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

Theresa A Kash1, Rachel F Ledyard2, Anne M Mullin3

  • 1Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.

International Journal of Environmental Research and Public Health
|June 10, 2023
PubMed

Insights

Neighborhood walkability may decrease the risk of medically indicated preterm birth (mPTB), but not spontaneous preterm birth (sPTB). Protective effects were not observed for Black mothers, highlighting urban planning needs for health equity.

Area of Science:

  • Environmental Health
  • Perinatal Epidemiology
  • Urban Planning

Background:

  • Preterm birth (PTB) affects 1 in 10 U.S. infants, with significant racial disparities.
  • Neighborhood characteristics, including walkability, are increasingly recognized as potential contributors to PTB.
  • PTB presents as spontaneous (sPTB) or medically indicated (mPTB), with distinct underlying causes.

Purpose of the Study:

  • To investigate the association between neighborhood walkability and the risk of sPTB and mPTB.
  • To examine if these associations differ by PTB phenotype.
  • To explore potential race-based differences in the protective effects of walkability.

Main Methods:

  • Analysis of a Philadelphia birth cohort (n=19,203).
  • Quantification of neighborhood walkability using Walk Score® rankings.
  • Race-stratified analyses to assess disparities in associations between walkability and PTB phenotypes.

Main Results:

  • Increased walkability was associated with decreased odds of medically indicated preterm birth (mPTB) (aOR 0.90).
  • No significant association was found between walkability and spontaneous preterm birth (sPTB) (aOR 1.04).
  • A significant interaction (p=0.03) indicated walkability was not protective for mPTB in Black patients (aOR 1.05) compared to White patients (aOR 0.87).

Conclusions:

  • Neighborhood walkability may reduce the risk of medically indicated preterm birth.
  • The protective association of walkability on mPTB is not equitable across racial groups.
  • Urban planning interventions should consider neighborhood walkability to promote health equity in birth outcomes.

Keywords:
pregnancypreterm birthracial disparitieswalkability

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