Project 1: The Environmental Riskscape, Disasters and Obstetric Outcomes

尽管在医疗保健方面取得了进展，非洲裔美国人（AA）继续经历着不成比例的负担， 产科结果不佳。这是令人震惊的，因为怀孕是未来健康的一个窗口，许多产科 结果，如早产，与严重的发病率和死亡率的母亲和她的孩子， 并导致高昂社会和经济代价。不幸的是，产科的种族差异的起源 结果似乎不是遗传的，也不能完全由个人因素解释;因此，我们必须着眼于 在物质、建筑和社会环境的更广泛背景下，减少孕产妇健康方面的种族差异。 由于有色人种和社会经济地位较低的社区承受着更高的化学品暴露负担， 部分地由于它们的邻近区域接近关键曝光源（例如，工业和危险废物 地点），“环境”被假设为是产科结果中种族差异的驱动因素。两类 在德克萨斯州休斯顿，历史污染的污染物是多环芳烃（PAH）和金属， 每一种都与早产有正相关。此外，在环境风险背景下， 在一个框架内，基于地点的压力因素也可能直接导致孕产妇健康方面的种族差异， 影响疾病风险和改变妇女对化学品暴露的敏感性。增强 了解风险景观的作用，以及化学和非化学应激源的混合物，在种族 产科结果的差异将促进设计成功干预措施的努力， 健康差距人群的福利。最后，休斯顿是一个灾害易发地区，这可能会导致 健康差距中可能加剧的化学、生物和非化学压力因素的暴露 人口。我们的目标是减轻生活在贫困地区负担过重的人口中的母婴健康差距。 易受灾害的地区。为了实现这一目标，本研究项目的目标，环境 风险景观，灾害和产科结果，是利用一个大规模的围产期生物银行和数据储存库 （Peribank）在贝勒医学院，以描述AA和非AA风险的种族差异。 休斯顿的西班牙裔白色孕妇，以评估化学品和 非化学应激源在早产风险景观，并探讨自然灾害的影响， 飓风哈维（Hurricane Harvey）对化学品暴露的种族差异造成了前所未有的影响。通过 应用基于风险景的方法与统计方法相结合，以解决混合效应，结果 这项研究将加强我们对化学和非化学应激源在种族中的作用的理解。 在灾害易发地区早产的差异。本文的工作将为今后的研究奠定基础， 提高我们对产科结果中黑人和白人差异的驱动因素的理解， 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.