Racial and ethnic disparities in pregnancy complications and the protective role of greenspace: A retrospective birth cohort study
Racial and ethnic disparities in pregnancy complications and the protective role of greenspace: A retrospective birth cohort study
复制标题
DOI：
10.1016/j.scitotenv.2021.152145
复制
发表时间：
2021-12-10
影响因子：
9.8
通讯作者：
Sugg，Margaret M.
中科院分区：
文献类型：
--
作者：
Runkle，Jennifer D.;Matthews，Jessica L.;Sugg，Margaret M.
绿色空间可能对种族和经济上的少数群体的怀孕健康产生积极影响;很少有研究审查当地绿色/公园空间在降低孕产妇发病率方面的可用性和可及性。这项回顾性出生队列研究的目的是在美国南部一个以孕产妇健康高贫困和种族差异为特征的州（2013-2017年）研究住宅暴露于绿地与不良妊娠健康结局之间的关联。来自保护区数据库的国家数据-美国（PAD-US）和ParkServe估计了三个公开可用和可访问的住宅绿地测量-这是比使用遥感绿色指标更直接的代理（例如，归一化差异植被指数（NDVI）-（a）绿地面积百分比（M1），（B）人均可用绿地面积（M2），（c）步行10分钟内的总人口（M3）。广义估计方程与逻辑回归被用来检查个人绿地指标和南卡罗来纳州医院分娩之间的关联（n = 238，922例分娩），对于妊娠期高血压（GHTN）、妊娠期糖尿病（GD）、重度孕产妇发病率（SMM）、先兆子痫（PRE）、精神障碍（MD）、抑郁症（DD）、早产（PTB）所有三个指标的最低三分位数与最高三分位数相比，与MD、DD的风险增加和GD的单调增加相关，特别是对于黑人女性。获得M2和M3最少的妇女更容易发生PRE，PTB和MD。我们观察到，与主要是高收入白人社区相比，M2最低与最高三分位数的低收入黑人社区的妇女更有可能经历DD，MD，SMM或PTB。可用和可访问的绿色/公园空间可能是一种有效的基于自然的干预措施，以减少孕产妇并发症，特别是妊娠糖尿病和其他妊娠健康风险，目前很少有已知的循证初级预防战略。
Greenspace may positively impact pregnancy health for racially and economically minoritized populations; few studies have examined local availability and accessibility of green/park space in reducing maternal morbidity. The objective of this retrospective birth cohort study was to examine the association between residential exposure to greenspace and adverse pregnancy health outcomes in a Southern US state characterized by high poverty and racial disparities in maternal health (2013–2017). National data from the Protected Area database – United States (PAD-US) and ParkServe estimated three publicly available and accessible residential greenspace measures—a more direct proxy than using remotely-sensed greenness indicators (e.g., normalized difference vegetation index (NDVI))—(a) percent area of greenspace (M1), (b) area of available greenspace per person (M2), (c) total population within a 10-minute walk (M3). Generalized Estimating Equations with logistic regression were used to examine the association between individual greenspace metrics and South Carolina hospital deliveries (n = 238,922 deliveries) for women with correlated maternal health outcomes for gestational hypertension (GHTN), gestational diabetes (GD), severe maternal morbidity (SMM), preeclampsia (PRE), mental disorders (MD), depressive disorders (DD), and preterm birth (PTB). Lowest compared to highest tertiles of all three metrics were associated with increased risk for MD, DD, and a monotonic increase in GD, particularly for black women. Women with the lowest access to M2 and M3 were more at risk for PRE, PTB, and MD. We observed that women in low-income, majority-black communities in the lowest versus highest tertile of M2 were more likely to experience a DD, MD, SMM, or PTB compared to primarily high-income majority-white communities. Available and accessible green/park space may present as an effective nature-based intervention to reduce maternal complications, particularly for gestational diabetes and other pregnancy health risks for which there are currently few known evidence-based primary prevention strategies.