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

项目摘要/摘要 肢体残疾妇女在妊娠护理、并发症和结局方面存在明显差异， 与非残疾女性相比。黑人女性和拉丁裔女性之间的差异也很大。 与白人妇女相比，这与围产期护理和结局有关。黑人女性和拉丁裔身体健康 因此，残疾人可能面临更高的不良经历和后果风险。尽管如此，没有 已知的研究调查了残疾和种族/民族的交集与围产期护理和 差距。研究小组的初步发现表明，黑人女性和拉丁裔女性 身体残疾极有可能导致不良的妊娠结局。努力改善她们的妊娠状况 在降低成本的同时提供护理和体验需要对这些妇女的怀孕风险进行明确的评估 和结果。这项研究的主要目标是使用混合方法来理解 怀孕经历、母婴结局、相关的医疗费用和未满足的围产儿 有肢体残疾的黑人妇女和拉丁裔及其婴儿的医疗需求，并检查 来自两种边缘化途径(种族或族裔和身体状况)的差异的交叉影响 残疾)。本研究的具体目的是：1)比较围产期护理收受情况、妊娠相关情况 基于以下因素的女性队列中的并发症、健康结局、住院医疗保健利用和费用 种族、民族和身体残疾状况，并决定作为黑人女性或 肢体残疾的拉丁裔是加法或乘法；2)使用来自佐治亚州、加利福尼亚州和 马萨诸塞州将检查第一年的健康结果、医疗保健利用率和女性队列的成本 基于种族、民族和身体残疾及其婴儿(&lt；1岁)，并确定联合 黑人女性或拉丁裔肢体残疾的影响是相加或相乘的；以及3)认同感 黑人妇女和拉丁裔肢体残疾妇女在围产期护理方面未得到满足的需求和障碍：(A) 采访目前怀孕或最近怀孕的黑人妇女和身体残疾的拉丁裔妇女 (B)有产科护理人员的重点小组。这项研究将导致有史以来第一次系统地 了解黑人妇女的孕期和婴儿健康结果和孕期保健费用 拉丁裔肢体残疾，从而为未来的发展和测试奠定了基础 旨在改善结果的干预措施。这项研究将填补一个关键的知识空白的理解 黑人妇女和拉丁裔肢体残疾妇女在怀孕前、期间和之后的怀孕相关经历 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.