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，美国最高法院对多布斯诉杰克逊妇女健康案的裁决推翻了罗伊诉韦德案， 取消对全国范围内堕胎的联邦保护。多布斯的决定迅速颠覆了五十年的历史。 州立法机构已经制定了法律先例和卫生政策的规定，已有 14 个州禁止堕胎。 85 项保护或限制堕胎的法案，八个州的法院暂时阻止了该法案的通过 目前有超过 3360 万有生育能力的人生活在禁止堕胎的州。 这些快速变化的政策对堕胎的影响可能会受到严格限制。 但这些政策对慢性病患者的公共卫生指数的影响尚不清楚。 复杂的医疗状况特别容易因以下原因而对健康造成不良后果： 在基线时，这些人面临严重孕产妇发病和孕产妇死亡的高风险。 在多布斯做出决定之前，堕胎护理允许终生死亡。 改变对那些因潜在健康状况而导致健康怀孕变得困难的人的护理。 研究描述了堕胎对慢性病患者的健康和福祉的影响； 因此，尚不清楚多布斯的决定将如何影响他们的临床结果。 慢性病患者的敏感生殖健康公平后多布斯 (INTREPID) 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 患有会增加严重孕产妇发病和孕产妇死亡风险的慢性疾病的人（例如， 心血管疾病、癌症、系统性红斑狼疮）； 患有慢性疾病的人；以及人口层面的下游临床结果。 基于定性和流行病学的方法来实现我们的具体目标，这些目标是：1）评估， 在寻求堕胎的人中，谁能够或不能获得想要的堕胎，并评估他们的情况 与健康和福祉相关的纵向结果；2) 在医生中评估堕胎的影响 医疗决策和实践的政策；以及 3) 产生有关堕胎影响的新证据 基于人口的妊娠结局政策（例如严重孕产妇发病率、孕产妇死亡率）以及 医疗保健相关结果（例如，避孕和致畸药物处方）。 研究团队拥有医学、产科、计划生育研究、健康公平、 我们的项目旨在为优化生殖健康的卫生政策提供信息。 后多布斯时代的医疗保健和临床结果。