Spatial analysis of environmental and socioeconomic factors impacting maternal and infant health outcomes in North Carolina

Abstract Environmental stressors like high temperatures and pollution, often compounded by socioeconomic factors, have been linked to adverse maternal and birth outcomes. Despite this well-established link, limited studies have examined the spatial relationship between these factors to prioritize community interventions and future research needs. This study examines the spatial trends linking environmental parameters, socioeconomic factors, and adverse maternal and infant health outcomes in North Carolina from 2011 to 2019. Through exploratory spatial data analysis methods, including bivariate Local Indicators of Spatial Association (LISA) and spatial regression, clusters of environmental risks and health outcomes were identified, shedding light on the disproportionate impact of structural racism and income inequality on adverse health outcomes. In addition, this analysis highlights a significant association between hazardous pollutants, as indicated by Risk-Screening Environmental Indicator (RSEI) toxicity-weighted concentrations, and adverse health outcomes, persisting even after adjusting for racial and income segregation. In contrast, heatwaves, defined as any heatwave event across the pregnancy period, showed varied effects and little significance with birth and maternal outcomes. These findings underscore the critical need for targeted interventions addressing socioeconomic disparities and environmental health hazards to enhance maternal and infant health outcomes in North Carolina and similar regions.