Pregnancy-Associated Mortality

项目摘要/摘要 迫切需要找出根深蒂固和不可接受的种族问题背后的原因 美国孕期和产后死亡率的不平等。与白人女性相比 黑人女性死于产科和非产科原因的可能性要高出3-4倍。 以前的努力集中在风险差异背后的个人水平和医疗保健因素上 这未能解释不平等，引发了人们对更广泛的社会和结构性 条件可能在起作用。此外，尽管有证据表明凶杀是导致 在怀孕和产后死亡方面，人们对它的研究仍然严重不足。未能识别 解决与怀孕有关的凶杀案背后的因素将使种族不平等在 孕期和产后死亡率。我们在此应用程序中的总体目标是 审查妇女生活的社会背景的主要特征--收入不平等， 结构性种族主义、社区暴力和空间社会两极分化--增加了他们患上 在怀孕/产后死亡，并在死亡率方面造成种族不平等。我们将建造 基于并扩展我们现有的重要记录和社会背景数据库，以建立一个系统 对健康决定因素和孕产妇人口的分布进行公共卫生监测 全国各地的健康状况。这包括对历史数据到最近数据的持续分析 现有的国家死亡记录以及死亡、出生和胎儿死亡生命记录之间的联系 路易斯安那州。我们的具体目标是(1)确定哪些社会背景(收入 不平等、结构性种族主义、暴力和空间社会两极分化)增加了 与妊娠有关的死亡率，同时开发国家地理数据库以监测#年的趋势 美国各地的社会背景和孕产妇死亡，(2)确定哪些社会背景 (收入不平等、结构性种族主义、暴力和空间社会两极分化)增加了 与怀孕相关的凶杀案和监测两者随时间的趋势，和(3)确定 社会背景和妊娠相关死亡率之间的不同中介途径 与怀孕有关的凶杀案。本研究包括两个分析设计：1)国家 县级妊娠相关死亡率与妊娠相关生态分析 凶杀案，辅以2)地方多层次和调解分析，以估计个人- 孕期/产后死亡风险水平。这项工作的发现将包括从未 在记录妊娠相关死亡率的社会流行病学证据之前， 确定方案和政策干预的目标，旨在中断 孕期和产后妇女不良社会环境与死亡之间的路径。

PROJECT SUMMARY/ABSTRACT There is a critical need to identify reasons behind the entrenched and unacceptable racial inequity in mortality during pregnancy and postpartum in the US. Compared to White women Black women are 3-4 times more likely to die from both obstetric and non-obstetric causes. Previous efforts focused on individual-level and health care factors underlying differences in risk that have failed to explain the inequity, raising the concern that broader societal and structural conditions may at play. Moreover, despite evidence suggesting homicide is a leading cause of death during pregnancy and postpartum, it remains severely understudied. Failure to identify and address factors underlying pregnancy-associated homicide will perpetuate racial inequity in mortality during pregnancy and postpartum. Our overall objective in this application is to examine how key features of the social context in which women live – income inequality, structural racism, community violence, and spatial social polarization – increase their risk of death during pregnancy/postpartum and contribute to racial inequity in mortality. We will build upon and expand our existing vital records and social contexts databases to establish a system for public health monitoring of both distributions of health determinants and maternal population health across the country. This includes ongoing analyses of historical to the most recently available national death records and linkage of death, birth, and fetal death vital records from the state of Louisiana. Our specific aims are (1) To identify which social contexts (income inequality, structural racism, violence, and spatial social polarization) increase risk for pregnancy-related mortality while developing a national geodatabase for monitoring trends in both social contexts and maternal deaths across the US, (2) To identify which social contexts (income inequality, structural racism, violence, and spatial social polarization) increase risk for pregnancy-associated homicide and to monitor trends in both over time, and (3) To identify distinct mediating pathways between social contexts and pregnancy-related mortality and pregnancy-associated homicide. The research includes two analytic designs: 1) national ecologic analysis of county-level pregnancy-related mortality and pregnancy-associated homicide, complemented by 2) local multi-level and mediation analysis to estimate individual- level mortality risk during pregnancy/postpartum. Findings from this work will include never before documented evidence of the social epidemiology of pregnancy-associated mortality and identification of targets for programmatic and policy intervention aimed at interrupting the pathway between adverse social contexts and death among pregnant and postpartum women.