vvEPA Indicators of Environmental Health Disparities: Underweight and Pre-Term Births About the Indicators of Environmental Health Disparities EPA's indicators of environmental health disparities aim to illustrate disparities in key environmental and public health conditions across race/ethnicity and socioeconomic status, as well as the relationship between these health outcomes and the work of EPA programs. This project was created in direct response to EPA's 2022-2026 Strategic Plan. These indicators are intended solely as an informational tool and are not intended to be the basis for agency decision making. EPA does not, consistent with applicable laws, distribute governmental benefits or burdens based on race, color, national origin, or sex. Background Information Preterm births are defined as a live birth before 37 weeks of gestation. Birth weight, which is impacted by the length of gestation and fetal growth, is considered low when infants weigh less than 51 bs and 8 ounces. Preterm birth and low birth weight are associated with a range of health issues for children, including breathing problems, feeding difficulties, developmental delay, hearing and vision problems, and more.1 There are many potential causes for adverse birth outcomes, including maternal health conditions and lifestyle factors.2 The role that exposure to environmental contaminants plays in adverse birth outcomes is not yet fully understood, particularly in the potential causation of preterm birth and low birth weight.3 Various exposures have been implicated as risk factors for full-term low birth weight, including maternal exposure to lead and exposure to toxic substances in air, water or food.4 Research suggests that exposure to PM2.5, carbon monoxide, and nitrogen oxides might contribute to preterm birth and low birth weight.5,6,7 Exposure to lead is also known to cause reduced fetal growth and may cause preterm birth.8 Preterm and low birth weight infants have a higher risk of health issues and mortality from childhood to adulthood.3 The EPA is leading research to better understand the relationship between exposure to environmental contaminants and adverse birth outcomes.9 1 ------- Figure 1. Low-weight Births by Race and Ethnicity Percent L i Li NCHS changes gestational period standard >¦' .J m m m m m m mm m m m .m JV Non-Hispanic Black or African American 5.3% I Non-Hispanic Asian 3.9% | Other Hispanic 2.6% I Mexican or Mexican American 2.3% | Non-Hispanic American Indian or Alaska Native 2.3% | Non-Hispanic White 2.1% 1995 2000 2005 2010 2015 2020 '22 Data Note: Beginning in 2014, NCHS changed the standard for gestational period from the Last Menstrual Period (LMP) based gestational age to the Obstetric/clinical Estimate (OE) based gestational age. Refer to Measuring Gestational Age in Vital Statistics Data: Transitioning to the Obstetric Estimate for more information. 2 ------- Figure 2. Pre-term Births by Race and Ethnicity Percent 15 9 6 3 Data Note: Beginning in 2014, NCHS changed the standard for gestational period from the Last Menstrual Period (LMP) based gestational age to the Obstetric/clinical Estimate (OE) based gestational age. Refer to Measuring Gestational Age in Vital Statistics Data: Transitioning to the Obstetric Estimate for more information. 1995 2000 2005 2010 2015 2020 '22 NCHSchanges gestational period standard | Mexican or Mexican American 8.6% | Other Hispanic 8.6% | Non-Hispanic Asian 7.9% | Non-Hispanic White 7.7% Non-Hispanic Black or African American 12.3% I Non-Hispanic American Indian or Alaska Native 11.0% 3 ------- Figure 3. Disparities in Low-weight Births by Race and Ethnicity Percent NCHSchanges gestational period standard Non-Hispanic Black or African American 5.3% | Overall average* 2.8% All other races and ethnicities 1995 2000 2005 2010 2015 2020 '22 Data Note: Beginning in 2014, NCHS changed the standard for gestational period from the Last Menstrual Period (LMP) based gestational age to the Obstetric/clinical Estimate (OE) based gestational age. Refer to Measuring Gestational Age in Vital Statistics Data: Transitioning to the Obstetric Estimate for more information. The "overall average" line includes other racial and ethnic groups not shown in the other charts. 4 ------- Figure 4. Disparities iri Pre-term Births by Race and Ethnicity Percent 18 NCHS changes gestational period standard Non-Hispanic Black or African American 12.3% | Overall average* 8.6% All other races and ethnicities 1995 2000 2005 2010 2015 2020 '22 Data Note: Beginning in 2014, NCHS changed the standard for gestational period from the Last Menstrual Period (LMP) based gestational age to the Obstetric/clinical Estimate (OE) based gestational age. Refer to Measuring Gestational Age in Vital Statistics Data: Transitioning to the Obstetric Estimate for more information. The "overall average" line includes other racial and ethnic groups not shown in the other charts. 