Disparities in Perinatal Care and Outcomes among Black Women and Latinas with Physical Disabilities

项目概要/摘要 身体残疾的妇女在怀孕护理、并发症和结果方面存在明显差异， 与没有残疾的女性相比。黑人妇女和拉丁裔妇女也经历着巨大的差异 与白色妇女相比，黑人女性和拉丁裔有身体 因此，残疾人可能面临更大的不良经历和后果风险。不过，没有 已知的研究调查了残疾和种族/民族在围产期护理方面的交叉点， 差距。调查小组的初步调查结果表明， 身体残疾对不良妊娠结果的风险很大。努力改善她们的怀孕状况 护理和经验，同时降低成本，需要明确评估这些妇女的怀孕风险 和结果。本研究的总体目标是使用混合方法来了解 妊娠经历、母婴结局、相关医疗保健费用和未满足的围产期 黑人妇女和拉丁美洲人的身体残疾及其婴儿的医疗保健需求，并检查 两种边缘化途径（种族或族裔， 残疾）。本研究的具体目的是：1）比较围产期保健收据，妊娠相关 并发症，健康结果，住院医疗利用和费用的妇女队列的基础上， 种族，民族和身体残疾状况，并确定是否是一个黑人妇女或 身体残疾的拉丁裔是加法或乘法; 2）使用来自格鲁吉亚、加州和 马萨诸塞州研究第一年的健康结果，医疗保健利用和成本的妇女队列 根据种族，民族和身体残疾及其婴儿（<1岁），并确定是否结合 作为一个黑人妇女或拉丁美洲人与身体残疾的影响是加法或乘法;和3）确定 身体残疾的黑人妇女和拉丁裔妇女在围产期护理方面的需求得不到满足和遇到障碍，具体做法是： 采访目前怀孕或最近怀孕的黑人妇女和拉丁裔身体残疾者 （B）与产科护理提供者的重点小组。这项研究将导致有史以来第一次系统的 了解黑人妇女的怀孕和婴儿健康结果以及怀孕护理费用， 身体残疾的拉丁人，从而为未来的发展和测试奠定了基础 干预措施，以改善结果。这项研究将填补一个关键的知识差距，了解 身体残疾的黑人妇女和拉丁裔妇女在怀孕之前、期间和 怀孕后。

Project Summary/Abstract Women with physical disabilities experience stark disparities in pregnancy care, complications, and outcomes, compared to women without disabilities. Black women and Latinas also experience substantial disparities related to perinatal care and outcomes, compared to White women. Black women and Latinas with physical disabilities, thus, are presumably at heightened risk of adverse experiences and outcomes. Nonetheless, no known studies have investigated the intersection of disability and race/ethnicity in relation to perinatal care and disparities. Preliminary findings from the investigator team demonstrate that Black women and Latinas with physical disabilities are at substantial risk for adverse pregnancy outcomes. Efforts to improve their pregnancy care and experiences while reducing costs require a definitive assessment of these women’s pregnancy risks and outcomes. The overarching goal of this study is to use a mixed-methods approach to understand pregnancy experiences, maternal and infant outcomes, related healthcare costs, and unmet perinatal healthcare needs of Black women and Latinas with physical disabilities and their infants, and examine the intersecting impacts of disparities from two avenues of marginalization (race or ethnicity, and physical disability). The specific aims of this study are: 1) Compare perinatal care receipt, pregnancy-related complications, health outcomes, inpatient healthcare utilization and costs among cohorts of women based on race, ethnicity, and physical disability status, and determine if the combined effects of being a Black woman or Latina with physical disabilities are additive or multiplicative; 2) Use linked data from Georgia, California, and Massachusetts to examine first year health outcomes, healthcare utilization and costs for cohorts of women based on race, ethnicity, and physical disability and their infants (<1 year old), and determine if the combined effect of being a Black woman or Latina with physical disabilities is additive or multiplicative; and 3) Identify unmet needs and barriers to perinatal care for Black women and Latinas with physical disabilities through: (a) interviews with Black women and Latinas with physical disabilities who are currently pregnant or have recently given birth, and (b) focus groups with obstetric care providers. This study will lead to a first-ever systematic understanding of pregnancy and infant health outcomes and pregnancy care costs for Black women and Latinas with physical disabilities, thus establishing a foundation for development and testing of future interventions to improve outcomes. This study will fill a critical knowledge gap in understanding of the pregnancy-related experiences among Black women and Latinas with physical disabilities before, during and after pregnancy.