Reducing Racial and Ethnic Disparities in Maternal Health through Policy Interventions

通过政策干预减少孕产妇健康方面的种族和民族差异

• 批准号: 10635586
• 负责人: Jean R Guglielminotti
• 金额: $ 55.63万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-03 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10635586
• 关键词: Address; Adopted; Adoption; Adult; Affect; Affordable Care Act; Age; Birth; COVID-19; Childbirth; Conceptions; Coronavirus; Data; Databases; Effectiveness; Ethnic Origin; Ethnic Population; Evaluation; Family; Goals; Health; Health Care Costs; Health Disparities Research; Health Insurance; Health Policy; Hospitalization; Incidence; Income; Inpatients; Insurance Carriers; Insurance Coverage; Intervention; Labor Complications; Link; Low Income Population; Low income; Maintenance; Maternal Health; Maternal Mortality; Medicaid; Methods; Natural experiment; New York; Not Hispanic or Latino; Parents; Patients; Persons; Policies; Postpartum Period; Pregnancy; Privatization; Quasi-experiment; Research; Research Project Grants; Sampling; Series; Testing; Uninsured; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Variant; aged; disparity reduction; effectiveness evaluation; ethnic disparity; ethnic health disparity; experience; federal policy; federal poverty level; health data; health disparity; hospital readmission; improve minority health; indexing; maternal risk; policy recommendation; public health emergency; public health priorities; racial disparity; racial health disparity; racial minority; response; severe maternal morbidity; young adult

The long-term goal of the proposed research project is to improve the health of minoritized racial and ethnic birthing people by reducing racial and ethnic disparities in severe maternal morbidity and maternal mortality. Specifically, the proposed research project will assess the effectiveness of 3 significant health insurance expansion policies in reducing racial and ethnic disparities in severe maternal morbidity (SMM): 1) the 2010 Dependent Coverage Provision under the Patient Protection and Affordable Care Act (ACA), requiring private health insurers to allow young adults to remain on their parent’s plan until their 26th birthday; 2) the 2014 ACA Medicaid expansion, giving states the option to expand Medicaid coverage to non- elderly adults with incomes up to 138% of the Federal Poverty Level; and 3) the Maintenance of Effort of the 2020 Families First Coronavirus Response Act (FFCRA) temporarily maintaining Medicaid coverage beyond 60-days postpartum as long the COVID-19 Public Health Emergency is in place. Minoritized racial and ethnic birthing people are three times more likely than non-Hispanic White people to experience SMM during childbirth and the postpartum. Addressing racial and ethnic disparities in SMM is recognized as an urgent public health priority. SMM refers to unintended serious complications of labor and delivery and is associated with substantially increased risk of maternal death. Providing continuous health insurance coverage through health policies, from preconception to 1-year postpartum, is a suggested intervention to mitigate these disparities. Up to 80% of minoritized racial and ethnic birthing people do not have such continuous coverage. However, evidence linking health insurance policy changes to reduced racial and ethnic disparities in SMM is scant. The 2010 ACA Dependent Coverage Provision, the 2014 ACA Medicaid expansion, and the 2020 FFCRA Maintenance of Effort present three natural experiments for assessing the effectiveness of expanding health insurance coverage in reducing racial and ethnic disparities in SMM. The proposed project will test a series of hypotheses related to the specific aims, including: 1) Expanded access to private health insurance for people under age 26 is associated with reduced racial and ethnic disparities in SMM; 2) Expanded Medicaid coverage for low-income people is associated with reduced racial and ethnic disparities in SMM, and 3) Extending Medicaid coverage for low-income people from 60-day to 1- year postpartum is associated with reduced racial and ethnic disparities in postpartum SMM. National and state data from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, will be analyzed using robust quasi-experimental approaches such as the difference-in-difference-in-differences. Results of this project will help close important gaps in health disparities research and provide rigorous evidence to inform policy interventions to reduce racial and ethnic health disparities among birthing people. It aligns with the aims of the IMPROVE initiative of the National Institutes of Health.

拟议的研究项目的长期目标是改善少数赛车的健康和 族裔生日的人通过减少严重的母亲发病率和孕产妇的种族和种族分布来减少种族和种族分布 死亡。具体而言，拟议的研究项目将评估3个重要健康状况的有效性 在严重孕产妇发病率中减少种族和种族分布的保险扩展政策 （SMM）：1）根据《患者保护和负担得起的护理法》规定的2010年依赖覆盖范围 （ACA），要求私人健康确保允许年轻人继续遵守父母的计划，直到他们26日 生日; 2）2014年ACA医疗补助扩张，使国家可以选择扩大医疗补助覆盖范围 收入高达联邦贫困水平的138％的老年人； 3）维持努力 2020年家庭第一冠状病毒反应法案（FFCRA）暂时维护医疗补助范围 60天产后只要Covid-19即将到位。 少数化的种族和种族分娩人的可能性是非西班牙裔白人的三倍 在分娩时和产后体验SMM。解决SMM中的赛车和种族差异 被认为是紧急的公共卫生优先事项。 SMM指的是意想不到的严重劳动并发症 和交付，并且与物质死亡的风险大大增加有关。提供持续的健康 从事前到产后1年的健康政策保险范围是建议 干预以减轻这些差异。多达80％的少数赛车和种族分娩的人没有 如此连续的覆盖范围。但是，将健康保险政策变更与种族减少联系起来的证据 SMM中的种族差异很少。 2010年ACA依赖覆盖范围规定，2014年ACA 医疗补助的扩张和2020 FFCRA维护努力提出了三个自然实验 评估在减少赛车和种族分配中扩大健康保险范围的有效性 SMM。拟议的项目将测试与特定目标相关的一系列假设，包括：1）扩展 为26岁以下的人获得私人健康保险与种族和种族减少有关 SMM的差异； 2）向低收入人群扩大医疗补助覆盖范围与种族减少有关 和SMM中的种族差异，以及3）将低收入人群的医疗补助覆盖范围从60天扩展到1-- 产后年度与产后SMM的种族和种族差异有关。国家和 来自医疗保健成本和利用项目，医疗保健研究和质量机构的国家数据将 可以使用可靠的准实验方法（例如差异差异差异）进行分析。 该项目的结果将有助于弥合健康分布研究的重要差距，并提供 严格的证据以告知政策干预措施，以减少种族和种族健康差异 生日的人。它符合美国国立卫生研究院的改善倡议的目标。