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

项目总结 妊娠期高血压疾病(HDP)是美国孕产妇死亡和发病率的主要原因， 特别是对黑人女性来说，她们面临着最大的不良后果风险。除了对产妇的贡献之外 死亡率，HDP增加慢性高血压(CHTN)的风险，慢性高血压可导致心血管(CV) 疾病。社区绿地总体上与改善的个人简历结果有关 人口，但很少有研究评估绿地与HDP发展的关系 和随后的cHTN。该提案的广泛目标是通过评估以下方面的影响来填补这一空白 绿色空间和对HDP和cHTN的绿化干预，以及确定 绿地作为一种缓解种族差距的工具。我们将合并GeoBirth，这一队列将包括92,000 2008年至2021年宾夕法尼亚州费城的怀孕患者，以及几个社区绿地数据集， 包括我们团队最近进行的一项绿化干预的随机对照试验的数据。 我们的主要假设是，居住在绿地附近可以降低HDP和cHTN的风险，并减少黑人- 白人对这些结果的不平等。我们提出了以下目标：1)观察性：确定 社区绿地与怀孕后HDP和cHTN相关，以及在多大程度上 绿色空间在这些结果中调解了种族差异。我们将分析住宅的协会 基于个体和邻里关系调整的多水平Logistic回归分析 混杂因素(1a)。我们将在5年内确定绿地暴露是否与cHTN风险有关。 妊娠后采用生存分析方法(1b)。我们将量化更高的绿地面积 通过因果调解，黑人女性接触HDP和cHTN可减少黑白HDP和cHTN差异 和交互作用分析(1c)。2)准实验：测量社区绿化的影响 妊娠后对HDP和cHTN的干预，采用准实验设计。我们将分析 空地绿化对妊娠后5年内HDP和cHTN风险的影响 对2008-2017年间居住在绿化地块附近的女性与对照地块进行了差异分析。 3)实验：研究绿化干预对血压变化的影响 在怀孕期间，使用先前进行的随机对照试验。我们将使用已完成的群集RCT中的数据 (2011-2014)空地绿化，以研究绿化对血压变化的影响(轨迹如下 与HDP的发展有关)从怀孕20周到分娩，生活在GeoBirth参与者中 在三种试验条件下，近541个空置地块：绿化地块、仅清理垃圾地块和对照地块。这个 拟议的研究将是关于社区绿地是否可以降低HDP风险的最大规模的调查 怀孕后患cHTN的风险，并减少这些发病率的种族差异。

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.