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 严重的孕产妇发病率（SMM），其中包括使孕妇处于危险中的状况 在过去的二十年中，死亡（例如出血，败血症，器官衰竭）翻了一番。最常见的 SMM的前体 - 贫血，怀孕的高血压疾病（HDP）和剖宫产 - 也是 增加。有色人种，尤其是黑人和美国原住民，所有人的风险都会增加 这些结果。这项更新提案是基于我们以前的工作来解决孕产妇的不平等的工作 结果。通过父母赠款，我们的团队增强了对社会贡献的当前理解 环境（专注于社区社会劣势）和孕妇怀孕前健康（专注于身体 使用我们建立的加利福尼亚州（CA）出生的独特数据资源，质量指数）to SMM风险。这种更新使用 在我们对母校健康的理解中，依据的扎根的方法可以解决剩余的几个空白 在美国，由父母赠款照亮。我们将建立1600万分的独特资源 1997 - 2021年的三个州。数据集纵向链接重要记录（活产和胎儿死亡证明） 带有母亲和婴儿出院数据；包括居民地址；并链接数据以重复 随着时间的流逝，对同一人的怀孕，从而提供高质量的大规模数据的类型 有关孕产妇健康和社会环境的信息，该领域需要提高人口水平的研究 孕产妇健康。研究的所有阶段将由社区顾问委员会（CAB）指导。使用一个 交叉性框架，AIM 1将检查各种形式的边缘化对SMM的联合影响，ITS 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种族，教育，医疗保健付款人，耶稣降生和 社会灾难和结构性不平等的人口普查水平标记（例如贫困，隔离）。使用 生殖生活框架，AIM 2将决定社会和医疗风险的累积影响 在孕产妇健康方面成功怀孕的因素（即SMM，SMM亚型，SMM前体）。我们 将研究与社会环境（例如，持续的人口普查贫困），发病率（例如， 持续的HDP）和出生方式（原发性剖宫产）会影响随后的发生和复发 研究结果。 AIM 3将使用目标1和2的发现来确定和优先级改进策略 孕产妇的健康和公平。我们将使用a）因果推理方法（调解和G委托） 了解机制并比较选定假设干预对研究的潜在影响 结果和差异，b）社区参与的优先级方法，以综合我们的发现和 优先考虑下一步。通过了解各种形式的边缘化和成功的风险 怀孕，并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 推进下一代可行的人群级别SMM股票研究。