Evaluating maternal and newborn health inequities at the intersection of race, ethnicity, and disability in the U.S

评估美国种族、族裔和残疾交叉点的孕产妇和新生儿健康不平等

基本信息

批准号：
10722835
负责人：
Alka Dev
金额：
$ 13.64万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-28 至 2028-02-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10722835
关键词：
Address Advocate Affect Age Area Award Birth Birth Certificates Black Populations Cesarean section Characteristics Communities Coupled Data Data Files Development Development Plans Diagnosis Disabled Persons Discipline of obstetrics Disparity Disparity population Economic Conditions Educational workshop Enrollment Environment Ethnic Origin Faculty Funding Future Goals Health Health Food High-Risk Pregnancy Hispanic Populations Hospitalization Hospitals Household Housing Income Inequity Infant Infant Health Infant Mortality Institution Insurance Coverage Intellectual functioning disability Intervention K-Series Research Career Programs Knowledge Labor Complications Lead Life Link Low Birth Weight Infant Maternal Health Maternal Mortality Measurement Measures Medicaid Mentorship Methodology Methods Mothers Musculoskeletal Neighborhoods Neonatal Intensive Care Neonatal Mortality Newborn Infant Not Hispanic or Latino Outcome Persons Policies Population Postpartum Period Pregnancy Pregnancy Complications Pregnancy Rate Premature Birth Prenatal care Psyche structure Quality of Care Race Records Research Research Personnel Research Project Grants Risk Risk Factors Rural Series Services Small for Gestational Age Infant Testing Texas Training Urbanicity Variant Visit Well Child Visits Woman Work access disparities adverse birth outcomes adverse outcome black women black/white disparity career career development comorbidity cost data structure delivery complications deprivation design disability effective intervention ethnic disparity ethnic identity ethnic minority experience health care quality health disparity health equity health inequalities high risk improved improved outcome infant outcome lens mortality multilevel analysis neonatal health obstetric outcomes outcome disparities pilot test pregnancy hypertension pregnant public health insurance racial disparity racial minority residential tenure rural area rural residence rurality severe maternal morbidity skills social social determinants socioeconomic disparity socioeconomics stillbirth symposium therapy design urban area

Address Advocate Affect Age Area Award Birth Birth Certificates Black Populations Cesarean section Characteristics Communities Coupled Data Data Files Development Development Plans Diagnosis Disabled Persons Discipline of obstetrics Disparity Disparity population Economic Conditions Educational workshop Enrollment Environment Ethnic Origin Faculty Funding Future Goals Health Health Food High-Risk Pregnancy Hispanic Populations Hospitalization Hospitals Household Housing Income Inequity Infant Infant Health Infant Mortality Institution Insurance Coverage Intellectual functioning disability Intervention K-Series Research Career Programs Knowledge Labor Complications Lead Life Link Low Birth Weight Infant Maternal Health Maternal Mortality Measurement Measures Medicaid Mentorship Methodology Methods Mothers Musculoskeletal Neighborhoods Neonatal Intensive Care Neonatal Mortality Newborn Infant Not Hispanic or Latino Outcome Persons Policies Population Postpartum Period Pregnancy Pregnancy Complications Pregnancy Rate Premature Birth Prenatal care Psyche structure Quality of Care Race Records Research Research Personnel Research Project Grants Risk Risk Factors Rural Series Services Small for Gestational Age Infant Testing Texas Training Urbanicity Variant Visit Well Child Visits Woman Work access disparities adverse birth outcomes adverse outcome black women black/white disparity career career development comorbidity cost data structure delivery complications deprivation design disability effective intervention ethnic disparity ethnic identity ethnic minority experience health care quality health disparity health equity health inequalities high risk improved improved outcome infant outcome lens mortality multilevel analysis neonatal health obstetric outcomes outcome disparities pilot test pregnancy hypertension pregnant public health insurance racial disparity racial minority residential tenure rural area rural residence rurality severe maternal morbidity skills social social determinants socioeconomic disparity socioeconomics stillbirth symposium therapy design urban area

