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: 10837452
• 负责人: Heather Herson Burris
• 金额: $ 49.96万
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10837452
• 关键词: Address; Administrative Supplement; Adverse event; Affect; Air Pollution; American; Birth; Black Populations; Black race; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Chronic; Cities; Clinical; Data; Data Set; Development; Diagnosis; Diameter; Disparity; Environment; Environmental Exposure; Epidemiology; Exposure to; Green space; Health; Hospitals; Hour; Hypertension; Individual; Individual Adjustment; Live Birth; Logistic Regressions; Low income; Maternal Health; Maternal Mortality; Mediating; Mediation; Methods; Modeling; Neighborhoods; Outcome; Parents; Participant; Particulate Matter; Patients; Perinatal; Philadelphia; Plague; Plants; Policies; Pollution; Positioning Attribute; Pregnancy; Pregnancy Outcome; Pregnant Women; Prevention; Public Health; Race; Racial Segregation; Recommendation; Research; Resolution; Resources; Risk; Risk Factors; Risk Reduction; Role; Scientist; Survival Analysis; Temperature; Testing; Trees; Urban Population; Woman; black patient; black women; black/white disparity; cardiovascular health; climate change; climate impact; climate-related exposures; climate-related health; cohort; design; diet and exercise; epidemiology study; extreme heat; extreme temperature; health equity; heat island; maternal morbidity; mid-career faculty; mortality; outcome disparities; parent grant; parent project; post pregnancy; pregnancy disorder; pregnant; prevent; racial disparity; segregation; study population

PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in the US, particularly for Black patients 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. Our parent grant (R01HL157160) is focused on neighborhood greenspace and its impact on HDP and subsequent cHTN using observational and experimental methods. The objective of this supplement proposal is to add crucial variables relevant to climate change and health (CCH) to this project. We will bring Dr. Allan Just onto our team to add temperature and air pollution, specifically particulate matter <2.5µm in diameter (PM2.5) to GeoBirth which is the cohort on which our parent project is based. GeoBirth includes 116,000 pregnant patients who gave birth in two Philadelphia hospitals from 2008 to present. We will analyze the 89,827 Philadelphia residents who gave birth from 2008-2020. Our overarching hypothesis is that extreme heat and elevated PM2.5 exposure contribute to the risks of, and racial disparities in, HDP and cHTN after pregnancy. We propose the following aims: 1) Observational: Quantify associations of extreme heat with HDP and cHTN after pregnancy and determine the extent to which heat mediates racial disparities in these outcomes. We will analyze associations of extreme heat with risk of HDP using multilevel logistic regression adjusted for individual and neighborhood-level confounders (1a). We will determine if extreme heat exposure is associated with risk of cHTN within 5 years after pregnancy using survival analysis methods (1b). We will quantify the extent to which extreme heat exposure among Black patients contributes to Black-White HDP and cHTN disparities using causal mediation and interaction analyses (1c). 2) Observational: Quantify associations of PM2.5 with HDP and cHTN after pregnancy and determine the extent to which PM2.5 mediates racial disparities in these outcomes. We will perform analogous analyses to Aim 1, using trimester-specific PM2.5 exposure in lieu of temperature. 3) Experimental: Determine the extent to which vacant lot greening mitigates exposure to extreme heat. We will also use data from a completed cluster RCT (2011-2014) to examine the impact of greening on ambient temperature in neighborhoods with clusters of 541 vacant lots in three trial conditions: greened; trash clean-up only; and control. This study will advance the field of women's CVD research by addressing the impact of climate change-related exposures to HDP and cHTN that lead to disproportionately high rates of mortality among Black patients. Our findings will inform individual-level clinical prevention efforts of CVD through personal exposure reduction in addition to large-scale urban policy changes to mitigate heat and pollution exposures.

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患者。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。我们的父母赠款（R01HL157160）专注于邻里绿色空间及其对HDP和 随后使用观察和实验方法进行CHTN。该补充的目的 提案是在该项目中添加与气候变化和健康（CCH）相关的关键变量。我们将 将艾伦博士带到我们的团队中，以增加温度和空气污染，特别是颗粒物。 直径<2.5µm（PM2.5）至Geobirth，这是我们父项目所基于的同类。 Geobirth包括116,000名孕妇，他们在2008年的两家费城医院分娩 展示。我们将分析从2008 - 2020年出生的89,827名费城居民。我们的总体 假设是，极端热量和升高的PM2.5暴露有助于种族分布的风险 在怀孕后，HDP和CHTN。我们提出以下目的：1）观察：量化关联 怀孕后用HDP和CHTN极热，并确定热介导的程度 这些结果中的种族分布。我们将使用使用HDP的风险分析极热的关联 针对个人和邻里级别的混杂因子（1A）调整了多级逻辑回归。我们将 确定在使用 生存分析方法（1B）。我们将量化黑色的极端热量暴露的程度 患者使用因果中介和相互作用分析有助于黑白HDP和CHTN分布 （1C）。 2）观察性：量化PM2.5与HDP和CHTN的关联以及怀孕后的HDP和CHTN 确定PM2.5在这些结果中介导种族分布的程度。我们将表演 类似于AIM 1的类似分析，使用三个月特异性PM2.5暴露代替温度。 3）实验： 确定空置绿色绿色的程度减轻了暴露于极热的程度。我们还将使用 来自完整的集群RCT（2011-2014）的数据检查绿色对环境温度的影响 在三个试验条件下，有541个空置批次的社区：绿色；仅清理;和 控制。这项研究将通过解决攀登的影响来推动女性CVD研究领域 与HDP和CHTN发生变化相关的暴露，导致死亡率不成比例 黑人患者。我们的发现将为CVD提供个人级别的临床预防工作。 除了大规模的城市政策变化以减轻热量和污染暴露外，曝光减少。