Health disparities associated with exposure to animal feeding operations, including concentrated animal feeding operations (CAFOs), in North Carolina, Pennsylvania, and Virginia, USA.

Despite growing evidence of health risks posed by animal feeding operations (AFOs) including concentrated AFOs (CAFOs), few studies have explored the associated disproportionate health burdens. We investigated risk of cause-specific mortality associated with AFO/CAFOs and related disparities for North Carolina, Pennsylvania, and Virginia (2000-2020). We estimated associations between AFO/CAFO exposure and mortality (anemia, asthma, COPD, diabetes mellitus, cerebrovascular disease, and kidney disease) using logistic regression. For each participant, we applied two exposure metrics based on buffers around population-weighted ZIP-code centroids: (1) binary exposure based on presence or absence of AFOs/CAFOs, and (2) exposure intensity (no exposure, low, medium, and high). We investigated health disparities by individual-level (sex, race/ethnicity, age, education, marital status) and community-level (race, income, poverty, education, racial isolation, educational isolation) characteristics. Presence of AFO/CAFOs was associated with higher risks of cause-specific mortality, particularly for diabetes mellitus or cerebrovascular disease, across all states. People in ZIP codes within ⩽10 km of AFO/CAFO were 1.028 (95% Confidence Interval 1.014, 1.042), 1.039 (1.025, 1.053), and 1.053 (1.031, 1.075) times more likely to die from cerebrovascular disease compared to those in ZIP codes without AFO/CAFO exposure for North Carolina, Pennsylvania, and Virginia, respectively. We found disproportionate health burden associated with AFO/CAFO exposure in some subpopulations, however results varied by state. Our findings provide evidence of higher mortality risk with high AFO/CAFO exposure, with some populations facing disproportionate health burden, although such relationships differed by location.