Pregnancy-Associated Mortality

项目总结/摘要 目前迫切需要查明根深蒂固和不可接受的种族歧视现象背后的原因， 在美国怀孕期间和产后死亡率的不平等。与白色女性相比 黑人妇女死于产科和非产科原因的可能性要高出3-4倍。 以前的努力集中在个人水平和卫生保健因素的潜在差异的风险 这些都未能解释不平等，引起了人们的关注，更广泛的社会和结构， 条件可以发挥作用。此外，尽管有证据表明，杀人是导致死亡的主要原因， 怀孕期间和产后死亡，这仍然严重不足。未能识别 并解决与怀孕有关的杀人的潜在因素将使种族不平等永久化， 妊娠期和产后死亡率。本申请的总体目标是 研究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、社区暴力和社会空间两极分化-增加了他们的风险， 怀孕/产后死亡，造成死亡率方面的种族不平等。我们将建立 在我们现有的生命记录和社会背景数据库的基础上， 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。这包括对历史到最近的持续分析 可用的国家死亡记录和死亡、出生和胎儿死亡生命记录的联系， 方面应受中华我们的具体目标是（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 与怀孕有关的死亡率，同时开发国家地理数据库， 社会背景和美国各地的孕产妇死亡，（2）为了确定哪些社会背景 （收入不平等，结构性种族主义，暴力和空间社会两极分化）增加风险 （3）查明与怀孕有关的杀人案件，并监测这两方面的长期趋势， 社会背景与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该研究包括两个分析设计：1）国家 县级妊娠相关死亡率和妊娠相关死亡率的生态学分析 凶杀案，辅之以2）地方多层次和调解分析，以估计个人- 降低怀孕/产后死亡风险。这项工作的结果将永远不会包括 在有文件证明妊娠相关死亡的社会流行病学证据之前， 确定方案和政策干预的目标， 不良社会环境与孕妇和产后妇女死亡之间的关系。

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.