The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity

社区绿地在降低妊娠期高血压疾病、慢性高血压和孕产妇发病率种族差异方面的作用

• 批准号: 10363511
• 负责人: Heather Herson Burris
• 金额: $ 77.89万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-15 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10363511
• 关键词: Acute; Acute myocardial infarction; Address; Adult; Affect; Area; Birth; Birth Rate; Black race; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Chronic; Data; Data Set; Development; Disease; Dose; Environment; Feeling; General Population; Green space; Health; Health Promotion; Healthcare Systems; Heart Rate; Hispanic; Hypertension; Incidence; Individual; Intervention; Investigation; Lead; Link; Logistic Regressions; Maternal Mortality; Measures; Mediating; Mediation; Mental Depression; Methods; Modeling; Neighborhoods; Observational Study; Outcome; Participant; Patients; Philadelphia; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Provider; Quasi-experiment; Randomized Controlled Trials; Research Design; Risk; Role; Shapes; Source; Survival Analysis; Time; Trees; United States; Woman; adverse pregnancy outcome; black women; black/white disparity; cardiovascular disorder risk; cohort; data repository; disparities in morbidity; experimental study; health inequalities; high risk; improved; intervention cost; maternal morbidity; mortality; perinatal outcomes; pregnancy disorder; pregnancy hypertension; pregnant; prevent; racial disparity; repository; residential segregation; response; social; tool; violent crime

PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in the US, particularly for Black women who are at greatest risk of poor outcomes. In addition to contributions to maternal mortality, HDP increase the risk of chronic hypertension (cHTN), which can lead to cardiovascular (CV) disease. Neighborhood greenspace has been associated with improved CV outcomes in the general population, but few studies have evaluated the relationship between greenspace and the development of HDP and subsequent cHTN. The broad objective of this proposal is to fill this gap by evaluating the impact of greenspace and a greening intervention on HDP and cHTN as well as to determine the utility of greenspace as a racial disparities mitigation tool. We will merge GeoBirth, a cohort that will include 92,000 pregnant patients in Philadelphia, PA from 2008 to 2021, with several neighborhood greenspace datasets, including data from a randomized controlled trial of a greening intervention recently conducted by our team. Our overarching hypothesis is that living near greenspace lowers risk of HDP and cHTN and reduces Black- white racial disparities for these outcomes. We propose the following aims: 1) Observational: To determine if neighborhood greenspace is associated with HDP and cHTN after pregnancy and the extent to which greenspace mediates racial disparities in these outcomes. We will analyze associations of residential greenspace with risk of HDP using multilevel logistic regression adjusted for individual and neighborhood-level confounders (1a). We will determine if greenspace exposure is associated with risk of cHTN within 5 years after pregnancy using survival analysis methods (1b). We will quantify the extent to which higher greenspace exposure among Black women could reduce Black-white HDP and cHTN disparities using causal mediation and interaction analyses (1c). 2) Quasi-experimental: To measure the impact of a neighborhood greening intervention on HDP and cHTN after pregnancy, using a quasi-experimental design. We will analyze the impact of vacant lot greening on risks of HDP and cHTN in the 5 years after pregnancy, using a difference-in- differences analysis of women living near lots that were greened compared to control lots between 2008-2017. 3) Experimental: To examine the impact of a greening intervention on changes in blood pressure during pregnancy, using a previously conducted RCT. We will use data from a completed cluster RCT (2011-2014) vacant lot greening to examine the impact of greening on blood pressure changes (trajectories are associated with development of HDP) from 20 weeks' gestation to delivery, among GeoBirth participants living near 541 vacant lots in three trial conditions: greened lots, trash clean-up only lots, and control lots. The proposed study will be the largest investigation into whether neighborhood greenspace can mitigate HDP risk and cHTN risk after pregnancy and reduce racial disparities in these morbidities.

项目概要 妊娠期高血压疾病 (HDP) 是美国孕产妇死亡和发病的主要原因， 特别是对于黑人女性来说，她们面临着不良结果的最大风险。除了为母亲做贡献 HDP 会增加慢性高血压 (cHTN) 的风险，从而导致心血管疾病 (CV) 疾病。一般来说，社区绿地与改善心血管结果有关 人口，但很少有研究评估绿地与 HDP 发展之间的关系 和随后的 chHTN。该提案的总体目标是通过评估以下项目的影响来填补这一空白： 绿地和 HDP 和 cHTN 的绿化干预，以及确定 绿色空间作为缓解种族差异的工具。我们将合并 GeoBirth，该群体将包括 92,000 2008 年至 2021 年宾夕法尼亚州费城的怀孕患者，以及多个社区绿地数据集， 包括我们团队最近进行的绿化干预随机对照试验的数据。 我们的首要假设是，居住在绿地附近可以降低 HDP 和 cHTN 的风险，并减少黑人- 这些结果的白人种族差异。我们提出以下目标： 1) 观察：确定是否 社区绿地与怀孕后的 HDP 和 cHTN 相关，以及影响程度 绿色空间调节了这些结果中的种族差异。我们将分析住宅的关联 使用根据个人和社区级别调整的多级逻辑回归分析具有 HDP 风险的绿地 混杂因素（1a）。我们将在 5 年内确定绿地暴露是否与 cHTN 风险相关 怀孕后使用生存分析方法 (1b)。我们将量化更高绿地面积的程度 黑人女性的暴露可以通过因果中介减少黑人与白人 HDP 和 cHTN 差异 和交互分析 (1c)。 2) 准实验：衡量社区绿化的影响 采用准实验设计对妊娠后 HDP 和 cHTN 进行干预。我们将分析 空地绿化对怀孕后 5 年内 HDP 和 cHTN 风险的影响，使用差异 2008 年至 2017 年间居住在绿化地段附近的妇女与对照地段相比的差异分析。 3) 实验：检验绿化干预对血压变化的影响 怀孕期间，使用之前进行的随机对照试验。我们将使用来自已完成的集群 RCT 的数据 （2011-2014）空地绿化，检查绿化对血压变化的影响（轨迹为 与 HDP 的发展相关），在 GeoBirth 参与者中，从妊娠 20 周到分娩 在三种试验条件下的近 541 个空地：绿化地块、仅垃圾清理地块和对照地块。这 拟议的研究将是关于社区绿地是否可以减轻 HDP 风险的最大调查 怀孕后的 cHTN 风险，并减少这些发病率的种族差异。