Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018

IntroductionExposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States.MethodsThis ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability.ResultsSocial vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter <= 2.5 mu m in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed.DiscussionWe found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk. We are not aware of any nationwide studies in the United States that have assessed the relationship between stillbirth rates and social vulnerability. Our findings contribute to the understanding of the complex interplay between social vulnerability, environmental exposures, and adverse birth outcomes. The results of our study have important implications for public health interventions and policy decisions aimed at reducing stillbirth rates in communities with higher social vulnerability.