Project 1: The Environmental Riskscape, Disasters and Obstetric Outcomes

尽管在医疗保健方面取得了进展，但非洲裔美国人(AA)继续承受着不成比例的 产科结局不佳。这是令人担忧的，因为怀孕是未来健康的窗口，许多产科 结局，如早产，与母亲和母亲的严重发病率和死亡率有关 并导致高昂的社会和经济成本。不幸的是，产科种族差异的根源 结果似乎不是遗传的，也不是完全由个人层面的因素解释的；因此，我们必须着眼于 在物质、建筑和社会环境中的更广泛的背景下，以减轻产妇健康方面的种族差异。 因为有色人种和低社会经济地位的社区承受着更高的化学暴露负担， 部分原因是他们的社区靠近主要的暴露源(例如工业和危险废物 地点)，“环境”一直被认为是产科结局中种族差异的驱动因素。两节课 在德克萨斯州休斯敦历史上受到污染的污染物中，多环芳烃(PAHs)和金属， 每一种都与早产呈正相关。此外，在环境风险的情况下 在这一框架下，以地点为基础的压力源也可能直接导致孕产妇健康方面的种族差异。 通过改变妇女对化学物质暴露的敏感性来影响疾病风险。增强版 对风险环境以及化学和非化学应激源混合在种族中的作用的理解 产科结果的差异将促进努力设计成功的干预措施并改善 健康差距人群的福祉。最后，休斯顿是一个灾害多发的地区，这可能会导致 暴露于化学、生物和非化学应激源可能在健康差距中加剧 人口。我们的目标是在负担过重的人口中缓解孕产妇和婴儿的健康差距 一个灾难多发的地区。为了实现这一目标，本研究项目的目标是环境 Riskscape，灾难和产科结果，是利用一个大规模的围产期生物库和数据库 (PeriBank)在贝勒医学院研究再生障碍性贫血和非再生障碍性贫血风险方面的种族差异 休斯顿的西班牙裔白人(NHW)孕妇，以评估化学物质和 非化学应激源在风险场景中对早产的影响，并探讨自然灾害对 对化学品暴露的种族差异的前所未有的规模(飓风哈维)。通过 应用基于风险的方法与统计方法相结合来处理混合效应，结果 这项研究将加深我们对化学和非化学应激源在种族中的作用的理解 灾害多发地区早产的差异。这项工作将为今后的研究奠定基础 提高我们对产科结局中黑人和白人差异的驱动因素的理解，研究势在必行 制定和成功实施预防性干预措施，以缩小这些差距。

Despite advances in health care, African-Americans (AA) continue to experience a disproportionate burden of poor obstetric outcomes. This is alarming as pregnancy is a window of future health and many obstetric outcomes, such as preterm birth, are associated with severe morbidity and mortality for both the mother and her infant and result in high societal and economic costs. Unfortunately, the origin of racial disparities in obstetric outcomes does not appear to be genetic nor fully explained by individual-level factors; thus, we must look toward the broader context in the physical, built, and social environments to mitigate racial disparities in maternal health. Because communities of color and low socioeconomic status experience a higher burden of chemical exposures, in part due to the proximity of their neighborhoods to key exposure sources (e.g., industry and hazardous waste sites), ‘environment’ has been hypothesized to be a driver of racial disparities in obstetric outcomes. Two classes of pollutants with historic contamination in Houston, TX are polycyclic aromatic hydrocarbons (PAHs) and metals, which have each been positively associated with preterm birth. Additionally, under an environmental riskscape framework, place-based stressors may also contribute to racial disparities in maternal health by directly influencing disease risk and by modifying women’s susceptibility to chemical exposures. Enhanced understanding of the role of the riskscape, and mixtures of chemical and non-chemical stressors, in racial disparities in obstetric outcomes would promote efforts to design successful interventions and improve the wellbeing of health disparity populations. Finally, Houston is a disaster-prone area, which may result in increased exposures to chemical, biological and non-chemical stressors that may be heightened among health disparity populations. Our goal is to mitigate maternal and infant health disparities in an overburdened population living in a disaster-prone region. To achieve this goal, the Objective of this Research Project, The Environmental Riskscape, Disasters and Obstetric Outcomes, is to utilize a large-scale perinatal biobank and data repository (PeriBank) at Baylor College of Medicine to characterize racial disparities in the riskscape of AA and non- Hispanic white (NHW) pregnant women in Houston, to assess associations between the mixture of chemical and non-chemical stressors in the riskscape on preterm birth, and explore the impact of a natural disaster of unprecedented magnitude (Hurricane Harvey) on racial disparities in chemical exposures. Through the application of a riskscape-based approach paired with statistical methods to address mixture effects, the results from this study will enhance our understanding of the roles of chemical and non-chemical stressors in racial disparities in preterm birth in a disaster-prone region. This work will lay the foundation for future studies to improve our understanding of drivers of black-white disparities in obstetric outcomes, research that is imperative for the development and successful implementation of preventive interventions to mitigate these disparities.