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.

项目摘要 怀孕高血压疾病（HDP）是美国孕产妇死亡率和发病率的主要原因， 特别是对于最大风险不良风险的黑人妇女。除了对孕产妇的贡献 死亡率，HDP增加了慢性高血压（CHTN）的风险，这可能导致心血管（CV） 疾病。邻里greenspace与一般的CV结果相关联 人口，但很少有研究评估了绿色空间与HDP的发展之间的关系 和随后的CHTN。该提案的广泛目的是通过评估的影响来填补这一空白 绿空间以及对HDP和CHTN的绿色干预，并确定 Greenspace作为种族差异缓解工具。我们将合并Geobirth，这将包括92,000 2008年至2021年，宾夕法尼亚州费城的孕妇患者，有几个社区Greenspace数据集， 包括来自我们团队最近进行的绿色干预措施的随机对照试验的数据。 我们的总体假设是，住在Greenspace附近 这些结果的白人种族差异。我们提出以下目的：1）观察：确定是否是否 邻里绿空间与怀孕后的HDP和CHTN有关 Greenspace介导了这些结果中的种族差异。我们将分析住宅协会 使用多级logistic回归对个人和社区级别调整的多级逻辑回归有HDP风险的greenspace 混杂因素（1A）。我们将确定5年内绿地的风险是否与CHTN的风险有关 怀孕后使用生存分析方法（1B）。我们将量化更高的绿色空间的程度 黑白女性的暴露可以减少黑白HDP和CHTN差异 和交互分析（1C）。 2）准实验：衡量邻里绿色的影响 妊娠后使用准实验设计对HDP和CHTN进行干预。我们将分析 空缺绿色对HDP和CHTN风险在怀孕后5年的影响，使用差异 与2008年至2017年之间的对照批次相比，对居住在绿色绿色的妇女的差异分析。 3）实验：检查绿色干预对血压变化的影响 在怀孕期间，使用先前进行的RCT。我们将使用完整的群集RCT的数据 （2011-2014）空置的绿色绿色，以检查绿色对血压变化的影响（轨迹是 与HDP的发展有关）从20周的妊娠到交付，在居住的地理参与者中 在三个试验条件下，近541次空置地段：绿色地段，垃圾清理仅清理和控制批次。这 拟议的研究将是有关邻里绿空间是否可以减轻HDP风险的最大研究 和CHTN怀孕后的风险，并减少这些病因的种族差异。