5 ------- What these charts show These charts show the percent of full-term births in the United States that are low weight and the percent of births in the United States that are pre-term from 1995 to 2022. • In 2022, the total percentage of full-term births that were low weight across all populations was 2.8% (Figure 3). This number varied distinctly between racial and ethnic populations, however, with Non-Hispanic Black or African Americans experiencing the highest levels of low birth weight during the entirety of this period. • In 2022, the percent of full-term births that were low weight in non-Hispanic Black or African Americans reached its apex of 5.3% during this time period (Figure 1). This was followed by non- Hispanic Asians (3.9%), other Hispanic (2.6%), Mexican or Mexican Americans (2.3%), non- Hispanic American Indian or Alaska Natives (2.3%), and non-Hispanic whites (2.1%) (Figure 1). • Between 1995 to 2014, the percent of full-term births in the U.S. that were low weight remained relatively stable, before realigning downward to a new baseline in 2014 as a result of the change in the standard for determining gestational age (described below). Since 2014, these percentages have been increasing (Figure 1). • In 2022, the total percent of births that were pre-term were 8.6% (Figure 4). This number varied by race and ethnicity, with the highest rates experienced by the non-Hispanic Black population, which had a pre-term birth percentage of 12.3% in 2022 (Figure 2). Other percentages of pre- term births for different racial and ethnic groups include non-Hispanic American Indian or Alaska Native at 11.0%, Mexican or Mexican American at 8.6%, other Hispanic at 8.6%, non-Hispanic Asian at 7.9%, and non-Hispanic white at 7.7% (Figure 2). These charts make note of a change to the National Center for Health Statistics (NCHS) standard for determining gestational age. Prior to 2014 gestational age was measured based on maternal reporting of the Last Menstrual Period (LMP). Since 2014, the new more accurate Obstetric Estimate (OE) has been used for reporting. This data was reported to the National Vital Statistics System (NVSS). The NVSS compilation of this data is the result of the cooperation between the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS) and 57 vital registration jurisdictions (50 states, New York City, the District of Columbia, and five territories) to provide access to statistical information from birth certificates.10 What these charts do not show These charts do not demonstrate why there are higher rates of adverse birth outcomes for certain racial and ethnic groups. While analyzing the number of cases by racial and ethnic groups is useful for determining those who may be most vulnerable and impacted by adverse birth outcomes, these graphs do not suggest that race and ethnicity themselves cause these outcomes. Factors include maternal cigarette smoking, maternal alcohol and drug use, maternal weight at conception, pregnancy-induced hypertension and pre-eclampsia, being the first-born, congenital anomalies, and other genetic factors.5 While differences in socioeconomic status and other risk factors are known to impact birth outcomes, studies that have controlled for these variables still find differences between white women and women of color.1115 Relevant EPA Activities Offices across the EPA are engaged in activities to reduce exposure to environmental contaminants in utero and early in life, including the following: 6 ------- • Regulating criteria air pollutants and their precursors: Under the Clean Air Act, the EPA sets the National Ambient Air Quality Standards (NAAQS) for criteria air pollutants and works with state and local air quality management agencies to meet those standards. In 2024, the EPA strengthened the NAAQS for particulate matter below 2.5 micrometers in diameter (PM2.5) from 12.0 to 9.0 micrograms per cubic meter as the primary annual standard, continuing to protect Americans from harmful levels of pollution. The EPA also sets, reviews, and implements standards for lead pollution. For further information about the enforcement of these regulations, see EPA's webpage on Air Enforcement. • Reducing lead exposure: Offices across EPA are engaged in activities to reduce lead exposure. In October 2024, EPA announced the finalized improvements to the Lead and Copper Rule to better protect communities from lead in