Abstract Body (Do not enter title and authors here): Introduction: The Environmental Justice Index (EJI) uses data from the U.S. Census Bureau, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention to rank the cumulative impact of environmental injustice on health for every Census tract. Cross-sectional studies in adults identify an association between cumulative environmental burden and hypertension (HTN) in adults. The aim of this study is to examine the relationship between environmental injustice exposure, using the EJI, and HTN in youth.
Hypothesis: Greater cumulative exposure to environmental toxins is significantly associated with HTN status in adolescents, adjusting for other demographic and socioeconomic factors.
Methods: Using PEDSnet (a PCORI-funded aggregate of pediatric health data) data from 2009 to 2019 and geocoded EJI, we modeled the relationship between HTN and components of the EJI, adjusted for area deprivation index (ADI; scaled 1-100) terciles (ADI < 25 = best/low, 25-52, > 52 = worst/high); where ADI of 52 represents the upper quartile ADI for the state of Delaware. The HTN status of each youth, 13 to 17 years of age, was classified into three levels: Normal: SBP ≤ 120 + DBP < 80; Elevated: SBP 120-129 + DBP < 80; and HTN: SBP ≥ 130 or DBP ≥ 80. Multinomial logistic regression was used to analyze HTN status as the outcome and EJI index components and other covariables as predictors.
Results: Among the 122,177 youth, 51% were female, 58% were non-Hispanic white, and 22% were non-Hispanic Black. Twenty-four percent lived in neighborhoods with ADI < 25, and 35% lived in neighborhoods with ADI > 52. Female sex and private/other insurance were associated with lower odds of HTN and elevated BP (ref= normal BP). Compared to ADI < 25, ADI > 52 was associated with 35% and 21% greater odds of having HTN or elevated BP, respectively. For each unit increase in the Air Toxins Respiratory Hazard Index, the odds of having HTN vs. normal BP was 2.83 times higher, and the odds of having elevated BP vs. normal BP was 1.81 times higher. For each unit increase in the Air Toxics Cancer Risk or Lead Paint Index, the odds of having HTN vs. normal BP was significantly higher (Table).
Conclusions: Environmental toxin exposure is associated with greater odds of HTN in adolescents. Analysis of HTN and environmental injustice is an important step toward reducing HTN burden, beginning in youth.