Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight

严重的孕产妇发病率：对种族差异、社会弱势的调查

基本信息

批准号：
10660008
负责人：
SUZAN L CARMICHAEL
金额：
$ 60.08万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-01-19 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10660008
关键词：
Address Affect Anemia Birth Black American Body mass index California Censuses Cesarean section Child Communities Country Data Death Certificates Disparity Education Ensure Equity Ethnic Origin Exclusion Fetal Death Health Healthcare Hemorrhage Hospitals Hypertension Income Individual Inequality Inequity Infection Intervention Investigation Joints Knowledge Life Cycle Stages Link Live Birth Masks Maternal Health Maternal Mortality Mediation Medical Methods Morbidity - disease rate Mothers Multiple Pregnancy Native Americans Neighborhoods New Jersey Organ failure Outcome Outcome Study Persons Phase Population Population Research Postpartum Period Poverty Pregnancy Prevention strategy Proxy Race Records Recurrence Research Resources Risk Risk Assessment Risk Factors Risk Reduction Sepsis Social Environment Social Identification Survivors Time Translating Translations Virginia Woman Work community engagement community organizations data resource disparity elimination ethnic disparity health disparity high risk improved intersectionality large scale data longitudinal dataset marginalization maternal morbidity maternal outcome maternal weight neighborhood disadvantage next generation parent grant people of color pregnancy disorder pregnancy health pregnant prepregnancy racial disparity reproductive segregation severe maternal morbidity social social disparities social structure socioeconomics success

项目摘要

ABSTRACT Severe maternal morbidity (SMM), which encompasses conditions that put pregnant people most at risk of dying (e.g., hemorrhage, sepsis, organ failure), doubled in the last two decades. The most common precursors to SMM – anemia, hypertensive disorders of pregnancy (HDP), and cesarean birth – are also increasing. People of color, especially Black and Native American people, are at increased risk for all these outcomes. This Renewal proposal builds on our prior work to address inequities in maternal outcomes. Via the Parent Grant, our team enhanced current understanding of the contribution of social context (focusing on neighborhood social disadvantage) and maternal pre-pregnancy health (focusing on body mass index) to SMM risk, using a unique data resource we built of California (CA) births. This Renewal uses theoretically grounded approaches to address several remaining gaps in our understanding of maternal health in the U.S. that were illuminated by the Parent Grant. We will build a unique resource of 16 million births in three states from 1997-2021. The dataset longitudinally links vital records (live birth and fetal death certificates) with hospital discharge data for mother and baby; includes residential address; and links data for repeat pregnancies to the same person over time, thus providing the type of large-scale data with high-quality information on maternal health and social context that the field needs to advance population-level research on maternal health. All phases of the research will be guided by a community advisory board (CAB). Using an intersectionality framework, Aim 1 will examine joint impacts of multiple forms of marginalization on SMM, its subtypes (i.e., hypertension-, hemorrhage-, and sepsis-related SMM), and its precursors (i.e., HDP, anemia, mode of birth). Indicators of marginalization include race-ethnicity, education, health care payer, nativity, and census tract-level markers of social disadvantage and structural inequality (e.g., poverty, segregation). Using a reproductive life-course framework, Aim 2 will determine the cumulative impact of social and medical risk factors across successive pregnancies on maternal health (i.e., SMM, SMM subtypes, SMM precursors). We will examine how factors related to social context (e.g., persistent census tract poverty), morbidity (e.g., persistent HDP), and mode of birth (primary cesarean birth) affect subsequent occurrence and recurrence of the study outcomes. Aim 3 will use findings from Aims 1 and 2 to identify and prioritize strategies to improve maternal health and equity. We will use a) causal inference methods (mediation and g-computation) to understand mechanisms and compare the potential impact of selected hypothetical interventions on study outcomes and disparities, and b) community-engaged prioritization methods to synthesize our findings and prioritize next steps. By understanding risks across multiple forms of marginalization and successive pregnancies, and guided by rigorous analytics and community-grounded knowledge, our work will contribute to advancing the next generation of actionable population-level SMM equity research.

抽象的严重孕产妇发病率 (SMM)，包括使孕妇面临最大风险的病症死亡（例如出血、败血症、器官衰竭）在过去二十年翻了一番最常见。 SMM 的前兆——贫血、妊娠高血压疾病 (HDP) 和剖腹产——也是有色人种，尤其是黑人和美洲原住民，所有人面临的风险都在增加。本更新提案以我们之前解决孕产妇不平等问题的工作为基础。通过家长补助金，我们的团队加深了对社会贡献的当前理解。环境（关注邻里社会弱势）和孕产妇孕前健康（关注身体）质量指数）到 SMM 风险，使用我们为加州 (CA) 出生建立的独特数据资源。以理论为基础的方法来解决我们对孕产妇健康的理解中仍然存在的一些差距在美国，我们将建立一个包含 1600 万新生儿的独特资源。该数据集纵向链接了 1997 年至 2021 年的三个州的重要记录（活产和胎儿死亡证明）。母亲和婴儿的出院数据；包括居住地址和重复链接数据；随着时间的推移，同一个人怀孕，从而提供高质量的大规模数据类型该领域需要推进人口层面研究的有关孕产妇健康和社会背景的信息孕产妇健康研究的所有阶段都将由社区咨询委员会 (CAB) 进行指导。交叉性框架，目标 1 将研究多种形式的边缘化对 SMM 的联合影响，其亚型（即高血压、出血和败血症相关的 SMM）及其前体（即 HDP、贫血、出生方式）。边缘化指标包括种族、教育、医疗保健支付者、出生地和人口普查区层面的社会劣势和结构性不平等标记（例如贫困、种族隔离）。生殖生命历程框架，目标 2 将确定社会和医疗风险的累积影响连续妊娠对孕产妇健康的影响因素（即 SMM、SMM 亚型、SMM 前体）。将研究与社会背景（例如，持续的人口普查区贫困）、发病率（例如，持续性HDP）和分娩方式（初次剖腹产）会影响随后的发生和复发目标 3 将利用目标 1 和 2 的结果来确定改进策略并确定优先顺序。我们将使用 a) 因果推理方法（中介和 g 计算）来了解机制并比较所选假设干预措施对研究的潜在影响结果和差异，以及 b) 社区参与的优先排序方法来综合我们的发现和通过了解多种形式的边缘化和连续的风险，确定下一步的优先顺序。怀孕，并以严格的分析和社区知识为指导，我们的工作将有助于推进下一代可操作的人口层面 SMM 公平研究。