drinking water. The proposed rule would require the vast majority of water systems to replace lead service lines in the U.S. within 10 years. EPA is also investing $15 billion through the Bipartisan Infrastructure Law to identify and replace lead service lines around the nation. The Bipartisan Infrastructure Law also dedicates $11.7 billion to projects that improve drinking water quality, including reducing lead in drinking water. To address lead in air pollution, EPA is now working on proposing and promoting regulatory standards to address lead emissions from aircraft engines under the Clean Air Act. The EPA also released the Environmental Justice Toolkit for Lead Paint Enforcement Programs to help address toxic lead exposure in communities, especially those with high levels of lead pollution. Finally, EPA is taking steps to improve both Superfund and Brownfields sites to reduce lead exposure at contaminated properties. For further information on indicators related to environmental and human health, explore EPA's Report on the Environment, and for further information on indicators related to children's environmental health, explore EPA's America's Children and the Environment (ACE) report. 7 ------- References 1) CDC. Preterm Birth. Last updated May 15, 2024. Accessed November 4, 2024. Preterm Birth I Maternal Infant Health I CDC 2) CDC. National Environmental Public Health Tracking: Reproductive and birth outcomes. Last updated October 26, 2016. Accessed June 22, 2024. https://ephtracking.cdc.gov/showRbPrematureBirthEnv.action. 3) U.S. EPA. Health - Adverse Birth Outcomes. Published October 9, 2023. Accessed June 10, 2024. https://www.epa.gov/americaschildrenenvironment/health-adverse-birth-outcomes 4) NCHS. 2019. National Vital Statistics System improvements fact sheet. March 2019. https://www.cdc.gov/nchs/data/factsheets/factsheet-nvss-improvements-H.pdf (PDF). 5) U.S. EPA. Integrated Science Assessment for Particulate Matter. Published March 7, 2017. Accessed June 27, 2024. Integrated Science Assessment (ISA) for Particulate Matter (Final Report. Dec 2019) I Integrated Science Assessments I Environmental Assessment I US EPA 6) U.S. EPA. Integrated Science Assessment for Oxides of Nitrogen. Published January 2016. Accessed June 27, 2024. Integrated Science Assessment (ISA) for Oxides of Nitrogen - Health Criteria (Final Report. Jan 2016) I Integrated Science Assessments I Environmental Assessment I US EPA 7) U.S. EPA. Integrated Science Assessment for Carbon Monoxide. Published January 2010. Accessed June 27, 2024. Integrated Science Assessment (ISA) for Carbon Monoxide (Final Report. Jan 2010) I Integrated Science Assessments I Environmental Assessment I US EPA 8) U.S. EPA. Integrated Science Assessment for Lead. Published January 2024. Accessed November 27, 2024. Integrated Science Assessment (ISA) for Lead (Final Report) I Integrated Science Assessments I Environmental Assessment I US EPA 9) U.S EPA. Children's Health Research regarding Pre-term Birth, Low Birth Weight, Birth Defects and Infant Mortality. Published July 18, 2023. Accessed June 10, 2024. https://www.epa.gov/children/childrens-health-research-regarding-pre-term-birth-low-birth- weight-birth-defects-and. 10) NCHS. 2019. National Vital Statistics System improvements fact sheet. March 2019. https://www.cdc.gov/nchs/data/factsheets/factsheet-nvss-improvements-H.pdf (PDF). 11) CDC. Preterm Birth. Last updated May 15, 2024. Accessed November 4, 2024. Preterm Birth I Maternal Infant Health I CDC 12) Johnson, J. D., Green, C. A., Vladutiu, C. J., & Manuck, T. A. (2020). Racial disparities in prematurity persist among women of high socioeconomic status. American Journal of Obstetrics & Gynecology MFM, 2(3), 100104. https://doi.Org/10.1016/j.ajogmf.2020.100104 13) Burris, H. H., & Hacker, M. R. (2017). Birth outcome racial disparities: A result of intersecting social and environmental factors. Seminars in Perinatology, 41(6), 360-366. https://doi.Org/10.1053/j.semperi.2017.07.002 14) Almeida, J., Becares, L., Erbetta, K., Bettegowda, V. R., & Ahluwalia, I. B. (2018). Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress. Maternal and Child Health Journal, 22(8), 1154-1163. https://doi.org/10.1007/sl0995-018-2500-7 15) Fishman, S. H., Hummer, R. A., Sierra, G., Hargrove, T., Powers, D. A., & Rogers, R. G. (2020). Race/ethnicity, maternal educational attainment, and infant mortality in the United States. Biodemography and Social Biology, 66(1), 1-26. https://doi.org/10.1080/19485565.2020.1793659 United States Environmental Protection Agency EPA 231R24004 1200 Pennsylvania Avenue, NW December 2024 Washington, DC 20460 www.epa.gov 8 ------- |