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

产妇死亡率的上升，以及显著的种族/民族差异，导致 黑人妇女死于与怀孕有关的原因的比率是白人妇女的三到四倍。 考虑到每一例产妇死亡，就有100多名妇女经历了严重的产妇发病率--一条生命-- 因怀孕和分娩而直接导致的威胁性诊断或疾病-- 降低产妇发病率对黑人产妇健康具有深远的意义。产后发病率，如 以产后再住院为代表的女性对黑人女性的影响也要高出30%。有效 从全面的、多层次的证据基础上制定的干预措施需要成功地消除 这些差异。然而，这些多层次因素中的许多仍然没有得到充分的研究，证据的翻译 行动仍然具有挑战性，因为各种因素之间的复杂相互关系会产生意想不到的结果 结果。这项研究的目标是通过1)调查邻里关系来解决这两个差距 机会获取作为一个未被充分研究的多层次因素与孕产妇的种族/民族差异有关 2)在参与性框架内使用系统科学方法，如系统动力学 开发因果系统图，将邻里机会访问在 造成产妇发病率方面种族/族裔差异的复杂、相互关联的制度。使用宾夕法尼亚州费城作为 作为一个基本案例，我将与费城部门的母亲、儿童和家庭健康司合作 公共卫生部利用关联的医院出院、出生记录和社区指标数据来 实现以下目标：(1)评估邻里机会获取与 严重孕产妇发病率，使用综合衡量标准，包括来自社会、身体和 建筑环境，并评估它是否解释了种族/民族差异；(2)估计关联 社区机会准入和产后再住院之间的关系，并评估是否 解释种族/民族差异；(3)开发详细说明因果反馈的定性系统图 推动邻里机会获取和种族/民族差异之间的关联的结构 围产期孕产妇发病率，在其他多水平因素的生态系统中，使用 参与式系统动力学方法论。K01将使我能够获得关于使用 人口健康的管理数据，先进的空间统计数据，以地理空间为背景的健康 差异和参与性系统科学方法，以支持将证据转化为行动 以消除健康差距。这将帮助我实现成功地建立一个严谨的 研究议程，使用应用方法论了解社会结构决定因素 在孕产妇和婴儿保健方面存在种族/族裔差异，并为制定可持续政策和 计划来消除它们。

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.