Social and Economic Determinants of Maternal Morbidity in the United States

美国孕产妇发病率的社会和经济决定因素

• 批准号: 10231254
• 负责人: SARA MARKOWITZ
• 金额: $ 7.82万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-10 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10231254
• 关键词: Adverse event; Affect; African American; Caring; Cessation of life; Characteristics; Cigarette; Communities; County; Data; Drug usage; Environment; Goals; Health Services Accessibility; Hospitals; Infant Mortality; Influentials; Inpatients; Intervention; Life Expectancy; Literature; Maternal Age; Maternal Mortality; Measures; Medical; Morbidity - disease rate; Mothers; Not Hispanic or Latino; Patients; Policies; Pregnancy; Pregnancy Complications; Provider; Public Policy; Research; Research Personnel; Role; Sampling; Source; Structural Racism; Techniques; Time; United States; Variant; Weight; Weight Gain; Woman; adverse outcome; base; black women; economic determinant; low socioeconomic status; maternal morbidity; mortality; racial and ethnic disparities; racial disparity; severe maternal morbidity; social determinants; socioeconomics; trend

Project Summary Amid long standing improvements in life expectancy and infant mortality in the United States, a discordant new trend has emerged -- maternal mortality and morbidity are on the rise. Concurrent with this trend is evidence of racial disparities, particularly among non-Hispanic black women, who are experiencing these adverse outcomes at much higher rates than other groups. These phenomena are only beginning to be studied and understood by researchers. The medical causes of maternal mortality and morbidity are easily identified, but an explanation of the underlying reasons is lacking. In previous studies that document trends in maternal mortality and morbidity, researchers have hypothesized that factors contributing to these trends include older maternal age, increased body weight, cigarette and illegal drug use during pregnancy, low SES, and issues related to providers and medical care. However, we currently have little guidance from the literature on which factors are the most influential or where policy interventions can be most beneficial. The purpose of this proposed research is twofold. The first goal is to conduct an exploratory analysis of the determinants of maternal mortality and morbidity in an effort to identify the factors that may or may not contribute to the underlying causes. We group potential explanatory variables into maternal characteristics, hospital characteristics, variables reflecting access to care, and community-level measures of the socioeconomic environment. The second objective is to investigate the sources of racial disparities in maternal mortality and morbidity. To accomplish these aims, we will first generate rates of maternal morbidity and mortality for 1998-2011 using the Nationwide Inpatient Sample (NIS). We will combine this data with additional information from the patient, hospital, and the larger community (the county). We will estimate the contributions of the different variables and variable groups to the overall variation in morbidity and mortality rates across hospitals and within hospitals over time. We will then use regression-based re-weighting techniques to examine the sources of racial disparities. Our results will provide guidance on what types of variables would benefit from further study. Once these are identified, future research can focus on evaluating different public policies as potential solutions to reduce maternal morbidity and mortality.

项目摘要 在美国预期寿命和婴儿死亡率长期改善的情况下， 出现了不和谐的新趋势-孕产妇死亡率和发病率上升。与此同时 这一趋势是种族差异的证据，特别是在非西班牙裔黑人妇女中， 这些不良后果的发生率远远高于其他群体。这些现象才刚刚开始 被研究人员研究和理解。产妇死亡和发病的医学原因很容易被忽视， 这一点已得到确认，但缺乏对根本原因的解释。在以前的研究中， 产妇死亡率和发病率，研究人员假设，造成这些趋势的因素， 包括高龄产妇、体重增加、怀孕期间吸烟和使用非法药物、社会经济地位低下 以及与提供者和医疗护理有关的问题。然而，我们目前几乎没有指导， 关于哪些因素最具影响力或政策干预在哪些方面最有益的文献。的 这项拟议研究的目的是双重的。第一个目标是进行探索性分析， 产妇死亡率和发病率的决定因素，努力查明可能或可能不 有助于根本原因。我们将潜在的解释变量分组为母体特征， 医院的特点，反映获得护理的变量，以及社区一级的措施， 社会经济环境。第二个目标是调查孕产妇中种族差异的来源。 死亡率和发病率。为了实现这些目标，我们将首先计算产妇发病率， 1998-2011年使用全国住院患者样本（NIS）的死亡率。我们将联合收割机与其他数据相结合 来自患者、医院和更大社区（县）的信息。我们将估计 不同变量和变量组对发病率和死亡率总体变化的贡献 医院之间和医院内部的死亡率。然后，我们将使用基于回归的重新加权 研究种族差异来源的技术。我们的研究结果将提供指导， 变量将受益于进一步的研究。一旦这些被确定，未来的研究可以集中在评估 不同的公共政策作为降低孕产妇发病率和死亡率的潜在解决办法。