Impacts of structural racism on racial and ethnic disparities in perinatal health

结构性种族主义对围产期健康种族和民族差异的影响

• 批准号: 10637373
• 负责人: ELAINE SYMANSKI
• 金额: $ 55.62万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-03 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637373
• 关键词: Air Pollution; American College of Obstetricians and Gynecologists; Behavior; Bioinformatics; Biometry; Birth; Black race; Cities; Color; Communities; Complex; County; Criminal Justice; Discipline of obstetrics; Discrimination; Disparity; Electronic Health Record; Environmental Epidemiology; Environmental Exposure; Etiology; Exposure to; Foundations; Future; Genetic; Gestational Diabetes; Hazardous Waste Sites; Health; Health Disparities Research; Health Services Accessibility; Hispanic; Hospitals; Housing; Hypertension; Imprisonment; Industry; Infant; Intervention; Joints; Life Cycle Stages; Low Birth Weight Infant; Maternal and Child Health; Maternal-fetal medicine; Medicine; Mexican; Mothers; National Institute of Child Health and Human Development; National Institute of Environmental Health Sciences; National Institute on Minority Health and Health Disparities; Neighborhoods; Not Hispanic or Latino; Outcome; Perinatal Epidemiology; Personal Satisfaction; Police; Policies; Pregnancy; Pregnancy Outcome; Pregnancy in Diabetics; Pregnant Women; Premature Birth; Prevalence; Property; Reporting; Research; Resources; Retrospective cohort study; Risk; Role; Social Sciences; Source; Stress; Structural Racism; System; Texas; Universities; Violence; Water Pollution; Woman; Women' s Health; Work; adverse outcome; adverse pregnancy outcome; black women; cohort; college; community burden; economic cost; environmental health disparity; ethnic disparity; experience; follow-up; health disparity; health inequalities; high risk; improved; machine learning method; maternal hypertension; maternal morbidity; medical schools; people of color; perinatal health; perinatal outcomes; racial disparity; racism; residential segregation; segregation; societal costs; soil pollution; stressor; women of color

ABSTRACT Women of color have higher rates of poor pregnancy outcomes than non-Hispanic whites in the U.S. For example, the prevalence of preterm birth is 14.4%, 10.0% and 9.3% among Black, Hispanic, and non-Hispanic white mothers, respectively. Hispanic and Black women are also at higher risk of maternal morbidities such as hypertension in pregnancy and gestational diabetes. Along with the compelling evidence of the impact of adverse perinatal health on the health of a mother and her infant throughout the life course comes high societal and economic costs. Yet, the etiology of adverse pregnancy outcomes among women of color is not fully explained by genetics, behavior, or access to care and other factors, including structural racism, likely play a role. Historically, communities of color have been, and continue to be, burdened by downstream effects of redlining practices, including housing discrimination and neighborhood segregation. Given the proximity of their neighborhoods to key sources of air, water, and soil pollution (another consequence of redlining), communities of color also experience environmental racism, i.e., a disproportionate burden of environmental exposures. Moreover, women in high-risk communities are subject to spillover stress from disproportionate policing, police violence, arrests, and incarceration. While there is growing evidence of the impact of structural racism on perinatal health, findings are equivocal, and research related to the joint impact of multiple forms of structural racism is lacking. In this application, we will assess the independent effects of structural racism across multiple domains on racial/ethnic disparities in both maternal morbidity (hypertension in pregnancy and gestational diabetes) and adverse pregnancy outcomes (low birth weight and preterm birth), explore whether combined exposures to multiple domains of structural racism enhance disparities, and apply machine learning methods to identify the key structural racism predictors of adverse perinatal health outcomes. To achieve our aims, we will construct a retrospective birth cohort of women who delivered infants at major obstetric hospitals in the 3rd largest county (Harris) in the U.S. (where Houston is located) that will include follow-up throughout a mother’s pregnancy to the birth of her infant. Our project leverages established partnerships among Baylor College of Medicine, UTHealth McGovern Medical School, and Texas Southern University through our NIMHD/NIEHS/NICHD P50 Center of Excellence on Environmental Health Disparities Research, focused on reducing environmental health disparities in maternal and child health, and draws on our collective expertise in environmental and perinatal epidemiology, women’s health, maternal-fetal medicine, criminal justice, social science, biostatistics, and bioinformatics. This work is expected to elucidate the contribution of structural racism across multiple domains on racial/ethnic disparities in several key perinatal health outcomes. Importantly, the results from this study will also enhance our understanding of the complex interplay and identification of key structural racism drivers of perinatal health disparities and lay the foundation for future studies to promote interventions.

抽象的 有色妇女的怀孕结局率比美国的非西班牙裔白人高。 例如，在黑人，西班牙裔和非西班牙裔中，早产的患病率为14.4％，10.0％和9.3％ 白人母亲分别。西班牙裔和黑人妇女也面临着较高的母子病因的风险 怀孕和妊娠糖尿病的高血压。以及令人信服的证据表明逆境的影响 在整个人生过程中，关于母亲和婴儿健康的围产期健康，社交状况很高， 经济成本。然而，有色女性不良怀孕结局的病因尚未得到充分解释 通过遗传学，行为或获得护理和其他因素，包括结构性种族主义，可能起作用。 从历史上看，红线的下游效应烧毁了色彩社区 实践，包括住房歧视和邻里隔离。鉴于他们的接近 邻里空气，水和土壤污染的主要来源（红线的另一个结果），社区 颜色也经历了环境种族主义，即对环境暴露的伯宁不成比例。 此外，高风险社区中的妇女受到不成比例的政策压力，警察 暴力，逮捕和进化。尽管有越来越多的证据表明结构性种族主义对 围产期健康，发现是等效的，并且与多种形式的结构性影响有关的研究 种族主义缺乏。在此应用中，我们将评估多个结构性种族主义的独立影响 孕产妇发病率的种族/族裔差异的领域（怀孕和妊娠高血压 糖尿病）和不良妊娠结局（低出生体重和早产），探索是否合并 暴露于结构性种族主义增强差异的多个领域，并将机器学习方法应用于 确定不良围产期健康结果的关键结构种族主义预测因素。为了实现我们的目标，我们将 建造一个回顾性的妇女，这些妇女在第三大的主要产科医院送婴儿 美国（休斯顿所在的位置）县（哈里斯）将在整个母亲怀孕期间进行跟进 到婴儿的诞生。我们的项目利用在贝勒医学院之间建立了合作伙伴关系， Uthealth McGovern医学院和德克萨斯州南部大学通过我们的NIMHD/NIEHS/NICHD P50 环境健康差异研究卓越中心，重点是减少环境健康 孕妇和儿童健康的差异，并利用我们在环境和围产期领域的集体专业知识 流行病学，妇女健康，母亲医学，刑事司法，社会科学，生物统计学和 生物信息学。预计这项工作将阐明跨多个领域的结构种族主义的贡献 关于几个关键围产期健康成果的种族/种族差异。重要的是，这项研究的结果将 还增强我们对复杂的相互作用和对关键结构种族主义驱动因素的理解 围产期健康差异，并为未来的研究奠定基础，以促进干预措施。