Evaluating maternal and newborn health inequities at the intersection of race, ethnicity, and disability in the U.S

评估美国种族、族裔和残疾交叉点的孕产妇和新生儿健康不平等

• 批准号: 10722835
• 负责人: Alka Dev
• 金额: $ 13.64万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-28 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722835
• 关键词: Address; Advocate; Affect; Age; Area; Award; Birth; Birth Certificates; Black Populations; Cesarean section; Characteristics; Communities; Coupled; Data; Data Files; Development; Development Plans; Diagnosis; Disabled Persons; Discipline of obstetrics; Disparity; Disparity population; Economic Conditions; Educational workshop; Enrollment; Environment; Ethnic Origin; Faculty; Funding; Future; Goals; Health; Health Food; High-Risk Pregnancy; Hispanic Populations; Hospitalization; Hospitals; Household; Housing; Income; Inequity; Infant; Infant Health; Infant Mortality; Institution; Insurance Coverage; Intellectual functioning disability; Intervention; K-Series Research Career Programs; Knowledge; Labor Complications; Lead; Life; Link; Low Birth Weight Infant; Maternal Health; Maternal Mortality; Measurement; Measures; Medicaid; Mentorship; Methodology; Methods; Mothers; Musculoskeletal; Neighborhoods; Neonatal Intensive Care; Neonatal Mortality; Newborn Infant; Not Hispanic or Latino; Outcome; Persons; Policies; Population; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Rate; Premature Birth; Prenatal care; Psyche structure; Quality of Care; Race; Records; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Rural; Series; Services; Small for Gestational Age Infant; Testing; Texas; Training; Urbanicity; Variant; Visit; Well Child Visits; Woman; Work; access disparities; adverse birth outcomes; adverse outcome; black women; black/white disparity; career; career development; comorbidity; cost; data structure; delivery complications; deprivation; design; disability; effective intervention; ethnic disparity; ethnic identity; ethnic minority; experience; health care quality; health disparity; health equity; health inequalities; high risk; improved; improved outcome; infant outcome; lens; mortality; multilevel analysis; neonatal health; obstetric outcomes; outcome disparities; pilot test; pregnancy hypertension; pregnant; public health insurance; racial disparity; racial minority; residential tenure; rural area; rural residence; rurality; severe maternal morbidity; skills; social; social determinants; socioeconomic disparity; socioeconomics; stillbirth; symposium; therapy design; urban area

PROJECT SUMMARY (ABSTRACT) People with disabilities experience pregnancy at the same rate as people without disabilities but have disproportionately higher rates of adverse outcomes including pregnancy, labor and delivery complications, severe maternal morbidity, maternal death, preterm birth, stillbirth, low birth weight, and infant mortality rates. Although there is limited information about the extent of racial and ethnic disparities in maternal and newborn health outcomes among those who are disabled, current evidence suggests that these inequities are even more pronounced among racial and ethnic minorities compared to their White counterparts. Developing effective interventions to eliminate inequities at the intersection of race, ethnicity, and disability requires a comprehensive understanding of the relationships between these multiple levels of inequity and associated birth outcomes. This project aims to fill this research gap using a social determinants of maternal health lens to analyze linked maternal-infant Medicaid claims, natality, and mortality data files. Three research aims are proposed. Aim 1 focuses on the magnitude of racial and ethnic disparities in low birthweight, small for gestational age, preterm birth, and neonatal mortality at the intersection with disability; Aim 2 evaluates the extent to which disparities in these outcomes at the intersection of race, ethnicity, and disability are moderated by area-level socioeconomic inequities; and Aim 3 evaluates the association between race, ethnicity, and disability in nationally established quality measures for maternal-infant health. The proposed aims are supported by the PI’s career training goals, which include developing expertise in 1) using Medicaid claims data to produce measures of adverse birth outcomes by race, ethnicity, and disability, 2) analyzing area-level social determinants and quality of care measures associated with maternal and newborn health disparities, and 3) understanding disability measurement, public insurance coverage, risk factors for poor health, and community priorities needed to design effective interventions to reduce maternal and infant health inequities in this population. The proposed project supports the PI’s long-term career goal to become an independent investigator and advocate for maternal and newborn health equity in the U.S., with a particular emphasis on identifying and addressing the disparities resulting from social inequities using rigorous methodologies. Career development will include a series of formal courses, training workshops, and directed readings that will be completed with faculty at Dartmouth and other institutions over the first two years with additional topics covered as needed in the subsequent years. Attendance at conferences and related workshops will also be added to stay informed of current developments in the field. The award will be followed with a Research Project Grant (R01) to develop and test an intervention to improve outcomes among those most burdened by adverse outcomes at the intersection of race, ethnicity, and disability in the U.S.

项目概要（摘要） 残疾人的怀孕率与正常人相同，但 不良后果的发生率不成比例地较高，包括妊娠、分娩和分娩并发症， 严重的孕产妇发病率、孕产妇死亡、早产、死产、低出生体重和婴儿死亡率。 尽管有关孕产妇和新生儿种族和民族差异程度的信息有限 残疾人的健康状况，目前的证据表明这些不平等甚至 与发展中国家的白人相比，少数族裔和族裔的这种现象更为明显。 消除种族、族裔和残疾交叉方面的不平等现象的有效干预措施需要 全面了解这些多层次的不平等和相关的之间的关系 该项目旨在利用孕产妇健康的社会决定因素来填补这一研究空白 分析关联的母婴医疗补助申请、出生率和死亡率数据文件有三个研究目标。 提出的目标 1 侧重于低出生体重、小出生体重的种族和民族差异的程度。 目标 2 评估胎龄、早产和新生儿死亡率与残疾的交叉点； 在种族、族裔和残疾交叉点上这些结果的差异得到缓和的程度 目标 3 评估种族、族裔和社会经济不平等之间的关系 国家制定的母婴健康质量措施中的残疾问题 拟议的目标是 得到 PI 职业培训目标的支持，其中包括发展 1) 使用医疗补助索赔方面的专业知识 用于按种族、族裔和残疾情况衡量不良出生结果的数据，2) 分析地区级别 与孕产妇和新生儿健康差异相关的社会决定因素和护理质量措施，以及 3) 了解残疾衡量、公共保险覆盖范围、健康状况不佳的风险因素，以及 社区需要优先考虑设计有效的干预措施，以减少孕产妇和婴儿健康不平等 拟议的项目支持 PI 成为独立人士的长期职业目标。 美国孕产妇和新生儿健康公平的调查员和倡导者，特别强调 使用严格的方法来识别和解决社会不平等造成的差异。 开发将包括一系列正式课程、培训研讨会和定向阅读 前两年与达特茅斯和其他机构的教师一起完成，涵盖了其他主题 今后几年根据需要还将参加会议和相关研讨会。 随时了解该领域的当前发展。该奖项之后将获得研究项目补助金。 (R01) 开发和测试一项干预措施，以改善那些最受不利影响的人的结果 美国种族、族裔和残疾的交叉结果