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

项目摘要 在美国，严重孕产妇发病率（SMM），其中包括广泛的 在产前、产时或分娩期间发生的意外和危及生命的健康并发症， 产后时期，在1993-2014年间增加了三倍。SMM不成比例地影响黑人，西班牙裔， 土著、亚洲和太平洋岛民妇女，这一令人震惊和持续的差距仍然是一个令人担忧的问题。 未解决的公共卫生危机。个人、临床和医院层面的因素都无法解释这些 特别是，需要审查上游因素，如结构性种族主义， 健康成果。邻里环境已被证明是婴儿健康的一个深刻的决定因素 结果，但缺乏关于邻里环境如何影响孕产妇健康的证据。更少 一些研究审查了结构性种族主义的社会政治和地理空间表现， 居住隔离和中产阶级化，创造了不同的邻里社会和物质条件， 这可能反过来在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，的 具体目标是：1.研究历史红线和SMM之间的关联; 2.审查协会 现代中产阶级化与SMM之间的关系; 3.确定红线化和中产阶级化的共同影响 关于SMM鉴于影响黑人和土著母亲的特别严重的SMM差异，我们将 确定特定种族/族裔和社会经济亚群体是否更容易受到 在SMM上划红线和中产阶级化。研究优势和创新包括：使用基于大量人口的 具有足够的种族/民族、地理和社会经济异质性的数据集，以评估SMM，一种罕见的 影响1%人口的事件;在社区一级探索新的暴露措施， 包括红线化和中产阶级化，这些都没有在SMM中得到审查; 因果推理方法来阐明提出的关系。 这项研究将告知我们对上游社会政治过程如何影响 SMM风险和制定多层次、基于地方的战略，以改善 SMM。有了这个奖学金的支持，来自跨学科团队的指导，以及丰富的学术知识， 在加州大学伯克利分校的环境中，申请人将在概念化驱动种族/民族的结构因素方面进行培训 产妇保健、生殖流行病学和先进的生物统计方法，如多方面 层次建模和因果推理。通过完成研究和培训目标，申请人将很好地- 准备过渡到一个博士后和早期职业生涯的调查员的位置。该奖学金将支持 申请人的长期目标是成为一名研究结构性种族主义交叉点的社会流行病学家， 邻里环境，以及种族/民族不平等的妇女的健康在整个生命过程中。

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.