Pregnancy-associated mortality and morbidity due to drugs, self-harm, and violence in the United States

美国因毒品、自残和暴力而导致的妊娠相关死亡率和发病率

• 批准号: 10204483
• 负责人: Sidra Goldman-Mellor
• 金额: $ 59.72万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10204483
• 关键词: Accident and Emergency department; Birth; California; Cause of Death; Cessation of life; Clinical; Data; Data Set; Databases; Death Certificates; Demography; Development; Diagnosis; Drug usage; Foundations; Funding; Future; Goals; Health Personnel; Hemorrhage; High Risk Woman; Homicide; Hospital Departments; Hospital Records; Hospitalization; Hospitals; Hypertension; Incidence; Income; Interdisciplinary Study; Intervention; Knowledge; Life; Link; Live Birth; Maternal Health; Maternal Mortality; Measures; Mental Health; Methods; Morbidity - disease rate; Mothers; Not Hispanic or Latino; Outcome; Pharmaceutical Preparations; Positioning Attribute; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevention; Prevention strategy; Provider; Psychiatric epidemiology; Public Health; Research; Risk; Risk Factors; Savings; Self-Injurious Behavior; Services; Suicide; Testing; Time; United States; Violence; Woman; Women Status; Work; base; black women; clinical practice; experience; falls; health disparity; health knowledge; high risk; improved; innovation; knowledge base; low socioeconomic status; maternal morbidity; mortality; mortality disparity; novel; population based; postpartum morbidity; pregnancy associated death; pregnant; prevent; public health priorities; racial and ethnic disparities; rural area; service utilization; socioeconomic disparity; substance use; suicide mortality; trend; venous thromboembolism; violence victimization

PROJECT SUMMARY Reducing maternal morbidity and mortality is a clinical and public health priority in the United States (US). Substantial research, public health, and clinical efforts focus on reducing morbidity and mortality thought to be due to or aggravated by pregnancy, specifically hemorrhage, hypertension, and venous thromboembolism. However, deaths due to drugs (both illicit and prescription), suicide, and homicide are increasing and may be equally as common among pregnant women and new mothers. It is currently almost impossible to calculate national estimates of pregnancy-associated deaths due to drug use, suicide, and homicide, because the checkbox used to identify these deaths on US death certificates has been shown to undercount cases by 50% or more. We also know little about trends or disparities in these deaths, morbidity due to similar causes that does not result in death, or risk factors for drug use, self-harm, and violence during pregnancy and postpartum. The overall goals of our proposed R01 are to provide the first population-based estimates of incidence, trends, and disparities in mortality and morbidity during pregnancy and the first year postpartum due to drug use, self-harm, and violence, and to ascertain which factors can identify women at high risk of these outcomes in a hospital-based setting. Our first aim is to provide comprehensive national estimates on incidence, trends, and disparities in pregnancy-associated mortality due to drugs, suicide, and homicide in the US between 2007- 2021, adjusted for misclassification arising from errors in the pregnancy checkbox method. Our second aim is to determine incidence, trends, and disparities in pregnancy-associated morbidity due to drugs, self-harm, and violence. Our third aim is to investigate whether hospital or ED service utilization and diagnoses during pregnancy or at delivery can be used to identify women at high risk of future postpartum morbidity and mortality due to drugs, self-harm, or violence. To achieve these aims, we will use a unique set of linked California databases that will allow us to quantify misclassification of pregnancy-associated mortality and apply an innovative bias adjustment to national estimates of pregnancy-associated mortality due to drugs, suicide, and homicide. This dataset will further allow us to estimate pregnancy-associated morbidity due to drug use, self-harm, and violence using a novel linkage approach that follows mothers forward in time from their pregnancy or delivery, and to identify hypothesized antecedent risk factors (“red flags”) for such morbidity and mortality that could create new opportunities for intervention and prevention. The proposed research will extend the current knowledge base in research on maternal morbidity and mortality to encompass non-obstetric causes that are likely of substantial and growing importance. Achieving our aims will change clinical practice by finding ways to identify women at high risk for future morbidity and mortality due to drug use, self-harm, and violence and lay the foundation for future research developing preventive strategies.

项目总结 在美国，降低孕产妇发病率和死亡率是临床和公共卫生的优先事项。 大量的研究、公共卫生和临床努力集中在降低发病率和死亡率上，人们认为 妊娠引起的或因怀孕而加重的，特别是出血、高血压和静脉血栓栓塞症。 然而，因毒品(非法和处方)、自杀和凶杀而死亡的人数正在增加，而且可能 在孕妇和新妈妈中同样常见。目前几乎不可能计算 国家估计因吸毒、自杀和他杀而导致的妊娠相关死亡人数，因为 用于识别美国死亡证明上这些死亡人数的复选框被显示将病例数低估了50% 或者更多。我们对这些死亡的趋势或差异也知之甚少，因为类似的原因导致的发病率 不会导致死亡，也不会导致怀孕和产后使用药物、自我伤害和暴力的危险因素。 我们建议的R01的总体目标是提供第一个基于人群的发病率估计， 怀孕期间和产后第一年因药物导致的死亡率和发病率的趋势和差异 使用、自我伤害和暴力，并确定哪些因素可以确定这些结果的高危女性 在以医院为基础的环境中。我们的第一个目标是提供关于发病率、趋势、 以及2007年间美国因毒品、自杀和凶杀而导致的与怀孕相关的死亡率差异- 2021，对怀孕复选框法中的错误引起的错误分类进行了调整。我们的第二个目标是 确定因药物、自我伤害和其他原因引起的妊娠相关发病率、趋势和差异 暴力。我们的第三个目标是调查医院或急诊科的服务利用和诊断在 怀孕或分娩时可用来识别未来产后发病率高风险的妇女 因吸毒、自残或暴力而死亡。为了实现这些目标，我们将使用一套独特的链接 加州数据库，这将使我们能够量化错误分类的妊娠相关死亡率和 将创新的偏差调整应用于国家估计的因以下原因导致的妊娠相关死亡率 毒品、自杀和凶杀案。这一数据集将进一步允许我们估计与怀孕相关的 使用一种跟踪母亲的新的连锁方法，因吸毒、自我伤害和暴力而导致的发病率 从她们怀孕或分娩的时间提前，并确定假想的先前风险因素(“红色” 这种发病率和死亡率可能为干预和预防创造新的机会。 拟议的研究将扩展目前孕产妇发病率和产妇死亡率研究的知识库 死亡率包括可能具有重大和日益重要的非产科原因。实现 我们的目标将改变临床实践，通过寻找方法来识别高危女性未来的发病率和 因吸毒、自残和暴力造成的死亡，为未来的研究发展奠定了基础 预防策略。