Evaluating maternal and newborn health inequities at the intersection of race, ethnicity, and disability in the U.S

项目概要（摘要） 残疾人怀孕的比率与非残疾人相同，但 不成比例的高不良结局发生率，包括妊娠、分娩和分娩并发症， 严重的孕产妇发病率、孕产妇死亡率、早产、死产、低出生体重和婴儿死亡率。 虽然关于孕产妇和新生儿中种族和族裔差异程度的信息有限， 目前的证据表明，这些不平等现象甚至 与白色人相比，在种族和少数民族中更为明显。发展中 有效的干预措施，以消除在种族，民族和残疾的交叉不平等，需要一个 全面了解这些多层次的不平等和相关的 出生结果。该项目旨在填补这一研究空白，利用孕产妇健康的社会决定因素透镜， 分析关联的母婴医疗补助索赔、出生率和死亡率数据文件。三个研究目标是 提出了目标1侧重于低出生体重的种族和族裔差异的程度， 胎龄、早产和新生儿死亡率与残疾的交叉点;目标2评估 在种族、民族和残疾交叉点，这些结果的差异得到缓和的程度 目标3评估了种族、民族和文化之间的关系， 在国家制定的母婴健康质量衡量标准中，残疾人比例最高。建议的目标是 由PI的职业培训目标支持，其中包括1）使用Medicaid索赔的专业知识 数据，以产生按种族、民族和残疾划分的不良出生结果的测量，2）分析地区水平 与孕产妇和新生儿健康差距相关的社会决定因素和护理质量措施，以及 3)了解残疾测量，公共保险覆盖范围，健康状况不佳的风险因素，以及 社区优先事项需要设计有效的干预措施，以减少孕产妇和婴儿健康的不平等， 这个人口。拟议的项目支持PI的长期职业目标，成为一个独立的 调查员和倡导孕产妇和新生儿健康公平在美国，特别强调 采用严格的方法查明和解决社会不平等造成的差异。职业生涯 发展将包括一系列的正式课程，培训讲习班，并指导阅读，将 在前两年与达特茅斯和其他机构的教师一起完成，并涵盖了其他主题 在接下来的几年里，需要。还将增加出席会议和有关讲习班的次数， 随时了解该领域的最新发展。该奖项将随后与研究项目补助金 (R01)开发和测试一种干预措施，以改善那些负担最重的不良反应患者的结果。 美国种族、民族和残疾交叉点的结果。

PROJECT SUMMARY (ABSTRACT) People with disabilities experience pregnancy at the same rate as people without disabilities but have disproportionately higher rates of adverse outcomes including pregnancy, labor and delivery complications, severe maternal morbidity, maternal death, preterm birth, stillbirth, low birth weight, and infant mortality rates. Although there is limited information about the extent of racial and ethnic disparities in maternal and newborn health outcomes among those who are disabled, current evidence suggests that these inequities are even more pronounced among racial and ethnic minorities compared to their White counterparts. Developing effective interventions to eliminate inequities at the intersection of race, ethnicity, and disability requires a comprehensive understanding of the relationships between these multiple levels of inequity and associated birth outcomes. This project aims to fill this research gap using a social determinants of maternal health lens to analyze linked maternal-infant Medicaid claims, natality, and mortality data files. Three research aims are proposed. Aim 1 focuses on the magnitude of racial and ethnic disparities in low birthweight, small for gestational age, preterm birth, and neonatal mortality at the intersection with disability; Aim 2 evaluates the extent to which disparities in these outcomes at the intersection of race, ethnicity, and disability are moderated by area-level socioeconomic inequities; and Aim 3 evaluates the association between race, ethnicity, and disability in nationally established quality measures for maternal-infant health. The proposed aims are supported by the PI’s career training goals, which include developing expertise in 1) using Medicaid claims data to produce measures of adverse birth outcomes by race, ethnicity, and disability, 2) analyzing area-level social determinants and quality of care measures associated with maternal and newborn health disparities, and 3) understanding disability measurement, public insurance coverage, risk factors for poor health, and community priorities needed to design effective interventions to reduce maternal and infant health inequities in this population. The proposed project supports the PI’s long-term career goal to become an independent investigator and advocate for maternal and newborn health equity in the U.S., with a particular emphasis on identifying and addressing the disparities resulting from social inequities using rigorous methodologies. Career development will include a series of formal courses, training workshops, and directed readings that will be completed with faculty at Dartmouth and other institutions over the first two years with additional topics covered as needed in the subsequent years. Attendance at conferences and related workshops will also be added to stay informed of current developments in the field. The award will be followed with a Research Project Grant (R01) to develop and test an intervention to improve outcomes among those most burdened by adverse outcomes at the intersection of race, ethnicity, and disability in the U.S.