Penn-CHOP ECHO

项目摘要 健康差距在生命早期就开始了，黑人婴儿(每1000人中有10.6人)死亡的可能性是白人婴儿的两倍 婴儿(每1000人中有4.5人)。不良妊娠结局是大多数黑白婴儿的原因 死亡率悬殊。已经采取了广泛的医疗保健努力，以防止不良妊娠结局和 以优化儿童生长、健康和神经发育。然而，出生和儿童的结局仍然是主要的。 公共卫生领域持续存在的不平等现象。大环境健康促进因素 (绿色空间，可步行)和威胁健康的因素(污染，邻里暴力，极端 温度)可能通过炎症和免疫途径直接影响健康。大环境 也可能有助于获得收入潜力和教育程度的生活体验。与 人与人之间的接触，如种族主义和暴力，大环境可能会改变个人的 微环境健康因素，如饮食、体力活动、心理社会压力和睡眠。而宏观- 并对微环境暴露进行了单独研究，邻里环境的影响 关于妊娠期和儿童早期的复杂健康障碍仍未得到充分研究，并与 缩小差距的微环境因素是完全未知的。我们提出了一个因果推论 评估特定宏观环境因素的作用的框架(目标1)，以减少异常风险 胎儿发育、早产、肥胖、哮喘和3岁前的神经发育迟缓，以及这些因素 这些因素可能会改善这些结果中的种族差异。我们还将确定最佳组件 孕期饮食、体力活动和睡眠的微环境因素(目标2)和夫妻间 在先入为主(目标4)期间，最好地利用这一点来最大限度地减少健康差距。我们有 在宾夕法尼亚大学和儿童医院组建了一个多学科的专家团队 费城有能力完成这项研究，招募多达2500名孕妇、伴侣、 和后代，在3岁时至少保留75%，其中1250人将被招募到 先入为主的试点(目标3)。宾夕法尼亚州立大学/CHOP的医疗系统服务于在其他地区代表性不足的人群 美国的怀孕和儿科队列(主要是医疗补助保险和多元黑人)。浅谈临床文化 研究、优良的科学环境和多样化的人口使宾夕法尼亚大学成为 在母婴健康公平领域创新。宾夕法尼亚大学的回声研究团队致力于 这项工作取得了成功，并期待着与其他ECHO研究站点合作， 协调中心和核心。

Project Summary Health disparities start early in life, with Black infants (10.6 per 1,000) twice as likely to die compared to White infants (4.5 per 1,000). Adverse pregnancy outcomes are responsible for the majority of the Black-White infant mortality disparity. Extensive healthcare efforts have been taken to prevent adverse pregnancy outcomes and to optimize child growth, health, and neurodevelopment. However, birth and childhood outcomes remain major areas of public health concern with ongoing inequities. Macroenvironmental health promoting factors (greenspace, walkability) and health threatening factors (pollution, neighborhood violence, extreme temperatures) may affect health directly through inflammatory and immunologic pathways. Macroenvironments may also contribute to lived experiences of income potential and educational attainment. Combined with interpersonal individual exposures such as racism and violence, macroenvironments may alter individuals' microenvironmental health factors such as diet, physical activity, psychosocial stress, and sleep. While macro- and microenvironmental exposures have been studied individually, the impact of neighborhood environments on complex health disorders in pregnancy and early childhood remains understudied and the interplay with microenvironmental factors to reduce disparities is completely unknown. We propose a causal inference framework to evaluate the role of specific macroenvironment factors (Aim 1) to reduce the risks of abnormal fetal growth, preterm birth, obesity, asthma, and neurodevelopmental delays by age 3, as well as whether such factors may improve racial disparities in these outcomes. We will also identify optimal components of microenvironmental factors of diet, physical activity, and sleep, during pregnancy (Aim 2) and among couples during preconception (Aim 4), that can best be utilized to maximize reductions in health disparities. We have assembled a multidisciplinary team of experts at the University of Pennsylvania and Children's Hospital of Philadelphia who are well-positioned to complete the study and recruit up to 2500 pregnant people, partners, and offspring, with retention of at least 75% at age 3, among whom 1250 will be recruited into the preconception pilot (Aim 3). The health system at Penn/CHOP serves a population underrepresented in other pregnancy and pediatric cohorts in the US (largely Medicaid-insured and plurality Black). The culture of clinical research, excellent scientific environment, and diverse population makes Penn and CHOP the ideal place to innovate in the field of maternal-child health equity. The Penn-CHOP ECHO study team is committed to the success of this work and looks forward to working collaboratively with the other ECHO Study Sites, Coordinating Centers, and Cores.