Rural populations are exposed to a variety of environmental risks from point and non-point pollution sources. Our preliminary analysis in Year 1 found significant associations between air and water pollution discharge sources and population mortality rates in rural areas. However, an analysis of the number of Toxics Release Inventory (TRI) sites showed no association to mortality. This may be due to the imprecision of the measure - we counted TRI sites but did not investigate the volume or type of chemical release. Some TRI sites report zero releases.

Project Goals: The current project will conduct two mini-studies to examine discharges in more detail by refining the TRI exposure measure and investigating variability in exposure across population subgroups; the first study will focus on mortality rates and the second on low-birth weight and preterm delivery rates.

Methods: The study will utilize and supplement the previously developed environmental hazards inventory from Year 1 to conduct a county-level analysis of mortality rates and birth outcomes in association with TRI sites. We have already linked existing county-level databases to assess potential pollution sources and corresponding health outcomes, with particular attention to rural settings but including analyses for both urban and rural locations. Data were drawn from the Environmental Protection Agency, Department of Agriculture, National Land Cover Dataset, Energy Information Administration, Centers for Disease Control and Prevention (CDC), US Census, and other sources. We will refine this dataset with additional mortality rates specific to race and ethnic minority groups, and will continue to update other data sources as data become available. We will also incorporate natality data from the CDC on low birth weight and preterm births. Analysis will include calculation of descriptive and inferential statistics. We will examine the statistical associations between population health outcomes and TRI pollution sources separately in rural and urban counties. This will be done using Poisson regression models (for mortality rates) or ordinary least squares models (for birth outcomes) that adjust for population characteristics. Subgroup analyses will be conducted for race/ethnic minority populations and for counties stratified by socioeconomic indicators, comparing rural to urban locations. Anticipated publications or products: The study will result in at least one final report and one policy brief to HRSA, and at least one academic peer reviewed publication. We may also present the findings of this study at a national conference relevant to rural and/or environmental health.

Publications

• Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States
  Policy Brief
  West Virginia Rural Health Research Center
  Date: 02/2010
  Rural counties contain more than 65,000 EPA-recognized point pollution sources. A greater density of water and air pollution sources in rural counties is associated with higher cancer mortality rates, adjusting for other risks. Rural areas also experience mortality risks in association with coal mining activity.
• Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States (Final Report)
  West Virginia Rural Health Research Center
  Date: 02/2010
  Rural counties contain more than 65,000 EPA-recognized point pollution sources. A greater density of water and air pollution sources in rural counties is associated with higher cancer mortality rates, adjusting for other risks. Rural areas also experience mortality risks in association with coal mining activity.
• Toxics Release Inventory Discharges and Population Health Outcomes in Rural and Urban Areas of the United States
  Policy Brief
  West Virginia Rural Health Research Center
  Date: 2010
  

  Examined whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program were associated with population mortality rates for both rural and urban populations.

• Toxics Release Inventory Discharges and Population Health Outcomes in Rural and Urban Areas of the United States (Final Report)
  West Virginia Rural Health Research Center
  Date: 08/2010
  This report examined if chemical releases from facilities monitored in the Toxics Release Inventory (TRI) program were associated with population mortality rates and birth outcomes for rural/urban populations. It also examined whether rural/urban areas with poor socioeconomic status or higher percentages of minorities had greater TRI releases.