{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:30:52Z","timestamp":1789500652093,"version":"build-2803163510"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T00:00:00Z","timestamp":1624233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,24]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Geographic differences in eosinophilic esophagitis (EoE) prevalence suggest the possibility that environmental exposures contribute to EoE pathogenesis. We aimed to examine the association between environmental quality and risk of EoE, using the Environmental Quality Index (EQI), which provides quantification of environmental quality in five domains: air, land, water, built, and sociodemographic for all counties in the United States. To do this, we performed a case\u2013control study in a large pathology database. EoE cases were defined by \u226515 eosinophils per high-power field with other pathologic diagnoses excluded; controls did not have EoE. The pathology data were geocoded and linked with the EQI by county of residence. Logistic regression was used to estimate odds ratio (OR and 95% confidence interval [CI]) of EoE with overall EQI and for each domain, after adjusting for sex, age, and proportion minority race or ethnicity at the county level (higher EQI score indicates worse environmental quality). Of 29,802 EoE cases and 593,329 controls analyzed, odds of EoE were highest in the worst quintile of EQI (OR 1.25; 95% CI: 1.04\u20131.50), which was largely explained by poor scores in the water domain (OR: 1.33; 1.17\u20131.50). Conversely, odds of EoE were reduced with higher scores in the air domain (OR: 0.87, 0.74\u20131.03) and land domain (OR 0.87; 0.76\u20130.99). Poor EQI, mostly reflected by poor water quality, was associated with increased odds of EoE, while poor air and land quality were inversely associated with EoE. Additional work to identify specific water pollutants that may have an etiologic role in EoE may be warranted.<\/jats:p>","DOI":"10.1093\/dote\/doab041","type":"journal-article","created":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T05:09:09Z","timestamp":1624338549000},"source":"Crossref","is-referenced-by-count":15,"title":["Increased risk of eosinophilic esophagitis with poor environmental quality as measured by the Environmental Quality Index"],"prefix":"10.1093","volume":"34","author":[{"given":"D","family":"Nance","sequence":"first","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K M","family":"Rappazzo","sequence":"additional","affiliation":[{"name":"United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E T","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, Wake Forest University Public Health Sciences, Winston-Salem, NC, USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Nicholas School of the Environment, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C C","family":"Cotton","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A K","family":"Krajewski","sequence":"additional","affiliation":[{"name":"United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K O","family":"Turner","sequence":"additional","affiliation":[{"name":"Inform Diagnostics, Irving, TX, USA"},{"name":"Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R M","family":"Genta","sequence":"additional","affiliation":[{"name":"Inform Diagnostics, Irving, TX, USA"},{"name":"Department of Pathology, Baylor College of Medicine, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D T","family":"Lobdell","sequence":"additional","affiliation":[{"name":"United States Environmental Protection Agency, Office of Research and Development, Research Triangle Park, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1167-1101","authenticated-orcid":false,"given":"E S","family":"Dellon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"issue":"4","key":"2021122406140237200_ref1","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1053\/j.gastro.2018.07.009","article-title":"Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference","volume":"155","author":"Dellon","year":"2018","journal-title":"Gastroenterology"},{"issue":"2","key":"2021122406140237200_ref2","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1053\/j.gastro.2017.06.067","article-title":"Natural 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