Social and biological determinants of pregnancy-related mortality and morbidity among rural, underserved women

农村、服务不足的妇女中妊娠相关死亡率和发病率的社会和生物决定因素

• 批准号: 10676160
• 负责人: Anna Hansen
• 金额: $ 5.27万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-02 至 2024-08-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10676160
• 关键词: Address; Adopted; Alaska Native; American; Appalachian Region; Biological; Caring; Cessation of life; Chronic Disease; Classification; County; Data; Data Set; Databases; Death Records; Detection; Development; Diabetes Mellitus; Diagnosis; Discipline of obstetrics; Disease; Distress; Emergency Medical Technicians; Epidemiology; Etiology; Evaluation; Evidence based intervention; Extramural Activities; Female of child bearing age; Foundations; Future; Health Personnel; Healthcare; High Prevalence; Home; Hospitalization; Hypertension; Intervention; Interview; Investigation; Kentucky; Knowledge; Link; Location; Logistic Regressions; Maternal Health; Maternal-fetal medicine; Medical; Mentors; Mentorship; Methods; Mississippi; Morbidity - disease rate; Mothers; Native Americans; Organ; Outcome; Participant; Patient Care; Patients; Pattern; Persons; Physicians; Policies; Population; Populations at Risk; Postnatal Care; Postpartum Period; Postpartum Women; Poverty; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Prevalence; Prevention; Provider; Research; Research Support; Residencies; Resources; Risk; Risk Factors; Rural; Rural Appalachia; Rural Population; Scientist; Structure; Training; United States; United States National Center for Health Statistics; United States National Institutes of Health; Universities; Validity of Results; Woman; World Health Organization; black women; burden of illness; cultural competence; data centers; evidence base; experience; health care availability; health disparity populations; health equity; health inequalities; implementation science; innovation; insight; maternal outcome; member; mortality; mortality risk; neglect; obstetric care; patient level intervention; predictive modeling; pregnancy health; prepregnancy; protective factors; residence; responsible research conduct; risk mitigation; rural area; rural health disparities; rural setting; rural underserved; secondary analysis; severe maternal morbidity; skills; social; social determinants; social health determinants; sociodemographic factors

ABSTRACT Over the past two decades, the number of women dying from pregnancy-related causes in the United States has nearly doubled, and cases of severe maternal morbidity have nearly tripled.2, 3 Research concerning the factors influencing pregnancy-related mortality (PRM) and severe maternal morbidity (SMM) has previously neglected women in Central Appalachia, despite the risk profile of this health disparate population. This study utilizes a rigorous mixed methods approach guided by the conceptual framework for action on the social determinants of health adopted by the World Health Organization to identify structural and intermediary determinants influencing Central Appalachian women's risk for SMM and PRM.1, 4 This study is highly innovative in that it is the first study nationally outside the National Center for Health Statistics (NCHS) to utilize a new database from the NCHS, which links morbidity and mortality data. Furthermore, it is the first known study to focus on SMM and PRM in women living in Central Appalachia, and may yield critical intervention insights for this underserved, health disparate population. The following aims will: (1) Identify predictors of PRM and SMM in Central Appalachia. This aim will perform hierarchical logistic regressions on nation-wide data from the NCHS to determine risk and protective factors influencing women's risk of SMM and PRM at delivery and one year postpartum. (2) Elucidate healthcare providers' and patients' perspectives on underlying mechanisms of PRM and SMM in Central Appalachia. In-depth semi-structured interviews will be conducted with: (1) 10 patients who have experienced SMM, and (2) 10 healthcare providers and 10 EMTs in Central Appalachia who have provided care for patients experiencing SMM and PRM. The PI will leverage resources and expertise from the University of Kentucky's Center for Health Equity Research, Research Data Center, and a highly supportive interdisciplinary mentorship team who are experts in rural health disparities, implementation science, and maternal-fetal medicine. Mentorship by team members will provide the PI with ample training concerning the implementation of mixed methods studies, project management, responsible conduct of research, and the dissemination of findings. This training will provide the PI with the skillset necessary to carry out the specific aims, and lay the foundation for the PI to become an independent physician-scientist with an extramurally supported research portfolio in the field of maternal health. Results from this study will produce essential knowledge concerning predictors of SMM and PRM in an at-risk population, and identify factors influencing poor maternal outcomes which may be targeted by future interventions. Findings may also inform development of future empirical investigations into in other rural populations.

抽象的 在过去的二十年中，统一因妊娠有关的原因而死的妇女人数 各州几乎翻了一番，严重孕产妇发病率的病例几乎增加了两倍。2，3个研究 关于影响妊娠相关死亡率（PRM）和严重母体发病率（SMM）的因素 尽管这种健康状况不同 人口。这项研究利用了一种严格的混合方法方法，以概念框架为指导 世界卫生组织采用的卫生社会决定因素的行动，以识别结构性和 影响阿巴拉契亚中部妇女对SMM和PRM.1、4的中央决定因素 这项研究具有很高的创新性，因为它是国家卫生中心以外的全国性研究 统计（NCHS）利用NCH的新数据库，该数据库链接了发病率和死亡率数据。 此外，这是第一个专注于阿巴拉契亚中部妇女的SMM和PRM的知名研究， 可能会给这个服务不足的健康人群提供关键的干预见解。 以下目标将： （1）确定阿巴拉契亚中部的PRM和SMM的预测因子。这个目标将执行层次逻辑 NCH的全国数据回归，以确定影响妇女的风险和保护因素 SMM和PRM的风险和产后一年。 （2）阐明医疗保健提供者和患者对PRM和SMM基础机制的观点 中央阿巴拉契亚。深入的半结构化访谈将与：（1）10名患者 经验丰富的SMM，（2）在阿巴拉契亚中部的10个医疗保健提供者和10个EMT 照顾经历SMM和PRM的患者。 PI将利用肯塔基大学健康公平中心的资源和专业知识 研究，研究数据中心以及高度支持的跨学科指导团队 在农村健康差异，实施科学和孕产妇医学方面。团队成员的指导 将为PI提供有关实施混合方法研究的充分培训，项目 管理，负责任的研究以及调查结果的传播。这项培训将提供 PI具有执行特定目标所需的技能，并为PI成为一个基础 独立医师科学家，具有外部支持的研究组合 健康。这项研究的结果将产生有关SMM和PRM预测指标的基本知识 高危人口，并确定影响孕产妇预后不良的因素，这可能是未来的目标 干预措施。调查结果还可能为其他农村的未来实证研究发展提供信息 人群。