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

• 批准号: 10532844
• 负责人: Collette N Ncube
• 金额: $ 5.34万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 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/10532844
• 关键词: Address; Aspirin; Award; Birth Rate; Childbirth; Communities; Complex; Cost-Benefit Analysis; Custom; Development; Disparity; Dose; Epidemiologist; Ethnic Origin; Evaluation; Feedback; Goals; Health Care Sector; Health Disparities Research; Health Policy; Healthcare; Individual; Inequality; Inequity; Intervention; Laws; Maternal and Child Health; Measurement; Methodology; Modeling; Morbidity - disease rate; Outcome; Pathway interactions; Perinatal; Policies; Pre-Eclampsia; Premature Birth; Process; Progestins; Public Health; Race; Research; Research Personnel; Risk; Science; Societies; Statistical Methods; System; Testing; Time; Training; Training Programs; Woman; Work; analytical tool; career; design; disparity reduction; dynamic system; economic cost; effective intervention; ethnic disparity; ethnic minority population; experience; health determinants; health equity; infant death; mathematical model; mortality; racial disparity; racial minority population; social; social health determinants; structural determinants

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 cost-benefit 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 cost-benefit 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、卫生政策和成本效益分析。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 是进行成本效益分析并模拟 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