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. 2023 May 24;20(11):5932.
doi: 10.3390/ijerph20115932.

Neighborhood Walkability as a Risk Factor for Preterm Birth Phenotypes in Two Philadelphia Hospitals from 2013-2016

Theresa A Kash  1 , Rachel F Ledyard  2 , Anne M Mullin  3 , Heather H Burris  2   4
Affiliations

Neighborhood Walkability as a Risk Factor for Preterm Birth Phenotypes in Two Philadelphia Hospitals from 2013-2016

Theresa A Kash et al. Int J Environ Res Public Health. .

Abstract

A total of one in ten infants is born preterm in the U.S. with large racial disparities. Recent data suggest that neighborhood exposures may play a role. Walkability-how easily individuals can walk to amenities-may encourage physical activity. We hypothesized that walkability would be associated with a decreased risk of preterm birth (PTB) and that associations would vary by PTB phenotype. PTB can be spontaneous (sPTB) from conditions such as preterm labor and preterm premature rupture of membranes, or medically indicated (mPTB) from conditions such as poor fetal growth and preeclampsia. We analyzed associations of neighborhood walkability (quantified by their Walk Score® ranking) with sPTB and mPTB in a Philadelphia birth cohort (n = 19,203). Given racial residential segregation, we also examined associations in race-stratified models. Walkability (per 10 points of Walk Score ranking) was associated with decreased odds of mPTB (aOR 0.90, 95% CI: 0.83, 0.98), but not sPTB (aOR 1.04, 95% CI: 0.97, 1.12). Walkability was not protective for mPTB for all patients; there was a non-significant protective effect for White (aOR 0.87, 95% CI: 0.75, 1.01), but not Black patients (aOR 1.05, 95% CI: 0.92, 1.21) (interaction p = 0.03). Measuring health effects of neighborhood characteristics across populations is key for urban planning efforts focused on health equity.

Keywords: pregnancy; preterm birth; racial disparities; walkability.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Average Walk Score rankings of Philadelphia neighborhoods listed on WalkScore.com (accessed on 1 March 2021). The Walk Score ranking is calculated using a point system. Points are determined by distance to amenities and the ability to conduct daily errands.
Figure 2
Figure 2
GeoBirth participants included in the analytic cohort; births occurred at the Hospital of the University of Pennsylvania (HUP) and Pennsylvania Hospital (PAH).
Figure 3
Figure 3
Adjusted models stratified by race/ethnicity a showing the association with walkability and medically indicated preterm birth (mPTB), mPTB due to hypertensive disorders †, and mPTB due to other reasons. a Non-Hispanic Black (NHB), Non-Hispanic White (NHW), † Hypertensive Disorders of Pregnancy (HDP).
See this image and copyright information in PMC

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