Evaluating maternal and newborn health inequities at the intersection of race, ethnicity, and disability in the U.S

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PROJECT SUMMARY (ABSTRACT) People with disabilities experience pregnancy at the same rate as people without disabilities but have disproportionately higher rates of adverse outcomes including pregnancy, labor and delivery complications, severe maternal morbidity, maternal death, preterm birth, stillbirth, low birth weight, and infant mortality rates. Although there is limited information about the extent of racial and ethnic disparities in maternal and newborn health outcomes among those who are disabled, current evidence suggests that these inequities are even more pronounced among racial and ethnic minorities compared to their White counterparts. Developing effective interventions to eliminate inequities at the intersection of race, ethnicity, and disability requires a comprehensive understanding of the relationships between these multiple levels of inequity and associated birth outcomes. This project aims to fill this research gap using a social determinants of maternal health lens to analyze linked maternal-infant Medicaid claims, natality, and mortality data files. Three research aims are proposed. Aim 1 focuses on the magnitude of racial and ethnic disparities in low birthweight, small for gestational age, preterm birth, and neonatal mortality at the intersection with disability; Aim 2 evaluates the extent to which disparities in these outcomes at the intersection of race, ethnicity, and disability are moderated by area-level socioeconomic inequities; and Aim 3 evaluates the association between race, ethnicity, and disability in nationally established quality measures for maternal-infant health. The proposed aims are supported by the PI’s career training goals, which include developing expertise in 1) using Medicaid claims data to produce measures of adverse birth outcomes by race, ethnicity, and disability, 2) analyzing area-level social determinants and quality of care measures associated with maternal and newborn health disparities, and 3) understanding disability measurement, public insurance coverage, risk factors for poor health, and community priorities needed to design effective interventions to reduce maternal and infant health inequities in this population. The proposed project supports the PI’s long-term career goal to become an independent investigator and advocate for maternal and newborn health equity in the U.S., with a particular emphasis on identifying and addressing the disparities resulting from social inequities using rigorous methodologies. Career development will include a series of formal courses, training workshops, and directed readings that will be completed with faculty at Dartmouth and other institutions over the first two years with additional topics covered as needed in the subsequent years. Attendance at conferences and related workshops will also be added to stay informed of current developments in the field. The award will be followed with a Research Project Grant (R01) to develop and test an intervention to improve outcomes among those most burdened by adverse outcomes at the intersection of race, ethnicity, and disability in the U.S.