Hypertensive Disorders of Pregnancy – The Black/White Disparity

妊娠期高血压疾病 — 黑人/白人的差异

基本信息

批准号：
10679604
负责人：
Leah Verna Dodds
金额：
$ 5.27万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10679604
关键词：
Address Adult Affect Age American Heart Association Behavior Birth Black race Blood Glucose Blood Pressure Body mass index Cardiometabolic Disease Caring Chronic Communities Competence Complex Coronary Artery Risk Development in Young Adults Study Data Development Diet Discipline of obstetrics Disparity Eclampsia Epidemiology Ethnic Population Etiology Grant Gynecology Health Health Disparities Research Health behavior High Prevalence Hypertension Incidence Individual Intervention Knowledge Life Longitudinal, observational study Maternal Health Maternal Mortality Medical Mental Health Mentors Modeling Neighborhoods Outcome Physical activity Physicians Pre-Eclampsia Pregnancy Pregnancy Complications Premature Birth Prospective, cohort study Psychosocial Stress Public Health Race Racial Segregation Research Risk Factors Scientist Secure Sleep Societal Factors Structure System Training United States Woman Women&apos s Health Work black women black/white disparity blood lipid built environment cardiovascular risk factor career career development clinical training community-level factor design disease disparity effective intervention epidemiologic data health care service health disparity health equity health equity promotion health inequalities improved maternal hypertension maternal morbidity maternal outcome mortality risk nicotine exposure parous perceived discrimination physical conditioning population health pregnancy disorder pregnancy hypertension prepregnancy psychological distress public health priorities racial discrimination racial disparity racial population racism residential segregation segregation sleep difficulty social health determinants socioeconomic disadvantage success

项目摘要

Project Abstract The United States (US) has one of the highest maternal mortality rates in the developed world. Hypertensive disorders of pregnancy (HDP) such as gestational hypertension, preeclampsia, and eclampsia are major contributors to maternal mortality and morbidity, complicating approximately 2% to 8% of all pregnancies. In the US, Black women have disproportionately higher rates of HDP and are almost four times more likely to die from HDP compared to White women. Urgent action is required to address this racial disparity in HDP and lower the maternal mortality rate. While traditional cardiovascular risk factors are important contributors to HDP, social determinants of health (SDOH) have been identified as a fundamental cause of disease and health disparities, acting at multiple levels of influence. Yet, few studies go beyond the individual level to examine how SDOH, particularly multi-level products of structures and systems, contribute to the substantial racial gap in HDP. To address this need, I will identify contributors to HDP disparities using the socio-ecological framework. Specifically, this proposal will determine whether neighborhood-level racial residential segregation, interpersonal-level perceived discrimination, and individual-level pre-pregnancy CVD risk factors contribute to or explain the observed Black-White disparity in HDP. This multi-level research model considers the complex interplay between individual, community, and societal factors providing a comprehensive approach to understanding the etiology of HDP disparities. To do this work, I will leverage data from the Coronary Artery Risk Development in Young Adults study, a prospective cohort study of 5,114 Black and White adults (nBlackWomen=1480; nWhiteWomen =1307), age 18-30 in 1985 and followed for over 30 years. In aim 1 (neighborhood), I will determine whether racial residential segregation is associated with incident HDP among Black parous women. In aim 2 (interpersonal), I will determine whether perceived racial discrimination in the medical care setting is associated with incident HDP and whether it contributes to the Black-White disparity in HDP. In aim 3 (individual), I will determine whether pre-pregnancy CVD risk factors (defined by the American Heart Association’s Life’s Essential 8) are associated with incident HDP and whether these factors contribute to the Black-White disparity in HDP. These aims are embedded within a training plan designed to build my competence in epidemiology and health disparities research while facilitating my success as a physician-scientist specializing in women’s health. Identifying reasons for the disparities in HDP is fundamental to develop targeted and effective interventions to close the racial gap and improve maternal care in the US. This proposal will therefore address a critical and emergent public health priority to reduce maternal mortality, particularly among Black women.

项目摘要美国（美国）是发达国家的孕产妇死亡率最高的之一。高血压怀孕疾病（HDP），例如妊娠高血压，先兆子痫和eClampsia是主要的孕产妇死亡率和发病率的贡献者约为所有怀孕的2％至8％。在美国，黑人妇女的HDP比例不成比例地增加，死亡的可能性几乎是四倍与白人妇女相比，HDP。需要紧急行动以解决HDP中的这种种族差异并降低孕产妇死亡率。虽然传统的心血管危险因素是HDP的重要因素确定健康（SDOH）已被确定为疾病和健康分布的基本原因，在多个层次的影响下行动。然而，很少有研究超越个人层面，以研究SDOH，尤其是结构和系统的多层次产品，有助于HDP的大量种族差距。到满足这种需求，我将使用社会生态框架确定HDP差异的贡献者。特别是，该提案将确定邻里级的种族居住地隔离，人际级别的感知歧视，个人级别的怀孕前CVD风险因素有助于或说明HDP中观察到的黑白差异。这个多层研究模型考虑了复杂个人，社区和社会因素之间的相互作用，提供了一种全面的方法了解HDP差异的病因。为了完成这项工作，我将利用冠状动脉风险的数据年轻人的发展研究，一项针对5,114名黑白成年人的前瞻性队列研究（NblackWomen = 1480; NwhiteWomen = 1307），1985年的18-30岁，随后30多年。在AIM 1（附近）中我将确定种族居住地种族隔离是否与黑色疾病中的HDP事件有关女性。在AIM 2（人际关系）中，我将确定是否在医疗中感知的种族歧视设置与事件HDP有关，以及它是否有助于HDP中的黑白差异。在目标3中（个人），我将确定怀孕前CVD危险因素是否（由美国心脏定义协会的生命的基本8）与事件HDP有关，这些因素是否有助于 HDP中的黑白差异。这些目标嵌入到旨在建立我的能力的培训计划中在流行病学和健康差异研究中，同时促进我作为身体科学家的成功在妇女的健康中。确定在HDP中分配的原因是发展有针对性和有效的基础缩小种族差距并改善美国孕产妇护理的干预措施。因此，该建议将解决降低孕产妇死亡率的关键和新兴公共卫生优先事项，尤其是在黑人妇女中。