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

摘要 在过去的二十年里，美国死于与怀孕有关的原因的妇女人数 产妇死亡率几乎翻了一番，严重的产妇死亡率几乎增加了两倍。 关于影响妊娠相关死亡率和孕产妇严重发病率的因素的报告 以前忽视了阿巴拉契亚中部的妇女，尽管这种健康差异的风险状况 人口本研究采用了严格的混合方法的概念框架， 世界卫生组织通过的关于健康的社会决定因素的行动， 影响阿巴拉契亚中部妇女SMM和PRM.1，4风险的中介决定因素 这项研究是高度创新的，因为它是国家卫生中心以外的第一项全国性研究。 国家卫生统计局（NCHS）将利用NCHS的新数据库，该数据库将发病率和死亡率数据联系起来。 此外，这是第一个已知的研究，重点是SMM和PRM的妇女生活在中央阿巴拉契亚， 可能会为这一服务不足、健康状况不同的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PRM和SMM的预测因素。这一目标将执行分层逻辑 对国家卫生统计局的全国数据进行回归，以确定影响妇女健康的风险和保护因素， 分娩时和产后一年的SMM和PRM风险。 (2)阐明医疗保健提供者和患者对PRM和SMM的潜在机制的观点， 阿巴拉契亚中部。深入的半结构化访谈将进行：（1）10例患者， 经验丰富的SMM，以及（2）阿巴拉契亚中部的10名医疗保健提供者和10名急救人员，他们提供了 护理患有SMM和PRM的患者。 PI将利用肯塔基州大学健康公平中心的资源和专业知识 研究，研究数据中心，以及一个高度支持的跨学科导师团队，他们是专家 在农村健康差距，实施科学，和母胎医学。团队成员的指导 将为PI提供关于实施混合方法研究、项目 管理，负责任的研究行为，以及研究结果的传播。本次培训将提供 PI具有实现特定目标所需的技能，并为PI成为一个 独立的物理学家，科学家与一个在孕产妇领域的研究组合， 健康这项研究的结果将产生关于SMM和PRM预测因子的基本知识， 高危人群，并确定影响孕产妇不良结局的因素， 干预措施。调查结果也可能为未来在其他农村地区的实证调查提供信息。 人口。

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.