Extreme heat and its association with social disparities in the risk of spontaneous preterm birth
Lara Cushing, Rachel Morello‐Frosch, Alan Hubbard
Abstract
Abstract Background Climate change is increasing the frequency and intensity of heatwaves. Prior studies associate high temperature with preterm birth. Objectives We tested the hypotheses that acute exposure to extreme heat was associated with higher risk of live spontaneous preterm birth (≥20 and <37 completed weeks), and that risks were higher among people of colour and neighbourhoods with heat‐trapping landcover or concentrated racialised economic disadvantage. Methods We conducted a retrospective cohort study of people giving birth between 2007 and 2011 in Harris County, Texas (Houston metropolitan area) ( n = 198,013). Exposures were daily ambient apparent temperature (AT max in 5°C increments) and dry‐bulb temperatures (T max and T min >historical [1971–2000] summertime 99 th percentile) up to a week prior for each day of pregnancy. Survival analysis controlled for individual‐level risk factors, secular and seasonal trends. We considered race/ethnicity, heat‐trapping neighbourhood landcover and Index of Concentration at the Extremes as effect modifiers. Results The frequency of preterm birth was 10.3%. A quarter (26.8%) of people were exposed to AT max ≥40°C, and 22.8% were exposed to T max and T min >99 th percentile while at risk. The preterm birth rate among the exposed was 8.9%. In multivariable models, the risk of preterm birth was 15% higher following extremely hot days (hazard ratio [HR] 1.15 (95% confidence interval [CI] 1.01, 1.30) for AT max ≥40°C vs. <20°C; HR 1.15 (95% CI 1.02, 1.28) for T max and T min >99 th percentile). Censoring at earlier gestational ages suggested stronger associations earlier in pregnancy. The risk difference associated with extreme heat was higher in neighbourhoods of concentrated racialised economic disadvantage. Conclusions Ambient heat was associated with spontaneous preterm birth, with stronger associations earlier in pregnancy and in racially and economically disadvantaged neighbourhoods, suggesting climate change may worsen existing social inequities in preterm birth rates.