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

项目摘要(摘要) 残疾人的怀孕率与非残疾人相同，但 不良结局的发生率高得不成比例，包括妊娠、分娩和分娩并发症， 严重的孕产妇发病率、孕产妇死亡、早产、死产、低出生体重和婴儿死亡率。 尽管关于产妇和新生儿的种族和民族差异程度的信息有限 对于残疾人的健康后果，目前的证据表明，这些不平等是平等的 与白人相比，在种族和少数民族中更明显。发展中 有效的干预措施，以消除种族、民族和残疾交叉点的不平等，需要 全面了解这些不平等的多个层面之间的关系以及相关的 出生结局。该项目旨在利用孕产妇健康的社会决定因素来填补这一研究空白 分析关联的母婴医疗补助申请、出生和死亡率数据文件。三个研究目标是 建议。目标1侧重于低出生体重儿、小出生体重儿的种族和民族差异的程度 残疾交叉点的胎龄、早产和新生儿死亡率；目标2评估 在种族、民族和残疾的交叉点上，这些结果的差异被缩小的程度 通过地区层面的社会经济不平等；目标3评估种族、民族和 国家制定的母婴健康质量措施中的残疾问题。建议的目标是 由PI的职业培训目标支持，其中包括发展1)使用医疗补助索赔的专业知识 产生按种族、民族和残疾衡量不良生育结果的数据，2)分析地区级别 与孕产妇和新生儿健康差距有关的社会决定因素和护理质量措施； 3)了解残疾衡量、公共保险覆盖范围、健康状况不佳的风险因素，以及 社区需要优先设计有效的干预措施，以减少#年的母婴健康不平等现象 这群人。拟议的项目支持了PI成为一名独立员工的长期职业目标 美国孕产妇和新生儿健康公平的调查者和倡导者，特别强调 使用严格的方法确定和解决社会不平等造成的差距。职业生涯 开发将包括一系列正式课程、培训研讨会和定向阅读，这些将是 在前两年与达特茅斯和其他机构的教师一起完成，并涵盖了其他主题 在接下来的几年中根据需要。参加会议和相关研讨会的人数也将增加到 随时了解该领域的最新发展。获奖后将获得研究项目补助金 (R01)开发和测试干预措施，以改善那些受不利影响负担最重的人的结局 在美国，种族、民族和残疾交汇处的结果。

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.