Missing Shade, Missing Health: Tree Canopy Disparities and Neonatal Sepsis in a Midwestern U.S. City

Neonatal sepsis is a critical health concern, particularly affecting low birthweight and preterm infants, with higher incidence rates among Black infants. In urban settings, environmental inequities, such as reduced tree canopy coverage, may influence neonatal health outcomes by affecting maternal stress levels and exposure to air pollution. This retrospective study analyzed electronic medical records from six SSM Health hospitals in St. Louis, Missouri, encompassing over 74,000 births between 2013 and 2022. Tree canopy coverage around maternal residences was quantified using geospatial data and categorized based on recommended residential thresholds. Logistic regression models assessed the association between tree canopy coverage and neonatal sepsis, adjusting for sociodemographic and clinical covariates. Among the infants studied, 2.3% were diagnosed with neonatal sepsis. Infants born to mothers residing in areas with below-recommended tree canopy coverage (<20%) exhibited a higher risk of neonatal sepsis (RR=1.15; 95%; CI: 1.07–1.23; p<0.05). Additional risk factors included younger maternal age and maternal smoking. Notably, average tree canopy coverage in the study area declined from 20.3% in 2013 to 17.9% in 2021. Lower residential tree canopy density urban neighborhoods is associated with an increased risk of neonatal sepsis. These findings underscore the importance of environmental considerations in maternal and child health strategies. Enhancing urban tree canopy coverage may serve as a structural intervention to mitigate neonatal health disparities and improve overall urban population health.