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.

项目概要 妊娠期高血压疾病 (HDP) 是美国孕产妇死亡和发病的主要原因， 特别是对于黑人患者来说，他们的不良结果风险最大。除了为母亲做贡献 HDP 会增加慢性高血压 (cHTN) 的风险，从而导致心血管疾病 (CV) 疾病。我们的家长拨款 (R01HL157160) 重点关注社区绿地及其对 HDP 和 随后使用观察和实验方法进行 chHTN。本补充的目的 建议将与气候变化和健康（CCH）相关的关键变量添加到该项目中。我们将 让 Allan Just 博士加入我们的团队，以增加温度和空气污染，特别是颗粒物 GeoBirth 的直径 (PM2.5) <2.5 µm，这是我们父项目所基于的队列。 GeoBirth 包括 2008 年至 2019 年在费城两家医院分娩的 116,000 名孕妇 展示。我们将分析 2008 年至 2020 年期间生育的 89,827 名费城居民。我们的首要任务 假设极端高温和 PM2.5 暴露增加会导致风险和种族差异 怀孕后的 HDP 和 cHTN。我们提出以下目标：1）观察：量化关联 怀孕后用 HDP 和 chHTN 评估极端高温，并确定热介导的程度 这些结果中存在种族差异。我们将使用以下方法分析极端高温与 HDP 风险的关联 针对个人和邻里级别混杂因素进行调整的多级逻辑回归 (1a)。我们将 使用以下方法确定怀孕后 5 年内极端高温暴露是否与 cHTN 风险相关 生存分析方法(1b)。我们将量化黑人暴露在极端高温下的程度 使用因果中介和交互分析，患者导致黑白 HDP 和 cHTN 差异 (1c)。 2) 观察性：量化怀孕后 PM2.5 与 HDP 和 cHTN 的关联 确定 PM2.5 在多大程度上调节这些结果中的种族差异。我们将表演 与目标 1 类似的分析，使用妊娠期特定的 PM2.5 暴露代替温度。 3）实验： 确定空地绿化在多大程度上减轻了极端高温的暴露。我们还将使用 来自已完成的集群随机对照试验（2011-2014）的数据，旨在研究绿化对环境温度的影响 拥有 541 个空地的社区，处于三种试验条件：绿化；仅清理垃圾；和 控制。这项研究将通过解决气候的影响来推进女性心血管疾病研究领域 与变化相关的 HDP 和 cHTN 暴露导致了不成比例的高死亡率 黑人患者。我们的研究结果将为个人层面的 CVD 临床预防工作提供信息 除了大规模的城市政策变化以减轻热量和污染暴露之外，还需要减少暴露。