State-level factors and maternal and child health outcomes

州级因素和妇幼健康结果

• 批准号: 10708173
• 负责人: Sarah C.M. Roberts
• 金额: $ 53.08万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708173
• 关键词: Achievement; Address; Adoption; Adverse effects; Adverse event; Affect; Age; Birth; Buffers; Caring; Characteristics; Child; Code; Country; Data; Data Analyses; Data Set; Databases; Development; Disparity population; Economics; Epidemiologic Methods; Epidemiology; Ethnic Origin; Exposure to; Funding; Future; Geography; Healthcare Systems; Hearing; Heterogeneity; Income; Individual; Inequity; Infant Mortality; Infrastructure; Legal; Legal Status; Licensing; Low Birth Weight Infant; Maternal Mortality; Maternal and Child Health; Measures; Methodology; Methods; Modification; Monitor; National Institute of Child Health and Human Development; Neonatal Mortality; Outcome; Persons; Policies; Population; Pregnancy; Premature Birth; Prevention approach; Prevention strategy; Public Health; Race; Reduce health disparities; Research; Risk; Risk Assessment; Services; Severities; Socioeconomic Status; Structural Racism; Subgroup; Surveys; System; Termination of pregnancy; Testing; Time; Vital Statistics; Woman; Women' s Health; adverse birth outcomes; adverse outcome; court; econometrics; epidemiology study; gender equality; improved; innovation; insurance claims; maternal morbidity; meetings; physical conditioning; pregnant; public policy on alcohol; response; severe maternal morbidity; trend

PROJECT SUMMARY This project uses cutting-edge legal epidemiology techniques to examine population-level maternal and child health (MCH) impacts of pregnancy termination policies in the U.S., including identifying which groups experience adverse consequences and the conditions that buffer consequences. Pregnancy termination in the U.S. is common, with about one out of five pregnancies ending in a termination. Historically, most research about public health impacts of pregnancy termination policies focused on the relationship between legal status of pregnancy termination and maternal morbidity and mortality related to illegal versus legal pregnancy termination. In the U.S. today, however, most pregnancy termination policies do not make all pregnancy terminations illegal; rather, they create barriers to people being able to terminate their pregnancy. Most states have at least one such policy and some states have had some pregnancy termination policies for more than 40 years. Recently, though, the number, strength, types, and co-occurrence of such policies have dramatically changed; some of these policies and policy combinations have contributed to a decrease in the number of pregnancy terminations. The next few years could bring even more drastic changes in these policies. Such policy changes could have public health impacts on people who continue their pregnancies and give birth – particularly on MCH outcomes such as maternal morbidity and mortality, infant mortality, and adverse birth outcomes. Methodologically rigorous research about impacts of being unable to obtain a pregnancy termination on subsequent MCH has been conducted at the individual-level. Yet, only very limited research, much of it with notable methodological limitations, has been conducted at the population-level. This limits our understanding of population-level impacts of pregnancy termination policies. In this project, we assess whether state-level pregnancy termination policies from 2005-present affect MCH outcomes. We also examine whether effects differ by race/ethnicity and socioeconomic status as well as by other state-level characteristics such as economic, gender equality, and structural racism. This study involves state-of-the art coding of our exposure - state-level pregnancy termination policies from 2005-present, including policy adoption and effective dates. Outcomes include births and changes in composition of births, as well as MCH outcomes (maternal morbidity and mortality, preterm birth, low birthweight, and infant mortality). Outcome data will come from insurance claims data, vital statistics data, and the Pregnancy Risk Assessment Monitoring System. We will use both epidemiologic and econometric data analysis approaches to allow for causal interpretation of findings. Findings will provide key evidence to prepare public health and health care systems to care for groups of people most affected by pregnancy termination policies, as well as identify other state-level policies and characteristics that might help buffer any adverse MCH impacts of pregnancy termination policies.

项目摘要 该项目使用尖端的法律流行病学技术来检查人群水平的遗产和儿童 在美国，妊娠终止政策的健康（MCH），包括确定哪些群体 体验不良后果和缓冲后果的条件。怀孕终止 美国很常见，大约有五分之一的怀孕以终止结束。从历史上看，大多数研究 关于妊娠终止政策的公共卫生影响，重点是法律地位之间的关系 与非法妊娠有关的怀孕终止以及孕产妇发病率和死亡率 终止。然而，在今天的美国，大多数怀孕终止政策并不能使所有怀孕 终止非法；相反，它们为人们终止怀孕而造成了障碍。大多数州 至少有一项这样的政策，有些州有一定的怀孕终止政策，超过40多个 年。但是，最近，此类策略的数量，强度，类型和同时存在很大 变化；这些政策和政策组合中的一些已导致数量减少 怀孕终止。接下来的几年可能会带来这些政策的更大变化。这样的 政策变化可能会对继续怀孕并分娩的人们产生公共卫生的影响 - 特别是在MCH的结果，例如母校发病率和死亡率，婴儿死亡率和不良出生 结果。关于无法获得怀孕的影响的方法严格的研究 随后的MCH终止已在个人级别进行。但是，只有非常有限的研究， 在人群级别上已经进行了显着的方法学局限性。这限制了我们 了解怀孕终止政策的人口水平的影响。在这个项目中，我们评估是否 2005年至今的州级怀孕终止政策会影响MCH结果。我们还检查了是否 种族/种族和社会经济地位以及其他州级特征（例如 经济，性别平等和结构性种族主义。这项研究涉及我们暴露的最新编码 - 从2005年至今的州级怀孕终止政策，包括采用政策和有效日期。 结果包括出生和出生成分的变化以及MCH结果（母亲发病率 和死亡率，早产，低出生体重和婴儿死亡率）。结果数据将来自保险 索赔数据，重要统计数据和怀孕风险评估监测系统。我们将两者都使用 流行病学和经济数据分析方法允许对发现的因果解释。发现 将提供关键证据，准备公共卫生和保健系统，以照顾大多数人群 受怀孕终止政策的影响，并确定其他州级政策和特征 可能有助于缓冲怀孕终止政策的任何不良MCH影响。