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

总结/摘要 在美国，早产（PTB;分娩<37周）约占婴儿死亡的35%， 并且是短期和长期发病的重要原因。估计每年的社会经济成本 PTB全国超过260亿美元。PTB差异有据可查，种族/族裔少数 持续经历较高PTB率的人群。中介决定因素，包括个人和 人际层面的因素，以及结构性决定因素，如医疗保健，社区和社会层面 这些因素被认为是造成种族/民族不平等的因素。然而，研究人员还没有研究如何 这些相互依存和相互作用的决定因素影响着种族化社会制度内的结核病差异。 要制定有效的干预措施，就需要有这样的认识。候选人假设， 社会各部门不公平的习俗、惯例和法律以自我强化/纠正的方式运作 维持不平等。这些决定因素的功能是动态复杂的，不能通过 传统的统计方法由于多层次因素的相互依赖，固有的反馈过程 以及它们之间的相互作用，以及“接触”和结果之间的时间延迟。系统动力学 建模（SDM）是设计来研究动态复杂问题，并已成功地用于 为有关健康的社会决定因素的政策提供信息。候选人申请该奖项是为了 发展可持续发展机制方面的专门知识。该奖项的培训部分还包括正式/非正式的卫生培训 公平衡量、卫生政策和成本效益分析。该奖项的研究部分旨在 解决我们对结构性和中介性决定因素如何产生和 * 消除种族/族裔结核病差距，并为解决这些差距的战略提供信息。目标1： 查明结构性和中介性决定因素产生或维持种族/族裔 PTB差异。目标2将建立在第一个目标的基础工作上，并制定一个定量的可持续发展 代表因果机制的数学关系模型。此外，这一目标将测试 卫生保健部门干预措施的动态影响（孕激素和低剂量阿司匹林给药， 有早产和先兆子痫风险的妇女）。目标3是进行成本效益分析和模拟 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， 在定量和定性方法的各种互补分析工具方面接受过培训。的 拟议的培训计划支持候选人的长期职业目标，成为一名著名的调查员 在健康差异研究中，特别强调了解 孕产妇和儿童保健以及制定和评价有效干预措施， 通过包括系统科学在内的各种方法工具包，

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 cost-benefit 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 cost-benefit 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