RACIAL AND NEIGHBORHOOD DISPARITIES IN INFANT HEALTH

在这个项目中，我们为费城构建了一个独特的数据集，它将来自生命统计记录的信息与医疗补助索赔记录和来自公共资助健康中心的个人级别数据合并。然后，我们将个人层面的数据与来自多个来源的丰富的背景信息集合并，以创建各种社区质量衡量标准，包括住房和环境质量、经济困境、社会混乱、健康和服务可用性。我们使用适合于分析多水平数据的严格的统计技术，检验了个体和背景因素对种族和邻里差异对出生结果的影响。我们将研究种族内部的社会阶层差异以及种族差异本身。第二组分析涉及公共资助的卫生服务在产前护理使用、婴儿健康和低收入妇女成本方面的有效性。我们将比较在管理性保健环境中接受医疗补助服务的妇女和在-1992年接受医疗补助患者的收费服务提供者提供服务的妇女的产前护理内容和分娩结局。另一组分析将特别侧重于1993-1996年期间使用城市资助的保健中心进行产前护理的妇女。为了补充上述分析，我们将对低收入妇女进行深入的纵向研究。我们建议对大约1,900名妇女进行跟踪调查，从她们的第一次产前检查到她们的宝宝S一岁生日。这项研究将使我们能够检验概念框架中存在的因素的影响，这些因素是从生命统计数据中得不到的，包括母亲S的社会支持网络、生活安排、住房稳定性、心理社会因素、怀孕的需要和冒险行为。样本将包括白人、非裔美国人、西班牙裔和亚洲女性。样本构成将使我们能够明确讨论种族在婴儿健康中的作用，并检查所有种族/民族群体中的低收入妇女对婴儿健康的影响因素是否相似。

In this project, we construct a unique data set for Philadelphia, which merges information from vital statistics records with Medicaid claims records and individual-level data from publicly funded health centers. We then merge the individual-level data with a rich set of contextual information from multiple sources to create various measures of neighborhood quality, including housing and environmental quality, economic distress, social disorganization, health and service availability. We examine the influence of individual and contextual factors on racial and neighborhood variations on birth outcomes using rigorous statistical techniques suited for analyses of multilevel data. We will examine social class differences within race as well as the racial disparity itself. A second set of analyses addresses the effectiveness of publicly funded health services on prenatal care use, infant health, and costs for low-income women. We will compare the content of prenatal care and birth outcomes of women who received Medicaid services in a managed care setting versus women who received services from fee-for-service provides who accepted Medicaid patients in 1989-1992. Another set of analyses will focus specifically on women using city-funded health centers for prenatal care in 1993-1996. To complement the above analyses we will undertake an in-depth longitudinal study of low-income women. We propose to follow approximately 1,900 women from their first prenatal care visit through their baby s first birthday. This study will enable us to examine the effects of factors present in our conceptual framework that are not available from vital statistics data, including the mother s social support networks, living arrangements, housing stability, psychosocial factors, the wantedness of her pregnancy and risk-taking behaviors. The sample will consist of white, African American, Hispanic and Asian women. The sample composition will permit us to address explicitly the role of race in infant health, and to examine whether factors contributing to infant health are similar for low income women in all racial/ethnic groups.