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Background: Air pollutants may contribute to the development of Parkinson's disease (PD), but empirical evidence is limited and inconsistent. Objectives: This study aimed to prospectively investigate the associations of PD with ambient exposures to fine particulate matter with aerodynamic diameter [less than or equal to]2.5 [micro]m (P[M.sub.2.5]) and nitrogen dioxide (N[O.sub.2]). Methods: We analyzed data from 47,108 US women from the Sister Study, enrolled from 2003-2009 (35-80 years of age) and followed through 2018. Exposures of interest included address-level ambient P[M.sub.2.5] and N[O.sub.2] in 2009 and their cumulative averages from 2009 to PD diagnosis with varying lag-years. The primary outcome was PD diagnosis between 2009 and 2018 (n = 163). We used multivariable Cox proportional hazards and time-varying Cox models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: N[O.sub.2] exposure in 2009 was associated with PD risk in a dose- response manner. The HR and 95% CI were 1.22 (95% CI: 1.03, 1.46) for one interquartile [4.8 parts per billion (ppb)] increment in N[O.sub.2], adjusting for age, race and ethnicity, education, smoking status, alcohol drinking, caffeine intake, body mass index, physical activity, census region, residential area type, area deprivation index (ADI), and self-reported health status. The association was confirmed in secondary analyses with time-varying averaged cumulative exposures. For example, the multivariable adjusted HR for PD per 4.8 ppb increment in N[O.sub.2] was 1.25 (95% CI: 1.05, 1.50) in the 2-year lag analysis using cumulative average exposure. Post hoc subgroup analyses overall confirmed the association. However, statistical interaction analyses found that the positive association of N[O.sub.2] with PD risk was limited to women in urban, rural, and small town areas and women with [greater than or equal to]50th percentile ADI but not among women from suburban areas or areas with Discussion: In this nationwide cohort of US women, higher level exposure to ambient N[O.sub.2] is associated with a greater risk of PD. This finding needs to be independently confirmed and the underlying mechanisms warrant further investigation. https://doi.org/10.1289/EHP13009, Introduction Idiopathic Parkinson's disease (PD) is the second-most prevalent neurodegenerative disease in the US, primarily affecting adults 65 years of age or older. (1) Despite an increasing disease burden due [...]

Objectives: Evaluating population health initiatives at the community level necessitates valid counterfactual communities, which includes having similar population composition, health care access, and health determinants. Estimating appropriate county counterfactuals is challenging in states with large intercounty variation. We describe an application of K -means cluster analysis for determining county-level counterfactuals in an evaluation of an intervention, a county perinatal system of care for Medicaid-insured pregnant women. Methods: We described counties by using indicators from the American Community Survey, Area Health Resources Files, University of Wisconsin Population Health Institute County Health Rankings, and vital records for Michigan Medicaid-insured births for 2009, the year the intervention began (or the closest available year). We ran analyses of 1000 iterations with random starting cluster values for each of a range of number of clusters from 3 to 10 with commonly used variability and reliability measures to identify the optimal number of clusters. Results: The use of unstandardized features resulted in the grouping of 1 county with the intervention county in all solutions for all iterations and the frequent grouping of 2 additional counties with the intervention county. Standardized features led to no solution, and other distance measures gave mixed results. However, no county was ideal for all subpopulation analyses. Practice Implications: Although the K -means method was successful at identifying comparison counties, differences between the intervention county and comparison counties remained. This limitation may be specific to the intervention county and the constraints of a within-state study. This method could be more useful when applied to other counties in and outside Michigan. [ABSTRACT FROM AUTHOR]

Objectives: Investigate adverse birth outcomes in the United States (US) from 1989-2013 in relation to paternal and maternal race/ethnicity. Design: We used US natality data for singleton births to women 15-44 with information on birthweight, gestational age, and covariates (n = 90,771,339). We calculated unadjusted and adjusted probabilities of preterm birth (PTB, < 37 weeks gestation) and small for gestational age (SGA, < 10th percentile) among all combinations of maternal and paternal race/ethnicity: non-Hispanic black (NHB), non-Hispanic white (NHW), Hispanic, and Asian, and where paternal race/ethnicity was missing. Results: Missing, followed by NHB, paternal race/ethnicity had the two highest risks of PTB within each maternal racial/ethnic group. Asian, followed by NHW, paternal race/ethnicity had the two lowest risks of PTB. For SGA, however, Asian, followed by missing, paternal race/ethnicity had the two highest risks, and NHW race/ethnicity had the lowest risk. Our findings also demonstrate effect modification on the additive scale, with missing and NHB paternal race/ethnicity conferring a larger increase in risk of PTB for NHB women compared to women of other race/ethnicity groups. Conclusions: These data confirm US disparities in adverse birth outcomes by maternal and paternal race/ethnicity and argue for increased resources and interventions in response. [ABSTRACT FROM AUTHOR]