Social and biological determinants of pregnancy-related mortality and morbidity among rural, underserved women

摘要 在过去的二十年里，美国死于与怀孕有关的原因的妇女人数 各州几乎翻了一番，严重孕产妇发病率几乎增加了两倍。2，3研究 关于影响妊娠相关死亡率(PRM)和严重孕产妇发病率(SMM)的因素 之前忽视了阿巴拉契亚中部的女性，尽管这种健康状况的风险状况截然不同 人口。这项研究使用了严格的混合方法方法，以概念框架为指导 世界卫生组织通过的关于健康的社会决定因素的行动，以确定结构性和 影响阿巴拉契亚中部妇女患SMM和PRM.1、4风险的中介决定因素 这项研究具有很高的创新性，因为它是第一次在国家健康中心以外的国家进行的研究 统计(NCHS)利用来自NCHS的一个新数据库，该数据库将发病率和死亡率数据联系起来。 此外，这是已知的第一项针对居住在阿巴拉契亚中部的妇女的SMM和PRM的研究，以及 可能会为这一服务不足、健康状况迥异的人群提供关键的干预见解。 以下目标将： (1)找出阿巴拉契亚中部PRM和SMM的预测因子。这一目标将执行分层逻辑 对来自NCHS的全国数据进行回归，以确定影响女性患病的风险和保护因素 分娩时和产后一年发生SMM和PRM的风险。 (2)阐明医疗服务提供者和患者对PRM和SMM潜在机制的看法 阿巴拉契亚中部。将对以下患者进行深入的半结构化访谈：(1)10名患者 有经验的SMM，以及(2)阿巴拉契亚中部的10名医疗保健提供者和10名急救医生，他们提供了 护理经历SMM和PRM的患者。 PI将利用肯塔基大学健康公平中心的资源和专业知识 研究、研究数据中心和高度支持的专家跨学科指导团队 在农村健康差距、实施科学和母婴医学方面。团队成员的指导 将为PI提供关于混合方法研究、项目实施的充分培训 管理、负责任的研究行为和研究成果的传播。此次培训将为您提供 具有执行特定目标所需的技能集，并为PI成为一名 独立的医生-科学家，在孕产妇领域拥有外部支持的研究组合 健康。这项研究的结果将产生关于SMM和PRM的预测因素的基本知识 高危人群，并确定影响不良孕产妇结局的因素，这些因素可能是未来的目标 干预措施。这些发现也可能为未来对其他农村地区的实证调查的发展提供参考 人口。

ABSTRACT Over the past two decades, the number of women dying from pregnancy-related causes in the United States has nearly doubled, and cases of severe maternal morbidity have nearly tripled.2, 3 Research concerning the factors influencing pregnancy-related mortality (PRM) and severe maternal morbidity (SMM) has previously neglected women in Central Appalachia, despite the risk profile of this health disparate population. This study utilizes a rigorous mixed methods approach guided by the conceptual framework for action on the social determinants of health adopted by the World Health Organization to identify structural and intermediary determinants influencing Central Appalachian women's risk for SMM and PRM.1, 4 This study is highly innovative in that it is the first study nationally outside the National Center for Health Statistics (NCHS) to utilize a new database from the NCHS, which links morbidity and mortality data. Furthermore, it is the first known study to focus on SMM and PRM in women living in Central Appalachia, and may yield critical intervention insights for this underserved, health disparate population. The following aims will: (1) Identify predictors of PRM and SMM in Central Appalachia. This aim will perform hierarchical logistic regressions on nation-wide data from the NCHS to determine risk and protective factors influencing women's risk of SMM and PRM at delivery and one year postpartum. (2) Elucidate healthcare providers' and patients' perspectives on underlying mechanisms of PRM and SMM in Central Appalachia. In-depth semi-structured interviews will be conducted with: (1) 10 patients who have experienced SMM, and (2) 10 healthcare providers and 10 EMTs in Central Appalachia who have provided care for patients experiencing SMM and PRM. The PI will leverage resources and expertise from the University of Kentucky's Center for Health Equity Research, Research Data Center, and a highly supportive interdisciplinary mentorship team who are experts in rural health disparities, implementation science, and maternal-fetal medicine. Mentorship by team members will provide the PI with ample training concerning the implementation of mixed methods studies, project management, responsible conduct of research, and the dissemination of findings. This training will provide the PI with the skillset necessary to carry out the specific aims, and lay the foundation for the PI to become an independent physician-scientist with an extramurally supported research portfolio in the field of maternal health. Results from this study will produce essential knowledge concerning predictors of SMM and PRM in an at-risk population, and identify factors influencing poor maternal outcomes which may be targeted by future interventions. Findings may also inform development of future empirical investigations into in other rural populations.