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.

摘要 在美国，有色人种女性的不良妊娠结局率高于非西班牙裔白人。 例如，黑人、西班牙裔和非西班牙裔的早产率分别为14.4%、10.0%和9.3 白色母亲。西班牙裔和黑人妇女也有较高的风险，孕产妇发病率，如 妊娠期高血压和妊娠期糖尿病。沿着令人信服的证据表明， 围产期保健对母亲及其婴儿一生健康的影响在社会上十分重要， 经济成本。然而，有色人种妇女不良妊娠结局的病因尚未得到充分解释 遗传、行为或获得护理的机会以及其他因素，包括结构性种族主义，可能发挥了作用。 从历史上看，有色人种社区一直并将继续受到红线下游效应的影响 包括住房歧视和邻里隔离。考虑到他们的距离 社区到空气，水和土壤污染的主要来源（红线的另一个后果），社区 也经历了环境种族主义，即，不成比例的环境暴露负担。 此外，高风险社区的妇女还受到不成比例的警务、警察和警察的过度干预的压力。 暴力，逮捕和监禁。虽然有越来越多的证据表明结构性种族主义的影响， 围产期健康，调查结果是模棱两可的，和研究有关的多种形式的结构性疾病的联合影响， 缺乏种族主义。在这个应用程序中，我们将评估结构性种族主义在多个国家的独立影响。 在孕产妇发病率（妊娠期高血压和妊娠期高血压）和 糖尿病）和不良妊娠结局（低出生体重和早产），探讨是否结合 暴露于结构性种族主义的多个领域会加剧不平等，并将机器学习方法应用于 确定不利的围产期健康结果的关键结构性种族主义预测因素。为了实现我们的目标，我们将 对在第三大城市的主要产科医院分娩的妇女进行回顾性出生队列研究， 在美国的一个县（哈里斯县）（休斯顿所在地），将包括在母亲怀孕期间的随访 她孩子的出生我们的项目利用贝勒医学院之间建立的伙伴关系， UTHealth麦戈文医学院和德克萨斯南方大学通过我们的NIMHD/NIEHS/NICHD P50 环境健康差异研究卓越中心，专注于减少环境健康 在孕产妇和儿童健康的差距，并利用我们的集体专长，在环境和围产期 流行病学，妇女健康，母胎医学，刑事司法，社会科学，生物统计学， 生物信息学这项工作有望阐明结构性种族主义在多个领域的贡献 在几个关键的围产期健康结果的种族/民族差异。重要的是，这项研究的结果将 还加强我们对复杂的相互作用的理解，并确定关键的结构性种族主义驱动因素， 围产期健康差异，并为今后的研究奠定基础，以促进干预措施。