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

项目摘要 不孕症是一个重要的公共卫生问题，影响到美国多达15%的育龄夫妇。 美国的黑人妇女不孕的比率大约是白色妇女的两倍， 不太可能寻求医疗护理，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条件优越的白色夫妇中进行的 在生育诊所寻求治疗招募孕前或早期妇女的生育力研究 怀孕在招募黑人妇女方面也取得了有限的成功。因此，实际上没有 研究黑人妇女不孕的原因。种族居住隔离和种族化的 邻里投资和撤资导致了空间分布的不公平负担， 对有色人种社区的环境影响。在本提案中，我们研究了以下几种风险： 与黑人妇女高度相关，重点是环境和社区一级的暴露。我们将使用 来自黑人妇女健康研究（BWHS）的数据，这是现有的最大的研究，重点关注黑人妇女的健康。 黑人女性1995年，BWHS从美国招募了59 000名黑人妇女，并对她们进行了跟踪调查。 两年一次，超过25年。2011年回顾性收集了结局信息， 每次计划妊娠（以活产结束）的妊娠时间（TTP）信息， 他们是否曾经尝试怀孕超过12个月而没有成功，如果是，确定了什么原因。 我们将使用这些数据来研究TTP、不孕症和病因特异性不孕症之间的关系， 历史红线，20世纪30年代政府赞助的一项政策，其中社区被分类为 投资风险主要基于黑人居民的存在，2）住宅种族和经济 隔离和邻里社会经济地位，以及3）居住环境暴露（包括空气 污染、绿色空间和环境噪声）。最后，我们将探讨如何红线等级相关联 社区劣势和环境污染的模式，以及社会和 环境暴露与生育力有关。暴露量将根据BWHS之间的联系得出 与会者利用地理空间数据集进行演讲（1995-2011年每两年收集一次）。拟定研究 可能对生殖流行病学、环境卫生、 健康差距。黑人妇女在不孕症研究中的中心地位促进了健康公平， 种族主义的陈规定型观念，宣传不孕不育是一个非问题的黑人妇女的想法，并允许 确定采取干预措施的机会，以减少和消除不孕症方面的差距。这将是第一 研究的重点是黑人妇女不孕的原因，并高度相关的了解如何 环境塑造人类生殖。

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.