Understanding racial and ethnic disparities in preterm birth: a systems science approach

摘要/摘要 早产(PTB；分娩和37周)是美国大约35%的婴儿死亡的原因， 是短期和长期发病率的重要原因。估计每年的社会经济成本 全国的PTB超过260亿美元。结核分枝杆菌的差异有很好的记录，有种族/少数民族 持续经历较高肺结核发病率的人群。中介决定因素，包括个人和 人际层面的因素，以及医疗保健、社区和社会层面等结构性决定因素 这些因素被认为是造成种族/族裔差异的因素。然而，研究人员还没有研究如何 这些相互依赖和相互作用的决定因素影响着种族主义社会系统中的结核病差异。 要制定有效的干预措施，就需要这样的理解。这位候选人假定 社会各阶层中不公平的习俗、做法和法律以自我强化/纠正的方式运作 以维持不平等。这些决定因素的作用是动态复杂的，不能通过 传统的统计方法由于多层次因素的相互依存、内在的反馈过程 以及它们之间的相互作用，以及“暴露”和结果之间的时间延迟。系统动力学 建模(SDM)是为动态研究复杂问题而设计的，并已成功地用于 告知有关健康的社会决定因素的政策。候选人正在申请这一奖项，以便 发展SDM方面的专业知识。该奖项的培训部分还包括正式/非正式的保健培训。 权益计量、健康政策和收益-成本分析。该奖项的研究部分旨在 解决我们对结构性决定因素和中介决定因素如何产生和 保持PTB的种族/族裔差异，并为解决这些差异的战略提供信息。目标1是 确定产生或维持种族/民族的结构性决定因素和中介决定因素的途径 肺结核的差异。目标2将建立在第一个目标的基础工作的基础上，并开发一个量化的SD 表示因果机制的数学关系模型。此外，这一目标将考验 医疗保健部门干预措施的动态影响(孕激素和小剂量阿司匹林治疗 有早产和先兆子痫风险的妇女)。目标3是进行收益-成本分析和模拟 医疗保健部门干预措施的有效性。候选人是一位社会和围产期流行病学家，嗯 在定量和定性方法的多样化和互补性分析工具方面进行培训。这个 拟议的培训计划支持候选人成为一名知名调查员的长期职业目标 在健康差距研究中，特别强调了解健康差距的决定因素 妇幼保健以及制定和评估有效的干预措施，以减少 通过包括系统科学在内的各种方法论工具包，研究不同的差异。

SUMMARY/ABSTRACT Preterm birth (PTB; childbirth <37 weeks) is responsible for approximately 35% of infant deaths in the U.S., and is an important cause of short- and long-term morbidity. The estimated annual societal economic cost of PTB nationally is more than $26 billion. PTB disparities are well documented, with racial/ethnic minority populations persistently experiencing higher PTB rates. Intermediary determinants, including individual and interpersonal level factors, and structural determinants such as healthcare, community and societal level factors, are posited contributors to racial/ethnic disparities. However, researchers have not examined how these interdependent and interacting determinants influence PTB disparities within a racialized social system. Such an understanding is needed to develop effective interventions. The candidate hypothesizes that inequitable customs, practices and laws in various sectors of society operate in self-reinforcing/correcting ways to maintain inequality. The functioning of these determinants is dynamically complex and cannot be studied via conventional statistical methods due to the interdependence of multi-level factors, inherent feedback processes and interactions between them, and time delays between ‘exposures’ and outcome. System Dynamics Modeling (SDM) is designed to study dynamically complex problems, and has been successfully used to inform policies regarding social determinants of health. The candidate is applying for this award in order to develop expertise in SDM. The training component of the award also includes formal/informal training in health equity measurement, health policy, and benefit-cost analysis. The research component of the award aims to address significant gaps in our understanding of how structural and intermediary determinants generate and perpetuate racial/ethnic PTB disparities, as well as inform strategies to address these disparities. Aim 1 is to identify pathways through which structural and intermediary determinants generate or maintain racial/ethnic PTB disparities. Aim 2 will build upon the foundational work of the first aim and develop a quantitative SD model of mathematical relationships representing the causal mechanisms. Additionally, this aim will test dynamic effects of healthcare sector interventions (progestogens and low-dose aspirin administration for women at risk for preterm delivery and pre-eclampsia). Aim 3 is to conduct benefit-cost analyses and simulate efficacy of the healthcare sector interventions. The candidate is a social and perinatal epidemiologist, well trained in diverse and complementary analytical tools of quantitative and qualitative methodology. The proposed training program supports the candidate’s long-term career goal to become a renowned investigator in health disparities research, with particular emphasis on understanding determinants of disparities in maternal and child health and the development and evaluation of effective interventions to reduce the disparities via a diverse toolkit of methodology, including systems science.