Background: Cleft lip with or without cleft palate (CL$1P) is one of the most serious birth defects, occurring in about 1 per 1,000 deliveries. While air pollution and neighborhood socioeconomic position (SEP) are believed to be associated with CL±P, to our knowledge, there have been no assessments of CL±P and "neighborhood environment," which takes into account both place-based measures of air pollution and SEP. Aim: Determine the association between neighborhood environment and CL±P. Methods: Data on 2,555 cases of CL±P and 14,735 controls delivered between 1999 and 2008 were obtained from the Texas Birth Defects Registry. Neighborhood environment was based on maternal census tract at delivery. Census tract-level estimates of ambient levels of lead, diesel particulate matter, and trichloroethylene were obtained from the United States (US) Environmental Protection Agency 1999 National-Scale Air Toxics Assessment. Neighborhood SEP variables drawn from the US Census 2000 included information on poverty, occupation, and education. Principal components analysis was used to create a composite neighborhood environment score (NES), which was categorized into quartiles representing low, medium-low, medium-high, and high exposure to adverse neighborhood environment. Mixed-effects logistic regression was used to evaluate the association between neighborhood environment and CL+P while adjusting for relevant individual-level covariates including maternal age, smoking, race/ethnicity, and education. Results: Mothers with CL±P-affected offspring were more likely to live in high NES (adverse) areas compared to mothers with unaffected offspring (odds ratio=1.16, 95% confidence interval: 1.02-1.32). There was a statistically significant trend with increasing exposure category (p=0.03). Conclusions: Using data from one of the world's largest active birth defects surveillance systems, we found that adverse neighborhood environment is modestly associated with CL±P.
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