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
基本信息
- 批准号:10660008
- 负责人:
- 金额:$ 60.08万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AddressAffectAnemiaBirthBlack AmericanBody mass indexCaliforniaCensusesCesarean sectionChildCommunitiesCountryDataDeath CertificatesDisparityEducationEnsureEquityEthnic OriginExclusionFetal DeathHealthHealthcareHemorrhageHospitalsHypertensionIncomeIndividualInequalityInequityInfectionInterventionInvestigationJointsKnowledgeLife Cycle StagesLinkLive BirthMasksMaternal HealthMaternal MortalityMediationMedicalMethodsMorbidity - disease rateMothersMultiple PregnancyNative AmericansNeighborhoodsNew JerseyOrgan failureOutcomeOutcome StudyPersonsPhasePopulationPopulation ResearchPostpartum PeriodPovertyPregnancyPrevention strategyProxyRaceRecordsRecurrenceResearchResourcesRiskRisk AssessmentRisk FactorsRisk ReductionSepsisSocial EnvironmentSocial IdentificationSurvivorsTimeTranslatingTranslationsVirginiaWomanWorkcommunity engagementcommunity organizationsdata resourcedisparity eliminationethnic disparityhealth disparityhigh riskimprovedintersectionalitylarge scale datalongitudinal datasetmarginalizationmaternal morbiditymaternal outcomematernal weightneighborhood disadvantagenext generationparent grantpeople of colorpregnancy disorderpregnancy healthpregnantprepregnancyracial disparityreproductivesegregationsevere maternal morbiditysocialsocial disparitiessocial structuresocioeconomicssuccess
项目摘要
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.
摘要
严重孕产妇发病率(SMM),包括将孕妇置于最大风险的情况
死亡人数(如出血、败血症、器官衰竭)在过去20年中翻了一番。最常见的
SMM的前驱疾病--贫血、妊娠高血压疾病(HDP)和剖宫产--也是
越来越多。有色人种,特别是黑人和美洲原住民,对所有人来说都面临更高的风险
这些结果。这项续订提案建立在我们以前解决孕产妇不平等问题的工作的基础上
结果。通过家长助学金,我们的团队加深了目前对社会责任贡献的理解
背景(关注邻里社会劣势)和孕产妇孕前健康(关注身体
质量指数),使用我们建立的加州(CA)出生的独特数据资源。此续订使用
以理论为基础的方法来解决我们对孕产妇健康理解中的几个剩余差距
在美国,被父母格兰特照亮的。我们将建立一个独特的1600万出生人口资源
1997年至2021年的三个州。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;包括住址;链接数据以供重复
随着时间的推移,怀孕到同一个人,从而提供了高质量的大规模数据类型
关于孕产妇健康和社会背景的信息,外地需要这些信息来推动人口层面的研究
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
交叉框架,目标1将审查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)。边缘化的指标包括种族、教育、医疗保健支付者、出生地和
人口普查地区一级的社会劣势和结构性不平等(例如贫穷、隔离)的标志。使用
生殖生命过程框架,目标2将确定社会和医疗风险的累积影响
连续怀孕对产妇健康的影响因素(即SMM、SMM亚型、SMM前体)。我们
将审查与社会背景(例如,持续的人口普查区域贫困)、发病率(例如,
持续性HDP)和分娩方式(初次剖腹产)会影响随后的发生和复发
研究结果。目标3将使用目标1和目标2的调查结果来确定改进的策略并确定其优先顺序
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
了解机制并比较选定的假设性干预对研究的潜在影响
结果和差异,以及b)社区参与的优先排序方法,以综合我们的调查结果和
确定下一步的优先顺序。通过了解多种形式的边缘化和连续
在严格的分析和社区基础知识的指导下,我们的工作将有助于
推进下一代可操作的人口层面SMM股权研究。
项目成果
期刊论文数量(0)
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会议论文数量(0)
专利数量(0)
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SUZAN L CARMICHAEL其他文献
SUZAN L CARMICHAEL的其他文献
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{{ truncateString('SUZAN L CARMICHAEL', 18)}}的其他基金
Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity
斯坦福大学 PRIHSM:预防与出血相关的严重孕产妇发病率的不平等
- 批准号:
10748636 - 财政年份:2023
- 资助金额:
$ 60.08万 - 项目类别:
Building a causal pathway framework to identify interventions to eliminate racial/ethnic disparities in severe maternal morbidity
建立因果路径框架,以确定消除严重孕产妇发病率方面的种族/民族差异的干预措施
- 批准号:
10684599 - 财政年份:2022
- 资助金额:
$ 60.08万 - 项目类别:
Building a causal pathway framework to identify interventions to eliminate racial/ethnic disparities in severe maternal morbidity
建立因果路径框架,以确定消除严重孕产妇发病率方面的种族/民族差异的干预措施
- 批准号:
10656523 - 财政年份:2021
- 资助金额:
$ 60.08万 - 项目类别:
Building a causal pathway framework to identify interventions to eliminate racial/ethnic disparities in severe maternal morbidity
建立因果路径框架,以确定消除严重孕产妇发病率方面的种族/民族差异的干预措施
- 批准号:
10280836 - 财政年份:2021
- 资助金额:
$ 60.08万 - 项目类别:
Building a causal pathway framework to identify interventions to eliminate racial/ethnic disparities in severe maternal morbidity
建立因果路径框架,以确定消除严重孕产妇发病率方面的种族/民族差异的干预措施
- 批准号:
10878197 - 财政年份:2021
- 资助金额:
$ 60.08万 - 项目类别:
Building a causal pathway framework to identify interventions to eliminate racial/ethnic disparities in severe maternal morbidity
建立因果路径框架,以确定消除严重孕产妇发病率方面的种族/民族差异的干预措施
- 批准号:
10490296 - 财政年份:2021
- 资助金额:
$ 60.08万 - 项目类别:
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:
10087967 - 财政年份:2018
- 资助金额:
$ 60.08万 - 项目类别:
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:
10300988 - 财政年份:2018
- 资助金额:
$ 60.08万 - 项目类别:
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:
10091301 - 财政年份:2018
- 资助金额:
$ 60.08万 - 项目类别:
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