Hypertensive Disorders of Pregnancy – The Black/White Disparity

妊娠期高血压疾病 — 黑人/白人的差异

• 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
• 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' 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

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 美国是发达国家中孕产妇死亡率最高的国家之一。高血压 妊娠期疾病(HDP)，如妊娠期高血压、先兆子痫和子痫是主要的 产妇死亡率和发病率的贡献者，使大约2%至8%的怀孕复杂化。在 在美国，黑人女性患HDP的比例高得不成比例，死于HDP的可能性几乎是黑人的四倍 HDP与白人女性相比。需要采取紧急行动来解决HDP中的这种种族差距，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，但社会 健康决定因素(SDOH)已被确定为疾病和健康差距的根本原因， 在多个层面上发挥影响。然而，很少有研究超越个体层面来研究SDOH是如何， 特别是结构和制度的多层次产品，造成了两性平等方面的巨大种族差距。至 为了解决这一需求，我将使用社会生态框架确定造成HDP差距的因素。 具体地说，这项提案将决定邻里级的种族居住隔离， 人际层面的感知歧视和个人层面的孕前心血管疾病风险因素导致或 解释在HDP中观察到的黑白差异。这种多层次的研究模型考虑了复杂性 个人、社区和社会因素之间的相互作用提供了全面的方法 了解HDP差异的原因。为了完成这项工作，我将利用冠状动脉风险的数据 青年研究进展--对5114名黑人和白人成年人进行的前瞻性队列研究 (n黑人女性=1480；n白人女性=1307)，1985年年龄18-30岁，随后30多年。在目标1(邻居)中， 我将确定种族居住隔离是否与黑人产妇中的HDP事件有关 女人。在目标2(人际关系)中，我将确定是否在医疗保健中感知到种族歧视 设置与事件HDP以及它是否导致HDP中的黑白差异有关。在AIM 3中 (个人)，我将确定孕前心血管疾病的危险因素(由美国心脏定义 协会的生活必需品与HDP事件有关，以及这些因素是否有助于 HDP中的黑人和白人的差距。这些目标包含在旨在培养我的能力的培训计划中 在流行病学和健康差距研究方面，同时促进了我作为一名内科科学家的成功 在女性健康方面。找出HDP差异的原因是制定有针对性和有效的基础 美国为缩小种族差距和改善产妇保健而采取的干预措施。因此，这项提案将解决 降低产妇死亡率，特别是黑人妇女的死亡率，是一个关键和紧急的公共卫生优先事项。