. The 24-hr PM2.5 and O3 concentrations were estimated using a hierarchical Bayesian model of air pollution generated by combining modeled air pollution predictions from the U.S. Environmental Protection Agency's Community Multi-Scale Air Quality model with air monitor data from the Environmental Protection Agency's Air Quality System. Maternal residence was geocoded and assigned pollutant concentrations averaged over weeks 3 to 8 of gestation. Binomial regression was performed and adjusted for potential confounders. RESULTS: No association was observed between either PM2.5 or O3 concentrations and most birth defects. Positive effect estimates were observed between air pollution and microtia/anotia and lower limb deficiency defects, but the 95% confidence intervals were wide and included the null. CONCLUSION: Overall, this study suggested a possible relationship between air pollution concentration during early pregnancy and certain birth defects (e.g., microtia/anotia, lower limb deficiency defects), although this study did not have the power to detect such an association. The risk for most birth defects does not appear to be affected by ambient air pollution. © 2013 Wiley Periodicals, Inc. Source

Buescher P.A.,State Center for Health Statistics
North Carolina medical journal

Health disparities for many diseases are large and long-standing in North Carolina and the nation. This study examines medical care costs for diabetes associated with health disparities among adults (age, > or =78 years) enrolled in Medicaid in North Carolina during state fiscal year (SFY) 2007-2008 (i.e., July 7, 2007, through June 30, 2008). North Carolina Medicaid paid claims and enrollment data were used to calculate the prevalence of and medical care expenditures for diabetes among adult Medicaid enrollees overall and by white, African American, and American Indian race. The impacts of racial and economic health disparities on medical care costs for diabetes were determined by first calculating the proportionate differences between the diabetes prevalence for whites, African Americans, and American Indians enrolled in Medicaid and the diabetes prevalence among all whites in North Carolina. Then it was assumed that medical care costs for white, African American, and American Indian Medicaid recipients could be reduced by the same proportion if the overall prevalence among whites was achieved. The diabetes prevalence among adult Medicaid enrollees was 75.7%, compared with 9.1% for all North Carolina adults. During SFY 2007-2008, the state Medicaid program in North Carolina spent $525 million for diabetes-related medical care and prescription drugs among adults. An estimated $225 million in diabetes-related expenditures could be saved each year by the North Carolina Medicaid program if both racial and economic disparities in the diabetes prevalence were eliminated. We did not have data on non-Medicaid paid health care expenditures for the Medicaid enrollees in our study. The costs of interventions to eliminate health disparities associated with diabetes are not included in the calculation of the potential savings. The diabetes prevalence in the Medicaid population is much greater than that for all North Carolinians, and the Medicaid costs associated with this elevated prevalence are large. North Carolina health-policy makers and health-program managers should carefully evaluate investments in interventions to reduce these race- and economic-based differences in diabetes prevalence, which could potentially reduce Medicaid costs. Source

Vinikoor-Imler L.C.,U.S. Environmental Protection Agency | Davis J.A.,U.S. Environmental Protection Agency | Meyer R.E.,State Center for Health Statistics | Messer L.C.,Portland State University | Luben T.J.,U.S. Environmental Protection Agency
Environmental Research

A range of health effects, including adverse pregnancy outcomes, have been associated with exposure to ambient concentrations of particulate matter (PM) and ozone (O3). The objective of this study was to determine whether maternal exposure to fine particulate matter (PM2.5) and O3 during pregnancy is associated with the risk of term low birthweight and small for gestational age infants in both single and co-pollutant models. Term low birthweight and small for gestational age were determined using all birth certificates from North Carolina from 2003 to 2005. Ambient air concentrations of PM2.5 and O3 were predicted using a hierarchical Bayesian model of air pollution that combined modeled air pollution estimates from the EPA[U+05F3]s Community Multi-Scale Air Quality (CMAQ) model with air monitor data measured by the EPA[U+05F3]s Air Quality System. Binomial regression, adjusted for multiple potential confounders, was performed. In adjusted single-pollutant models for the third trimester, O3 concentration was positively associated with small for gestational age and term low birthweight births [risk ratios for an interquartile range increase in O3: 1.16 (95% CI 1.11, 1.22) for small for gestational age and 2.03 (95% CI 1.80, 2.30) for term low birthweight]; however, inverse or null associations were observed for PM2.5 [risk ratios for an interquartile range increase in PM2.5: 0.97 (95% CI 0.95, 0.99) for small for gestational age and 1.01 (95% CI 0.97, 1.06) for term low birthweight]. Findings were similar in co-pollutant models and linear models of birthweight. These results suggest that O3 concentrations in both urban and rural areas may be associated with an increased risk of term low birthweight and small for gestational age births. © 2014. Source

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