Abstract
BackgroundsRisk factors related to the built environment have been associated with women’s mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting.Methods In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients’ residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients’ residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study.ResultsWe discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality.ConclusionsIn an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients’ residing neighborhoods and healthy pregnancy.
Highlights
The built environment, referring to the surroundings and physical artifacts of where humans live, is considered to be one of the five major social determinants of health (SDoH) [1]
We evaluated the relationships among prenatal care patterns, postpartum depression (PPD) incidence, and the built environment using structural equation modeling [40]
We further studied the relationship between prenatal care, as reflected by the cluster membership, the built environment characteristics, and incidence of PPD using structural equation models (SEMs) [40]
Summary
The built environment, referring to the surroundings and physical artifacts of where humans live, is considered to be one of the five major social determinants of health (SDoH) [1]. The built environment is strongly associated with our way of life through determining the housing quality, mode of transportation, and exposure to pollutants, among others. Poor built environment has been reported to lead to adverse effects on physical and mental health by disrupting sleep, hindering healthy lifestyles, and lowering access to healthcare [2,3,4,5]. There is a gender difference in the association between the built environment and health. An increased risk of depression among female was reported by Mulling et al to be associated with living in an underdeveloped neighborhood characterized by inadequate sewer treatment, water supply, and dependable supply of electricity [6]. The Chicago Community Adult Health Study found the women’s use of preventive care to be associated with objective and perceived neighborhood support and stressors such as odors, presence of trees, and noise levels [7]
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