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， 尤其是对黑人患者来说，他们的预后不良的风险最大。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。我们的父母基金(R01HL157160)专注于社区绿地及其对HDP和HDP的影响 随后的cHTN使用观测和实验方法。本补充文件的目的是 该提案的目的是在该项目中增加与气候变化和健康(CCH)相关的关键变量。我们会 让艾伦博士加入我们的团队，增加温度和空气污染，特别是颗粒物 &lt；2.5微米直径(PM2.5)到GeoBirth，这是我们的父项目所基于的队列。 GeoBirth包括从2008年到年间在费城两家医院分娩的11.6万名孕妇。 现在时。我们将分析2008-2020年间出生的89,827名费城居民。我们最重要的是 假设是极端高温和PM2.5暴露增加了患上和种族差异的风险 孕后3个月、3个月、3个月、3个月。我们提出了以下目标：1)观察性：量化关联 怀孕后使用HDP和cHTN进行极热治疗，并确定热在多大程度上调节 这些结果中的种族差异。我们将分析极端高温与HDP风险之间的关联 调整了个人和邻里水平混杂因素的多水平Logistic回归(1a)。我们会 在怀孕后5年内确定极端高温暴露是否与cHTN风险相关 生存分析方法(1b)。我们将量化黑人中极端高温暴露的程度 使用因果调解和交互作用分析患者对黑白HDP和cHTN差异的影响 (1C)。2)观察性：量化PM2.5与妊娠后HDP和cHTN的关系 确定PM2.5在多大程度上调节了这些结果中的种族差异。我们将表演 类似于目标1的分析，使用特定于三个月的PM2.5暴露代替温度。3)实验性： 确定空地绿化在多大程度上减轻了酷热的暴露。我们还将使用 来自已完成的集群RCT的数据(2011-2014)，以考察绿化对 有541个空置地块的社区，在三种试验条件下：绿化；仅清理垃圾；以及 控制力。这项研究将通过解决气候的影响来推动女性心血管疾病研究领域的发展 与HDP和cHTN相关的暴露导致不成比例的高死亡率 黑人病人。我们的研究结果将为个人层面的心血管疾病临床预防工作提供信息 除了大规模的城市政策变化以减少高温和污染暴露外，还将减少暴露。