Medicaid Expansion and Maternal Health in Racial and Ethnic Minority Women

少数族裔妇女的医疗补助扩展和孕产妇健康

基本信息

批准号：
10495195
负责人：
Jean R Guglielminotti
金额：
$ 20.25万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-24 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10495195
关键词：
Absence of pain sensation Admission activity Affect Affordable Care Act Anesthesia procedures Birth Birth Certificates Blood Transfusion Caring Censuses Centers for Disease Control and Prevention (U.S.)Certification Cesarean section Characteristics Childbirth Data Discipline of obstetrics District of Columbia Effectiveness Eligibility Determination Ensure General Anesthesia Goals Health Policy Hemorrhage Hemostatic Agents Hospitals Hysterectomy Income Information Systems Intensive Care Units Intervention Labor Pain Life Live Birth Maternal Health Medicaid Methods Minority Women Morbidity - disease rate Not Hispanic or Latino Obstetrical Anesthesia Pain Pain management Pathway interactions Patients Perinatal Postpartum Hemorrhage Pregnancy Pregnant Women Prenatal care Research Project Grants Risk Spinal System Techniques Testing Uninsured United States Vaginal delivery procedure Vital Statistics Woman base disparity reduction effectiveness evaluation ethnic minority evidence base experience improved intrapartum maternal morbidity maternal outcome mortality population health racial and ethnic disparities racial minority severe maternal morbidity

项目摘要

The broad long-term objective of the proposed research project is to ensure equitable access to safe and quality maternal care. Compared with non-Hispanic White women, racial and ethnic minority women are at significantly increased risks of experiencing severe pain and life-threatening complications during childbirth. Reducing racial and ethnic disparities in peripartum pain management and severe maternal morbidity is a national priority. Neuraxial analgesia (i.e., epidural or spinal analgesia) is the most effective technique to relieve labor pain, and it is associated with a reduced risk of severe obstetric hemorrhage. In the United States, severe obstetric hemorrhage disproportionately affects racial and ethnic minority women and is the leading cause of preventable maternal morbidity, peripartum maternal blood transfusion, hemostatic hysterectomy, and intensive care unit admission. However, labor neuraxial analgesia is underutilized in uninsured racial and ethnic minority women. Increasing access and utilization of labor neuraxial analgesia in uninsured racial and ethnic minority women could help reduce peripartum disparities in pain management and severe maternal morbidity. The 2014 Medicaid expansion under the Affordable Care Act has decreased the proportion of uninsured pregnant women and may have been associated with increased utilization of labor neuraxial analgesia and decreased risk of severe maternal morbidity. The proposed research project aims to assess in racial and ethnic minority women: 1) the association between labor neuraxial analgesia and the risks of 1a) peripartum maternal blood transfusion or hemostatic hysterectomy, and 1b) intensive care unit admission; and 2) the effectiveness of the 2014 Medicaid expansion under the Affordable Care Act in 2a) increasing labor neuraxial analgesia utilization, and 2b) reducing the risk of severe maternal morbidity. These specific aims will be achieved by analyzing birth certificate data from 2010 to 2018 from the National Vital Statistics System of the Centers for Disease Control and Prevention. This data system is a census of US births in the 50 states and the District of Columbia, based on the 2003 revised US Standard Certificate of Live Birth. Results of this project could provide scientific evidence for evaluating the Affordable Care Act and for informing healthcare policy to reduce racial and ethnic disparities in maternal health.

拟议研究项目的广泛长期目标是确保公平获得安全的服务和优质的孕产妇护理。与非西班牙裔白人女性相比，少数族裔女性处于分娩期间经历剧烈疼痛和危及生命的并发症的风险显着增加。减少围产期疼痛管理和严重孕产妇发病率方面的种族和民族差异是一项重要任务国家优先事项。椎管内镇痛（即硬膜外或脊髓镇痛）是最有效的技术缓解分娩疼痛，并降低严重产科出血的风险。在美国，严重的产科出血不成比例地影响少数族裔妇女，是导致产科出血的主要原因可预防的孕产妇发病原因、围产期孕产妇输血、止血性子宫切除术以及入住重症监护室。然而，椎管内分娩镇痛在未参保的种族和群体中并未得到充分利用。少数民族妇女。增加未参保种族和地区分娩神经镇痛的获取和利用少数民族妇女可以帮助减少围产期疼痛管理和严重孕产妇方面的差异发病率。 2014 年《平价医疗法案》下的医疗补助扩展降低了未投保的孕妇，可能与椎管内分娩的使用增加有关镇痛并降低严重孕产妇发病的风险。拟议的研究项目旨在评估少数族裔妇女：1) 协会分娩椎管内镇痛与 1a) 围产期母亲输血或止血的风险之间的关系子宫切除术，以及 1b) 入住重症监护室； 2) 2014 年医疗补助扩展的有效性根据《平价医疗法案》，2a) 增加分娩椎管内镇痛的使用，2b) 降低风险严重的孕产妇发病率。这些具体目标将通过分析 2010 年出生证明数据来实现疾病预防控制中心国家生命统计系统至 2018 年。这个数据该系统是根据 2003 年修订的美国人口普查数据，对美国 50 个州和哥伦比亚特区进行的出生人口普查。标准活产证明。该项目的结果可以为评估平价医疗法案以及为医疗保健政策提供信息以减少孕产妇的种族和民族差异健康。