Time-Sensitive Research to Assess the Effects of Reproductive Health Policy on the Health Outcomes of People with Chronic Diseases

评估生殖健康政策对慢性病患者健康结果影响的时间敏感研究

• 批准号: 10768227
• 负责人: Mehret Birru Talabi
• 金额: $ 68.17万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10768227
• 关键词: Advertising; Affect; Age; Birth; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Clinical; Complex; Contraceptive methods; Dangerousness; Data; Decision Making; Disabled Persons; Discipline of obstetrics; Disease; Drug Prescriptions; Eligibility Determination; Epidemiology; Equity; Family Planning; Female; Health; Health Policy; Health Services; Healthcare; Individual; Interview; Legal; Life; Low income; Malignant Neoplasms; Maternal Mortality; Medicaid; Medical; Medicine; Outcome; Outcome Assessment; Patient Outcomes Assessments; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacy facility; Physicians; Policies; Population; Pregnancy; Pregnancy Outcome; Primary Care; Procedures; Public Health; Recommendation; Recording of previous events; Regulation; Reporting; Reproductive Health; Research; Respondent; Risk; Sampling; Surveys; Systemic Lupus Erythematosus; Teratogens; Time; Travel; Women' s Health; abortion; adverse pregnancy outcome; child bearing; clinical center; clinical practice; court; experience; fetal; health equity; health practice; healthy pregnancy; high risk; indexing; multidisciplinary; person centered; population based; pregnant; recruit; search engine; severe maternal morbidity; social; socioeconomics; unintended pregnancy

ABSTRACT In June 2022, the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health overturned Roe v. Wade, eliminating federal protections for abortion access nationwide. The Dobbs decision rapidly upended fifty years of legal precedent and health policy. Fourteen states have banned abortion, state legislatures have introduced 85 bills to protect or restrict abortion access, and courts in eight states have temporarily blocked the passage of abortion bans. Over 33.6 million people with childbearing capacity now live in states where abortion is banned or likely to be heavily restricted. The effect of these rapidly changing policies on abortion access will be profound, yet the consequences of these policies on public health indices are unknown. People with chronic and complex medical conditions are particularly vulnerable to adverse health consequences as a result of abortion policy. At baseline, these individuals are at high risk for severe maternal morbidity and maternal mortality as compared to other birthing people. Prior to the Dobbs decision, abortion care allowed for life- altering care among people whose underlying health conditions complicated healthy pregnancy. However, few studies had described the impact of abortion on the health and well-being of individuals with chronic diseases; thus, it is unclear how the Dobbs decision will impact their clinical outcomes. Our study, Investigating Time- sensitive Reproductive Health Equity Post-Dobbs for Patients with ChronIc Disease (INTREPID), will evaluate the time-sensitive impact of evolving abortion policies on the health and well-being of patients, particularly those with chronic diseases that increase the risk of severe maternal morbidity and maternal mortality (e.g., cardiovascular disease, cancer, systemic lupus erythematosus); the clinical practice of physicians who care for people with chronic diseases; and downstream clinical outcomes at a population level. We will use survey- based, qualitative, and epidemiologic approaches to realize our Specific Aims, which are to: 1) Evaluate, among people who are seeking abortion, who is able or not able to obtain a wanted abortion, and to assess their longitudinal outcomes related to health and well-being; 2) Assess, among physicians, the impact of abortion policy on medical decision-making and practice; and 3) Generate new evidence about the impact of abortion policy on population-based pregnancy outcomes (e.g., severe maternal morbidity, maternal mortality) and healthcare-related outcomes (e.g., contraception and teratogenic medication prescribing). The INTREPID research team has multidisciplinary expertise in medicine, obstetrics, family planning research, health equity, health policy, and epidemiology. Our project seeks to inform health policy that will optimize reproductive healthcare and clinical outcomes in the post-Dobbs era.

抽象的 2022年6月，美国最高法院在Dobbs诉Jackson妇女健康中的裁决推翻了Roe诉Wade， 消除联邦保护措施在全国范围内获得堕胎。多布斯的决定迅速升高了五十年 法律先例和卫生政策。 14个州已禁止堕胎，州立法机关已引入 85个保护或限制堕胎访问的账单，八个州的法院暂时阻止了 堕胎禁令。现在有超过3360万生产能力的人居住在禁止堕胎的州 或可能受到严格限制。这些快速变化的政策对流产访问的影响将是 这些政策对公共卫生指数的影响很大，尚不清楚。患有慢性的人 复杂的医疗状况尤其容易受到不良健康后果的影响 堕胎政策。在基线时，这些人有严重的母亲发病率和母亲的高风险 与其他生物学人相比，死亡率。在做出多布斯州的决定之前，允许堕胎护理终身 - 改变基本健康状况使健康怀孕复杂的人的护理。但是，很少 研究描述了堕胎对慢性疾病患者健康和福祉的影响。 就是这样，目前尚不清楚Dobbs的决定将如何影响其临床结果。我们的研究，调查时间 - 对患有慢性疾病患者（Intrepid）患者的敏感生殖健康公平企业将评估 不断发展的堕胎政策对患者健康和福祉的时间敏感影响，特别是 患有慢性疾病的人会增加严重的孕产妇发病率和孕产妇死亡率的风险（例如， 心血管疾病，癌症，全身性红斑狼疮）；关心医生的临床实践 患有慢性疾病的人；以及人群水平的下游临床结果。我们将使用调查 - 基于：1）评估，评估，定性和流行病学方法来实现我们的具体目标：1）评估，评估， 在寻求堕胎的人中，能够或无法获得通缉堕胎的人 与健康和福祉有关的纵向结果； 2）评估医生的堕胎影响 医疗决策和实践的政策； 3）生成有关堕胎影响的新证据 基于人群的怀孕结局（例如严重的母亲发病率，孕产妇死亡率）和 与医疗保健相关的结果（例如避孕药和致死性药物处​​方）。勇敢的 研究团队在医学，妇产科，计划生育研究，健康公平方面拥有多学科专业知识， 卫生政策和流行病学。我们的项目旨在为健康政策提供信息，以优化生殖 后DOBBS时代的医疗保健和临床结果。