Systems Science Approaches to Understand Neighborhood Opportunity and Racial/Ethnic Disparities in Maternal Morbidity

系统科学方法了解邻里机会和孕产妇发病率的种族/民族差异

• 批准号: 10341231
• 负责人: Irene Headen
• 金额: $ 13.37万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-26 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10341231
• 关键词: Address; Attenuated; Automobile Driving; Birth; Birth Records; Child Health; Childbirth; Complex; Crime; Data; Development; Diagnosis; Ecosystem; Exposure to; Family health status; Feedback; Food Access; Geography; Gestational Diabetes; Goals; Health; Health Food; Hospitals; Individual; Infant Health; Intervention; Joints; Life; Link; Literature; Maps; Maternal Health; Maternal Mortality; Measures; Mentors; Methodology; Methods; Morbidity - disease rate; Neighborhoods; Outcome; Patients; Perinatal; Philadelphia; Physical environment; Policies; Postpartum Period; Pregnancy; Procedures; Provider; Public Health; Records; Recreation; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Safety; Science; Services; Shapes; Social Environment; Structural Racism; Structure; Sustainable Development; System; Testing; Time; Training; Training Activity; Translating; Translations; Woman; Women' s Health; base; black women; built environment; career; child bearing; deprivation; disparity elimination; effective intervention; evidence base; experience; gestational weight gain; health care availability; health disparity; high risk; hospital readmission; improved; innovation; maternal morbidity; models and simulation; population health; postpartum morbidity; pregnancy hypertension; programs; racial and ethnic disparities; racial determinant; racial disparity; residential segregation; severe maternal morbidity; social; social cohesion; social deficits; social structure; socioeconomics; statistics; success; walkability; women of color

Rising maternal mortality rates, and the significant racial/ethnic disparities that characterize them, result in black women dying from pregnancy-related causes at three to four times the rate of their white counterparts. Considering that for every maternal death, over 100 women experience severe maternal morbidity —a life- threatening diagnosis or condition occurring as a direct result of pregnancy and childbirth—the implications of reducing maternal morbidity for black maternal health are profound. Morbidity during the postpartum period, as represented by postpartum hospital readmissions, is also 30% more likely to impact black women. Effective interventions developed from a comprehensive, multilevel evidence base are needed to successfully eliminate these disparities. However, many of these multilevel factors remain understudied, and translation of evidence into action remains challenging due to complex inter-relationships across factors that produce unanticipated outcomes. The objectives of this study are to address this twofold gap by 1) investigating neighborhood opportunity access as an understudied multilevel factor in relation to racial/ethnic disparities in maternal morbidity and 2) using systems science methodologies, such as system dynamics, in a participatory framework to develop a causal system map that contextualizes the role of neighborhood opportunity access within the complex, inter-related system shaping racial/ethnic disparities in maternal morbidity. Using Philadelphia, PA as a base case, I will partner with the Maternal, Child, and Family Health Division in the Philadelphia Department of Public Health to leverage linked hospital discharge, birth record, and neighborhood indicator data to accomplish the following aims: (1) To estimate associations between neighborhood opportunity access and severe maternal morbidity, using a composite measure that includes indicators from the social, physical, and built environment, and assess whether it explains racial/ethnic disparities; (2) To estimate associations between neighborhood opportunity access and postpartum hospital readmissions, and assess whether it explains racial/ethnic disparities; (3) To develop a qualitative system map detailing the causal feedback structure driving associations between neighborhood opportunity access and racial/ethnic disparities peripartum maternal morbidity, contextualized within an ecosystem of other multilevel factors, using participatory system dynamics methodologies. The K01 will allow me to gain integral training in the use of administrative data for population health, advanced spatial statistics to geospatially contextualize health disparities, and participatory systems science methodologies to support the translation of evidence into action to eliminate health disparities. This will help me achieve my long-term goal of successfully building a rigorous research agenda that uses applied methodologies to understand the sociostructural determinants of racial/ethnic disparities in maternal and infant health and informs the development of sustainable policies and programs to eliminate them.

产妇死亡率上升，以及作为其特征的严重种族/族裔差异，导致 黑人妇女死于与怀孕有关的原因的比率是白色妇女的三到四倍。 考虑到每有一名产妇死亡，就有100多名妇女患上严重的孕产妇疾病----一条生命， 威胁诊断或条件发生的直接结果，怀孕和分娩的影响， 降低孕产妇发病率对黑人孕产妇健康意义深远。在产后期间，如 以产后再次入院为代表，对黑人妇女的影响也要高出30%。有效 需要从一个全面的、多层次的证据基础上制定干预措施， 这些差异。然而，许多这些多层次的因素仍然研究不足， 由于各种因素之间复杂的相互关系， 结果。本研究的目的是解决这一双重差距1）调查邻里 机会获得作为一个未充分研究的多层次因素，与孕产妇保健中的种族/族裔差异有关。 发病率和2）在参与性框架内使用系统科学方法，如系统动力学 开发一个因果系统图，将邻里机会进入的作用置于 复杂的、相互关联的系统造成了孕产妇发病率方面的种族/族裔差异。Philadelphia，PA 作为一个基本案例，我将与费城部门的妇幼和家庭健康部门合作， 公共卫生利用关联的出院、出生记录和邻里指标数据， 实现以下目标：（1）估计邻里机会访问和 严重的孕产妇发病率，采用包括社会、身体和 建筑环境，并评估它是否解释种族/民族差异;（2）估计协会 邻里机会访问和产后医院再入院之间的关系，并评估它是否 解释种族/民族差异;（3）开发一个定性系统图，详细说明因果反馈 构建邻里机会获取与种族/民族差异之间的驱动关联 围产期孕产妇发病率，在其他多层次因素的生态系统中，使用 参与式系统动力学方法。K 01将使我能够获得使用 人口健康管理数据，高级空间统计，以地理空间方式了解健康状况 差异和参与性系统科学方法，以支持将证据转化为行动 消除健康差距。这将帮助我实现我的长期目标，成功地建立一个严格的 研究议程，使用应用方法来了解社会结构的决定因素， 孕产妇和婴儿健康方面的种族/族裔差异，并为制定可持续政策提供信息， 计划来消除它们。