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Residential greenness and birth outcomes: evaluating the influence of spatially correlated built-environment factors.

ABSTRACT: BACKGROUND: Half the world's population lives in urban areas. It is therefore important to identify characteristics of the built environment that are beneficial to human health. Urban greenness has been associated with improvements in a diverse range of health conditions, including birth outcomes; however, few studies have attempted to distinguish potential effects of greenness from those of other spatially correlated exposures related to the built environment. OBJECTIVES: We aimed to investigate associations between residential greenness and birth outcomes and evaluate the influence of spatially correlated built environment factors on these associations. METHODS: We examined associations between residential greenness [measured using satellite-derived Normalized Difference Vegetation Index (NDVI) within 100 m of study participants' homes] and birth outcomes in a cohort of 64,705 singleton births (from 1999-2002) in Vancouver, British Columbia, Canada. We also evaluated associations after adjusting for spatially correlated built environmental factors that may influence birth outcomes, including exposure to air pollution and noise, neighborhood walkability, and distance to the nearest park. RESULTS: An interquartile increase in greenness (0.1 in residential NDVI) was associated with higher term birth weight (20.6 g; 95% CI: 16.5, 24.7) and decreases in the likelihood of small for gestational age, very preterm (< 30 weeks), and moderately preterm (30-36 weeks) birth. Associations were robust to adjustment for air pollution and noise exposures, neighborhood walkability, and park proximity. CONCLUSIONS: Increased residential greenness was associated with beneficial birth outcomes in this population-based cohort. These associations did not change after adjusting for other spatially correlated built environment factors, suggesting that alternative pathways (e.g., psychosocial and psychological mechanisms) may underlie associations between residential greenness and birth outcomes.

SUBMITTER: Hystad P

PROVIDER: S-EPMC4181932 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe built environment, a key component of environmental health, may be an important contributor to health disparities, particularly for reproductive health outcomes.ObjectiveIn this study we investigated the relationship between seven indices of residential built environment quality and adverse reproductive outcomes for the City of Durham, North Carolina (USA).MethodsWe surveyed approximately 17,000 residential tax parcels in central Durham, assessing > 50 individual variables on each. These data, collected using direct observation, were combined with tax assessor, public safety, and U.S. Census data to construct seven indices representing important domains of the residential built environment: housing damage, property disorder, security measures, tenure (owner or renter occupied), vacancy, crime count, and nuisance count. Fixed-slope random-intercept multilevel models estimated the association between the residential built environment and five adverse birth outcomes. Models were adjusted for maternal characteristics and clustered at the primary adjacency community unit, defined as the index block, plus all adjacent blocks that share any portion of a line segment (block boundary) or vertex.ResultsFive built environment indices (housing damage, property disorder, tenure, vacancy, and nuisance count) were associated with each of the five outcomes in the unadjusted context: preterm birth, small for gestational age (SGA), low birth weight (LBW), continuous birth weight, and birth weight percentile for gestational age (BWPGA; sex-specific birth weight distributions for infants delivered at each gestational age using National Center for Health Statistics referent births for 2000-2004). However, some estimates were attenuated after adjustment. In models adjusted for individual-level covariates, housing damage remained statistically significantly associated with SGA, birth weight, and BWPGA.ConclusionThis work suggests a real and meaningful relationship between the quality of the residential built environment and birth outcomes, which we argue are a good measure of general community health.

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Residential greenness and birth outcomes: evaluating the influence of spatially correlated built-environment factors.

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