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项目摘要

PROJECT SUMMARY (ABSTRACT) People with disabilities experience pregnancy at the same rate as people without disabilities but have disproportionately higher rates of adverse outcomes including pregnancy, labor and delivery complications, severe maternal morbidity, maternal death, preterm birth, stillbirth, low birth weight, and infant mortality rates. Although there is limited information about the extent of racial and ethnic disparities in maternal and newborn health outcomes among those who are disabled, current evidence suggests that these inequities are even more pronounced among racial and ethnic minorities compared to their White counterparts. Developing effective interventions to eliminate inequities at the intersection of race, ethnicity, and disability requires a comprehensive understanding of the relationships between these multiple levels of inequity and associated birth outcomes. This project aims to fill this research gap using a social determinants of maternal health lens to analyze linked maternal-infant Medicaid claims, natality, and mortality data files. Three research aims are proposed. Aim 1 focuses on the magnitude of racial and ethnic disparities in low birthweight, small for gestational age, preterm birth, and neonatal mortality at the intersection with disability; Aim 2 evaluates the extent to which disparities in these outcomes at the intersection of race, ethnicity, and disability are moderated by area-level socioeconomic inequities; and Aim 3 evaluates the association between race, ethnicity, and disability in nationally established quality measures for maternal-infant health. The proposed aims are supported by the PI’s career training goals, which include developing expertise in 1) using Medicaid claims data to produce measures of adverse birth outcomes by race, ethnicity, and disability, 2) analyzing area-level social determinants and quality of care measures associated with maternal and newborn health disparities, and 3) understanding disability measurement, public insurance coverage, risk factors for poor health, and community priorities needed to design effective interventions to reduce maternal and infant health inequities in this population. The proposed project supports the PI’s long-term career goal to become an independent investigator and advocate for maternal and newborn health equity in the U.S., with a particular emphasis on identifying and addressing the disparities resulting from social inequities using rigorous methodologies. Career development will include a series of formal courses, training workshops, and directed readings that will be completed with faculty at Dartmouth and other institutions over the first two years with additional topics covered as needed in the subsequent years. Attendance at conferences and related workshops will also be added to stay informed of current developments in the field. The award will be followed with a Research Project Grant (R01) to develop and test an intervention to improve outcomes among those most burdened by adverse outcomes at the intersection of race, ethnicity, and disability in the U.S.

项目摘要（摘要）残疾人的怀孕与没有残疾人的率相同，但不成比例的不良后果发生率，包括怀孕，人工和分娩并发症，严重的母亲发病率，孕产妇死亡，早产，死产，低出生体重和婴儿死亡率。尽管关于母亲和新生儿种族和种族分布程度的信息有限当前的证据表明，这些不平等现象甚至是残疾人的健康状况与白人同行相比，种族和少数民族的少数民族更为明显。发展在种族，种族和残疾人交集时消除不平等的有效干预措施需要一个对这些多个不平等和相关层面之间的关系的全面理解生日成果。该项目旨在使用孕产妇健康镜头的社会决定者填补这一研究差距分析链接的产妇医疗补助索赔，出生和死亡率数据文件。三个研究目的是建议的。 AIM 1专注于低出生体重的种族和种族差异的大小，很小残疾交叉点的胎龄，早产和新生儿死亡率； AIM 2评估在种族，种族和残疾的交集中，这些结果的差异在哪些差异中得到了缓和的范围按地区级的社会经济不平等； AIM 3评估种族，种族和全国建立的孕产妇健康质量措施的残疾。拟议的目的是在PI的职业培训目标的支持下，其中包括在1）使用Medicaid索赔中发展专业知识数据以种族，种族和残疾来测量不良出生结果，2）分析面积级别社会决定者和与母校和新生儿健康差异相关的护理质量，以及 3）了解残疾测量，公共保险范围，健康状况不佳的风险因素以及社区优先事项需要设计有效的干预措施，以减少孕产妇和婴儿的健康询问这个人口。拟议的项目支持PI成为独立的长期职业目标美国的孕产妇和新生儿健康公平的研究者和倡导者，特别强调使用严格的方法来识别和解决由社会不平等导致的差异。职业开发将包括一系列正规课程，培训研讨会和定向阅读，将是在最初的两年中，达特茅斯和其他机构的教职员工完成了其他主题根据随后几年的需要。参加会议和相关研讨会的出席也将添加到了解该领域目前的发展。该奖项将遵循研究项目赠款（R01）开发和测试一种干预措施以改善最不利的人的结果美国种族，种族和残疾人的交集的结果