An assessment of environmental and neighborhood-level risk factors for subfertility among Black women in the U.S.

项目总结 不孕不育是一个重要的公共卫生问题，影响着高达15%的育龄夫妇 美国。黑人女性不孕不育的比例大约是白人女性的两倍，但 寻求医疗护理的可能性较小，生育治疗结果较差。尽管存在这种差异， 不孕症的流行病学研究主要是在经济上享有特权的白人夫妇中进行的。 在生育诊所寻求治疗。在怀孕前或怀孕早期招募妇女的生育力研究 同样，怀孕在招募黑人女性方面也取得了有限的成功。因此，几乎没有 黑人妇女不孕不育原因研究。种族居住隔离和种族主义模式 社区投资和撤资造成了空间分布的不公平负担 对有色人种社区的环境暴露。在本提案中，我们研究了以下几个问题 与黑人妇女高度相关，重点是环境和邻里层面的接触。我们将使用 黑人妇女健康研究(BWHS)的数据，这是目前存在的最大规模的研究，重点是黑人妇女的健康 黑人女性。BWHS在1995年从美国招募了5.9万名黑人女性，并一直在跟踪她们 每两年举办一次，超过25年。结果信息是在2011年回溯收集的，当时妇女报告 每一次以活产结束的计划怀孕的怀孕时间(TTP)信息， 她们是否曾尝试怀孕12个月但没有成功，如果是，原因是什么？ 我们将使用这些数据来检查TTP、不孕症和原因特异性不孕症之间的联系，1) 历史红线，20世纪30年代政府支持的一项政策，根据这项政策，社区按 投资风险主要基于黑人居民的存在，2)居住的种族和经济 隔离和邻里社会经济状况，以及3)住宅环境暴露(包括空气 污染、绿地和环境噪音)。最后，我们将探索红线批注等级如何关联 社区劣势和环境污染的模式，以及社会和社会的混合体 环境暴露与生育能力有关。曝光量将从BWHs之间的联系中获得 参与者地址(1995-2011年每两年收集一次)和地理空间数据集。建议的研究是 可能对生殖流行病学、环境健康、 和健康差距。黑人女性在不孕不育研究中的中心地位促进了健康公平，抗争 宣传不孕不育对黑人妇女来说不是问题的种族主义刻板印象，并允许 确定干预机会，以减少和消除不孕不育差距。这将是第一次 研究重点是黑人女性不孕不育的原因，这与理解 环境塑造了人类的繁衍。

PROJECT SUMMARY Infertility is an important public health problem that affects up to 15% of reproductive-aged couples in the United States. Black women experience infertility at approximately two times the rate of white women, yet are less likely to seek medical care and have poorer fertility treatment outcomes. Despite this disparity, epidemiologic research on infertility has largely been conducted among economically privileged white couples seeking treatment at fertility clinics. Studies of fertility that enroll women during preconception or early pregnancy have likewise had limited success in recruiting Black women. Thus, there has been virtually no study of causes of infertility in Black women. Racial residential segregation and racialized patterns of neighborhood investment and disinvestment have resulted in inequitable burdens of spatially-distributed environmental exposures on communities of color. In the present proposal, we examine several exposures of high relevance to Black women, with a focus on environmental and neighborhood-level exposures. We will use data from the Black Women’s Health Study (BWHS), the largest study in existence focusing on the health of Black women. BWHS recruited 59,000 Black women from the United States in 1995 and have followed them biennially for over 25 years. Outcome information was collected retrospectively in 2011, when women reported information on time-to-pregnancy (TTP) for each of their planned pregnancies that ended in a live birth, whether they had ever tried to conceive for >12 months without success, and if so, what cause was identified. We will use these data to examine the association of TTP, infertility, and cause-specific infertility, with 1) historical redlining, a 1930s government sponsored policy in which neighborhoods were classified by investment risk based largely on the presence of Black residents, 2) residential racial and economic segregation and neighborhood socioeconomic status, and 3) residential environmental exposures (including air pollution, green space, and environmental noise). Finally, we will explore how redlining grades are associated with patterns of neighborhood disadvantage and environmental pollution and how mixtures of social and environmental exposures are related to fertility. Exposures will be derived from linkage between BWHS participant addresses (collected biennially from 1995-2011) with geospatial data sets. The proposed study is likely to have a large and sustained impact on the fields of reproductive epidemiology, environmental health, and health disparities. The centering of Black women in infertility research advances health equity, combats racist stereotypes that propagate the idea that infertility is a non-issue for Black women, and allows for the identification of opportunities for intervention to reduce and eliminate infertility disparities. This will be the first study to focus on causes of infertility in Black women, and is highly relevant for understanding how the environment shapes human reproduction.