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

项目摘要 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谁是在最大的风险差的结果。除了对产妇的捐助外， 死亡率，HDP增加慢性高血压（cHTN）的风险，这可能导致心血管（CV） 疾病我们的母基金（R 01 HL 157160）专注于社区绿地及其对HDP的影响， 随后使用观察和实验方法进行cHTN。本补编的目的是 建议是在该项目中增加与气候变化和健康（CCH）相关的关键变量。我们将 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 直径小于2.5µm（PM2.5），以GeoBirth为基础，这是我们的母项目所基于的队列。 GeoBirth包括从2008年到2010年在费城两家医院分娩的116，000名孕妇。 礼物我们将分析2008年至2020年期间出生的89，827名费城居民。我们的总体 一种假设是，极端高温和PM2.5暴露增加了种族差异的风险 在妊娠后，HDP和cHTN。我们提出以下目标：1）观察：量化关联 妊娠后极热与HDP和cHTN的关系，并确定热介导的程度 这些结果中的种族差异。我们将分析极端高温与HDP风险的关系， 多水平logistic回归校正个体和社区水平混杂因素（1a）。我们将 使用以下方法确定极端高温暴露是否与妊娠后5年内cHTN的风险相关 生存分析方法（1b）。我们将量化极端高温暴露在黑人中的程度， 使用因果中介和交互作用分析，患者促成黑白HDP和cHTN差异 （1c）。2)观察：量化PM2.5与妊娠后HDP和cHTN的相关性， 确定PM2.5在这些结果中介导种族差异的程度。我们将执行 与目标1类似的分析，使用三个月特定的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 来自一项已完成的集群RCT（2011-2014年）的数据，以检查绿化对环境温度的影响， 在三个试验条件下，541块空地组成的社区：绿化;只清理垃圾; 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HDP和cHTN相关的变化暴露，导致 黑人病人我们的研究结果将通过个人干预为CVD的个体水平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热量和污染暴露之外，还需要减少暴露。

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.