Social and biological determinants of pregnancy-related mortality and morbidity among rural, underserved women

农村、服务不足的妇女中妊娠相关死亡率和发病率的社会和生物决定因素

基本信息

批准号：
10461098
负责人：
Anna Hansen
金额：
$ 5.18万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-02 至 2024-08-01
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10461098
关键词：
Address Adopted Alaska Native American Appalachian Region Biological Caring Cessation of life Chronic Disease County Data Data Set Databases Death Records Detection Development Diabetes Mellitus Diagnosis Discipline of obstetrics Disease Distress Emergency Medical Technicians Epidemiology Etiology Evaluation Evidence based intervention Extramural Activities Female of child bearing age Foundations Future Health Health Personnel Healthcare High Prevalence Home Hospitalization Hypertension Intervention Interview Investigation Kentucky Knowledge Link Location Logistic Regressions Maternal Health Maternal-fetal medicine Medical Mentors Mentorship Methods Mississippi Morbidity - disease rate Mothers Native Americans Organ Outcome Participant Patient Care Patients Pattern Persons Physicians Policies Population Populations at Risk Postnatal Care Postpartum Period Postpartum Women Poverty Pregnancy Pregnancy Complications Pregnancy Outcome Pregnant Women Prevalence Prevention Provider Regression Analysis Research Research Support Residencies Resources Risk Risk Factors Rural Rural Appalachia Rural Population Scientist Structure Sum Training United States United States National Center for Health Statistics United States National Institutes of Health Universities Validity of Results Woman World Health Organization black women burden of illness cultural competence data centers evidence base experience health care availability health disparity populations health equity health inequalities implementation science innovation insight maternal outcome member mortality mortality risk neglect obstetric care predictive modeling prepregnancy protective factors research data dissemination residence responsible research conduct rural area rural health disparities rural setting rural underserved secondary analysis severe maternal morbidity social social determinants social health determinants sociodemographic factors

项目摘要

ABSTRACT Over the past two decades, the number of women dying from pregnancy-related causes in the United States has nearly doubled, and cases of severe maternal morbidity have nearly tripled.2, 3 Research concerning the factors influencing pregnancy-related mortality (PRM) and severe maternal morbidity (SMM) has previously neglected women in Central Appalachia, despite the risk profile of this health disparate population. This study utilizes a rigorous mixed methods approach guided by the conceptual framework for action on the social determinants of health adopted by the World Health Organization to identify structural and intermediary determinants influencing Central Appalachian women's risk for SMM and PRM.1, 4 This study is highly innovative in that it is the first study nationally outside the National Center for Health Statistics (NCHS) to utilize a new database from the NCHS, which links morbidity and mortality data. Furthermore, it is the first known study to focus on SMM and PRM in women living in Central Appalachia, and may yield critical intervention insights for this underserved, health disparate population. The following aims will: (1) Identify predictors of PRM and SMM in Central Appalachia. This aim will perform hierarchical logistic regressions on nation-wide data from the NCHS to determine risk and protective factors influencing women's risk of SMM and PRM at delivery and one year postpartum. (2) Elucidate healthcare providers' and patients' perspectives on underlying mechanisms of PRM and SMM in Central Appalachia. In-depth semi-structured interviews will be conducted with: (1) 10 patients who have experienced SMM, and (2) 10 healthcare providers and 10 EMTs in Central Appalachia who have provided care for patients experiencing SMM and PRM. The PI will leverage resources and expertise from the University of Kentucky's Center for Health Equity Research, Research Data Center, and a highly supportive interdisciplinary mentorship team who are experts in rural health disparities, implementation science, and maternal-fetal medicine. Mentorship by team members will provide the PI with ample training concerning the implementation of mixed methods studies, project management, responsible conduct of research, and the dissemination of findings. This training will provide the PI with the skillset necessary to carry out the specific aims, and lay the foundation for the PI to become an independent physician-scientist with an extramurally supported research portfolio in the field of maternal health. Results from this study will produce essential knowledge concerning predictors of SMM and PRM in an at-risk population, and identify factors influencing poor maternal outcomes which may be targeted by future interventions. Findings may also inform development of future empirical investigations into in other rural populations.

抽象的过去二十年来，美国死于妊娠相关原因的女性人数州几乎增加了一倍，严重孕产妇发病率几乎增加了两倍。2, 3 研究关于影响妊娠相关死亡率（PRM）和严重孕产妇发病率（SMM）的因素此前曾忽视阿巴拉契亚中部地区的女性，尽管这种健康状况存在差异的风险状况人口。本研究采用严格的混合方法，以概念框架为指导世界卫生组织通过的关于健康问题社会决定因素的行动，旨在确定结构性和影响阿巴拉契亚中部妇女 SMM 和 PRM 风险的中间决定因素.1, 4 这项研究具有高度创新性，是国家卫生中心以外的第一项全国性研究统计 (NCHS) 利用 NCHS 的新数据库，将发病率和死亡率数据联系起来。此外，这是第一个已知的关注阿巴拉契亚中部女性 SMM 和 PRM 的研究，可能会为这一服务不足、健康状况不同的人群提供重要的干预见解。以下目标将： (1) 确定阿巴拉契亚中部 PRM 和 SMM 的预测因子。该目标将执行分层物流对 NCHS 的全国数据进行回归以确定影响妇女健康的风险和保护因素分娩时和产后一年的 SMM 和 PRM 风险。 (2) 阐明医疗保健提供者和患者对 PRM 和 SMM 潜在机制的看法阿巴拉契亚中部。深入的半结构化访谈将针对以下对象进行： (1) 10 名患有以下疾病的患者：经验丰富的 SMM，以及 (2) 中阿巴拉契亚地区的 10 名医疗保健提供者和 10 名急救人员，他们提供了护理经历 SMM 和 PRM 的患者。 PI 将利用肯塔基大学健康公平中心的资源和专业知识研究、研究数据中心和高度支持的跨学科专家指导团队农村健康差异、实施科学和母胎医学。团队成员的指导将为 PI 提供有关混合方法研究、项目实施的充分培训管理、负责任的研究行为以及研究结果的传播。本次培训将提供 PI 具备实现特定目标所需的技能，并为 PI 成为一名独立医师科学家，在孕产妇领域拥有校外支持的研究组合健康。这项研究的结果将产生有关 SMM 和 PRM 预测因素的基本知识风险人群，并确定影响不良孕产妇结局的因素，这些因素可能是未来的目标干预措施。研究结果还可能为其他农村地区未来实证调查的发展提供信息人口。