Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight

严重的孕产妇发病率：对种族差异、社会弱势的调查

• 批准号: 10660008
• 负责人: SUZAN L CARMICHAEL
• 金额: $ 60.08万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-19 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10660008
• 关键词: Address; Affect; Anemia; Birth; Black American; Body mass index; California; Censuses; Cesarean section; Child; Communities; Country; Data; Death Certificates; Disparity; Education; Ensure; Equity; Ethnic Origin; Exclusion; Fetal Death; Health; Healthcare; Hemorrhage; Hospitals; Hypertension; Income; Individual; Inequality; Inequity; Infection; Intervention; Investigation; Joints; Knowledge; Life Cycle Stages; Link; Live Birth; Masks; Maternal Health; Maternal Mortality; Mediation; Medical; Methods; Morbidity - disease rate; Mothers; Multiple Pregnancy; Native Americans; Neighborhoods; New Jersey; Organ failure; Outcome; Outcome Study; Persons; Phase; Population; Population Research; Postpartum Period; Poverty; Pregnancy; Prevention strategy; Proxy; Race; Records; Recurrence; Research; Resources; Risk; Risk Assessment; Risk Factors; Risk Reduction; Sepsis; Social Environment; Social Identification; Survivors; Time; Translating; Translations; Virginia; Woman; Work; community engagement; community organizations; data resource; disparity elimination; ethnic disparity; health disparity; high risk; improved; intersectionality; large scale data; longitudinal dataset; marginalization; maternal morbidity; maternal outcome; maternal weight; neighborhood disadvantage; next generation; parent grant; people of color; pregnancy disorder; pregnancy health; pregnant; prepregnancy; racial disparity; reproductive; segregation; severe maternal morbidity; social; social disparities; social structure; socioeconomics; success

ABSTRACT Severe maternal morbidity (SMM), which encompasses conditions that put pregnant people most at risk of dying (e.g., hemorrhage, sepsis, organ failure), doubled in the last two decades. The most common precursors to SMM – anemia, hypertensive disorders of pregnancy (HDP), and cesarean birth – are also increasing. People of color, especially Black and Native American people, are at increased risk for all these outcomes. This Renewal proposal builds on our prior work to address inequities in maternal outcomes. Via the Parent Grant, our team enhanced current understanding of the contribution of social context (focusing on neighborhood social disadvantage) and maternal pre-pregnancy health (focusing on body mass index) to SMM risk, using a unique data resource we built of California (CA) births. This Renewal uses theoretically grounded approaches to address several remaining gaps in our understanding of maternal health in the U.S. that were illuminated by the Parent Grant. We will build a unique resource of 16 million births in three states from 1997-2021. The dataset longitudinally links vital records (live birth and fetal death certificates) with hospital discharge data for mother and baby; includes residential address; and links data for repeat pregnancies to the same person over time, thus providing the type of large-scale data with high-quality information on maternal health and social context that the field needs to advance population-level research on maternal health. All phases of the research will be guided by a community advisory board (CAB). Using an intersectionality framework, Aim 1 will examine joint impacts of multiple forms of marginalization on SMM, its subtypes (i.e., hypertension-, hemorrhage-, and sepsis-related SMM), and its precursors (i.e., HDP, anemia, mode of birth). Indicators of marginalization include race-ethnicity, education, health care payer, nativity, and census tract-level markers of social disadvantage and structural inequality (e.g., poverty, segregation). Using a reproductive life-course framework, Aim 2 will determine the cumulative impact of social and medical risk factors across successive pregnancies on maternal health (i.e., SMM, SMM subtypes, SMM precursors). We will examine how factors related to social context (e.g., persistent census tract poverty), morbidity (e.g., persistent HDP), and mode of birth (primary cesarean birth) affect subsequent occurrence and recurrence of the study outcomes. Aim 3 will use findings from Aims 1 and 2 to identify and prioritize strategies to improve maternal health and equity. We will use a) causal inference methods (mediation and g-computation) to understand mechanisms and compare the potential impact of selected hypothetical interventions on study outcomes and disparities, and b) community-engaged prioritization methods to synthesize our findings and prioritize next steps. By understanding risks across multiple forms of marginalization and successive pregnancies, and guided by rigorous analytics and community-grounded knowledge, our work will contribute to advancing the next generation of actionable population-level SMM equity research.

抽象的 严重孕产妇发病率 (SMM)，包括使孕妇面临最大风险的病症 死亡（例如出血、败血症、器官衰竭）的人数在过去二十年中翻了一番。最常见的 SMM 的前兆——贫血、妊娠高血压疾病 (HDP) 和剖腹产——也是 增加。有色人种，尤其是黑人和美洲原住民，所有人都面临更大的风险 这些结果。这项更新提案建立在我们之前解决孕产妇不平等问题的工作基础上 结果。通过家长补助金，我们的团队加深了对社会贡献的当前理解 环境（关注邻里社会弱势）和孕产妇孕前健康（关注身体） 质量指数）到 SMM 风险，使用我们为加利福尼亚州 (CA) 出生建立的独特数据资源。本次更新使用 以理论为基础的方法来解决我们对孕产妇健康的理解中仍然存在的一些差距 在美国，这受到了家长补助金的启发。我们将在 1600 万新生儿中建立独特的资源 1997年至2021年期间的三个州。该数据集纵向链接重要记录（活产和胎儿死亡证明） 母亲和婴儿的出院数据；包括居住地址；并链接数据以进行重复 随着时间的推移同一个人怀孕，从而提供高质量的大规模数据类型 该领域需要推进人口层面研究的有关孕产妇健康和社会背景的信息 孕产妇健康。研究的所有阶段都将由社区咨询委员会 (CAB) 指导。使用 交叉性框架，目标 1 将研究多种形式的边缘化对 SMM 的联合影响，其 亚型（即高血压、出血和败血症相关的 SMM）及其前体（即 HDP、贫血、 出生方式）。边缘化指标包括种族、教育、医疗保健支付者、出生地和 人口普查区层面的社会劣势和结构性不平等（例如贫困、种族隔离）的标志。使用 生殖生命历程框架，目标 2 将确定社会和医疗风险的累积影响 连续妊娠对孕产妇健康的影响因素（即 SMM、SMM 亚型、SMM 前体）。我们 将研究与社会背景（例如，持续的人口普查区贫困）、发病率（例如， 持续性HDP）和分娩方式（初次剖宫产）会影响随后的发生和复发 研究结果。目标 3 将利用目标 1 和 2 的发现来确定改进策略并确定优先顺序 孕产妇健康和公平。我们将使用 a) 因果推理方法（中介和 g 计算）来 了解机制并比较所选假设干预措施对研究的潜在影响 结果和差异，以及 b) 社区参与的优先排序方法来综合我们的发现和 优先考虑后续步骤。通过了解多种形式的边缘化和连续性的风险 怀孕，并以严格的分析和社区知识为指导，我们的工作将有助于 推进下一代可操作的人口层面 SMM 公平研究。