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Understanding racial and ethnic disparities in preterm birth: a systems science approach

了解早产的种族和民族差异：系统科学方法

基本信息

批准号：
10651708
负责人：
Collette N Ncube
金额：
$ 12.59万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-24 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10651708
关键词：
Address Area Asian Aspirin Attention Award Behavior Biological Models Birth Rate Calibration Childbirth Communities Complex Computer Simulation Cost-Benefit Analysis Costs and Benefits Custom Data Development Discipline Disparity Dose Education Epidemiologist Epidemiology Ethnic Origin Evaluation Feedback Funding Goals Government Agencies Health Care Sector Health Disparities Research Health Personnel Health Policy Health Professional Healthcare Hispanic Housing Individual Inequality Inequity Infant Intervention Knowledge Laws Literature Live Birth Maps Massachusetts Maternal and Child Health Mathematical Model Simulation Measurement Medical Methodology Methods Modeling Morbidity - disease rate Outcome Parents Pathway interactions Perinatal Perinatal Epidemiology Policies Policy Maker Pre-Eclampsia Pregnant Women Premature Birth Process Progestins Psychosocial Factor Public Health Publishing Race Research Research Personnel Risk Science Societies Statistical Methods Structure System Testing Time Training Training Programs Woman Work analytical tool black women career clinical subtypes design disparity reduction dynamic system economic cost effective intervention efficacy evaluation ethnic difference ethnic disparity ethnic minority population experience health determinants health equity infant death innovation interest mathematical model member model building models and simulation mortality novel racial difference racial disparity racial minority population simulation skills social social health determinants structural determinants trend

项目摘要

SUMMARY/ABSTRACT Preterm birth (PTB; childbirth <37 weeks) is responsible for approximately 35% of infant deaths in the U.S., and is an important cause of short- and long-term morbidity. The estimated annual societal economic cost of PTB nationally is more than $26 billion. PTB disparities are well documented, with racial/ethnic minority populations persistently experiencing higher PTB rates. Intermediary determinants, including individual and interpersonal level factors, and structural determinants such as healthcare, community and societal level factors, are posited contributors to racial/ethnic disparities. However, researchers have not examined how these interdependent and interacting determinants influence PTB disparities within a racialized social system. Such an understanding is needed to develop effective interventions. The candidate hypothesizes that inequitable customs, practices and laws in various sectors of society operate in self-reinforcing/correcting ways to maintain inequality. The functioning of these determinants is dynamically complex and cannot be studied via conventional statistical methods due to the interdependence of multi-level factors, inherent feedback processes and interactions between them, and time delays between ‘exposures’ and outcome. System Dynamics Modeling (SDM) is designed to study dynamically complex problems, and has been successfully used to inform policies regarding social determinants of health. The candidate is applying for this award in order to develop expertise in SDM. The training component of the award also includes formal/informal training in health equity measurement, health policy, and benefit-cost analysis. The research component of the award aims to address significant gaps in our understanding of how structural and intermediary determinants generate and perpetuate racial/ethnic PTB disparities, as well as inform strategies to address these disparities. Aim 1 is to identify pathways through which structural and intermediary determinants generate or maintain racial/ethnic PTB disparities. Aim 2 will build upon the foundational work of the first aim and develop a quantitative SD model of mathematical relationships representing the causal mechanisms. Additionally, this aim will test dynamic effects of healthcare sector interventions (progestogens and low-dose aspirin administration for women at risk for preterm delivery and pre-eclampsia). Aim 3 is to conduct benefit-cost analyses and simulate efficacy of the healthcare sector interventions. The candidate is a social and perinatal epidemiologist, well trained in diverse and complementary analytical tools of quantitative and qualitative methodology. The proposed training program supports the candidate’s long-term career goal to become a renowned investigator in health disparities research, with particular emphasis on understanding determinants of disparities in maternal and child health and the development and evaluation of effective interventions to reduce the disparities via a diverse toolkit of methodology, including systems science.

摘要/摘要在美国，大约 35% 的婴儿死亡是由早产（PTB；分娩 <37 周）造成的。是短期和长期发病的重要原因。预计每年社会经济成本为全国 PTB 超过 260 亿美元。 PTB 差异有据可查，少数种族/族裔人群持续经历较高的 PTB 发生率。中间决定因素，包括个人和人际层面因素以及结构性决定因素，例如医疗保健、社区和社会层面因素被认为是造成种族/民族差异的因素。然而，研究人员尚未研究如何这些相互依存且相互作用的决定因素影响着种族化社会体系内的 PTB 差异。需要这样的理解来制定有效的干预措施。候选人假设社会各阶层的不公平习俗、做法和法律以自我强化/纠正的方式运作以维持不平等。这些决定因素的功能是动态复杂的，不能通过传统统计方法由于多层次因素的相互依赖、固有的反馈过程以及它们之间的相互作用，以及“暴露”和结果之间的时间延迟。系统动力学建模（SDM）旨在研究动态复杂问题，并已成功用于为有关健康的社会决定因素的政策提供信息。候选人申请该奖项是为了发展 SDM 方面的专业知识。该奖项的培训部分还包括健康方面的正式/非正式培训公平衡量、卫生政策和效益成本分析。该奖项的研究部分旨在解决我们对结构性和中间性决定因素如何产生和产生的理解上的重大差距延续种族/族裔 PTB 差异，并为解决这些差异提供策略。目标 1 是确定结构和中间决定因素产生或维持种族/族裔的途径 PTB 差异。目标 2 将建立在第一个目标的基础工作之上，并制定量化的 SD 代表因果机制的数学关系模型。此外，该目标将测试医疗保健部门干预措施（孕激素和低剂量阿司匹林给药）的动态影响有早产和先兆子痫风险的妇女）。目标 3 是进行效益成本分析并模拟医疗保健部门干预措施的有效性。候选人是一位社会和围产期流行病学家，嗯接受过定量和定性方法的多样化和互补分析工具的培训。这拟议的培训计划支持候选人成为著名研究者的长期职业目标在健康差异研究中，特别强调了解健康差异的决定因素孕产妇和儿童健康以及制定和评估有效干预措施以减少通过包括系统科学在内的多样化方法论工具包来消除差异。