Impact of historical redlining and contemporary gentrification on severe maternal morbidity racial/ethnic disparities

项目总结 在美国，严重孕产妇发病率(SMM)涵盖了广泛的 发生在产前、产中或产后的意外和危及生命的健康并发症 产后期，在1993-2014年间增加了三倍。SMM对黑人、西班牙裔、 土著、亚洲和太平洋岛民妇女，这一令人震惊的持续不平等仍然是 未解决的公共卫生危机。个人、临床和医院层面的因素未能解释这些因素 差异，强调需要审查上游因素，如结构性种族主义，与产妇 健康结果。邻里环境已被证明是婴儿健康的一个深刻决定因素 结果，但缺乏关于邻里环境如何影响产妇健康的证据。更少 研究审查了结构性种族主义的社会政治和地理空间表现，如种族歧视。 居住隔离和士绅化，造成了不同的社区社会和物质条件， 这反过来又可能在SMM中产生明显的种族/民族差异。这项研究将解决这些重要的差距 通过利用1997-2018年间加州1100多万新生儿的全州数据，在知识方面取得了进展。这个 具体目标是：1.检查历史红线与SMM之间的关联；2.检查关联 当代士绅化与SMM之间的关系；3、确定红线与士绅化的联合效应。 在SMM上。考虑到影响黑人和土著母亲的特别明显的SMM差异，我们将 确定特定的种族/族裔和社会经济亚群是否更容易受到 SMM上的红线和士绅化。研究的优势和创新包括：使用以大人口为基础的 具有足够的种族/民族、地理和社会经济异质性的数据集来评估SMM，这是一种罕见的 影响1%人口的事件；在社区层面探索新的暴露措施， 包括未与SMM相关的红线和士绅化；并使用严格的 用因果推论的方法来解释所提出的关系。 这项研究将使我们了解上游社会政治进程如何影响 SMM风险和制定多层次、以地点为基础的战略，以改善#年的种族/族裔不平等 SMM。有了这个奖学金的支持，一个跨学科团队的指导，以及一位富有的学者 在加州大学伯克利分校的环境方面，申请者将接受概念化结构因素的培训，这些因素会驱动种族/民族 孕产妇健康、生殖流行病学和先进的生物统计方法方面的不平等现象，如多种 水平建模和因果推理。通过完成研究和培训目标，申请者将更好地- 准备过渡到博士后和职业生涯早期的调查员职位。这项奖学金将支持 申请者的长期目标是成为一名研究结构性种族主义交集的社会流行病学家， 社区环境，以及妇女在整个生命过程中的健康方面的种族/族裔不平等。

PROJECT SUMMARY In the United States, rates of severe maternal morbidity (SMM), which encompasses a broad spectrum of unexpected and life-threatening health complications that occur during the antepartum, intrapartum, or postpartum periods, increased threefold between 1993-2014. SMM disproportionately affects Black, Hispanic, Indigenous, Asian, and Pacific Islander women, an alarming and persistent disparity that remains an unaddressed public health crisis. Individual, clinical, and hospital-level factors have failed to account for these disparities, highlighting the need to examine upstream factors, such as structural racism, in relation to maternal health outcomes. Neighborhood context has been shown to be a profound determinant of infant health outcomes, but evidence on how neighborhood environments influence maternal health is lacking. Even fewer studies have examined sociopolitical and geospatial manifestations of structural racism, such as racial residential segregation and gentrification, that create differential neighborhood social and material conditions, which may in turn produce stark racial/ethnic differences in SMM. This study will address these important gaps in knowledge by leveraging state-wide data on over 11 million births in California between 1997-2018. The specific aims are to: 1. examine associations between historical redlining and SMM; 2. examine associations between contemporary gentrification and SMM; and 3. determine the joint effect of redlining and gentrification on SMM. Given the especially stark SMM disparities impacting Black and Indigenous mothers, we will determine whether specific racial/ethnic and socioeconomic subgroups are more vulnerable to the influence of redlining and gentrification on SMM. Study strengths and innovations include: using a large population-based dataset with sufficient racial/ethnic, geographic, and socioeconomic heterogeneity to assess SMM, a rare event that impacts 1% of the population; exploring novel exposure measures at the neighborhood-level, including redlining and gentrification, that have not been examined in relation to SMM; and employing rigorous causal inference methods to elucidate the proposed relationships. This research will inform both our understanding of how upstream sociopolitical processes influence SMM risk and the development of multi-level, place-based strategies to improve racial/ethnic inequities in SMM. With the support from this fellowship, mentorship from an interdisciplinary team, and a rich academic environment at UC Berkeley, the applicant will train in conceptualizing structural factors that drive racial/ethnic inequities in maternal health, reproductive epidemiology, and advanced biostatistical methods such as multi- level modeling and causal inference. By completing the research and training goals, the applicant will be well- prepared to transition into a postdoctoral and early-career investigator position. This fellowship will support the applicant’s long-term goal of becoming a social epidemiologist researching the intersection of structural racism, neighborhood context, and racial/ethnic inequities in women’s health across the life course.