Social and Economic Determinants of Maternal Morbidity in the United States

项目摘要 在美国预期寿命和婴儿死亡率长期改善的情况下， 出现了不协调的新趋势--孕产妇死亡率和发病率正在上升。与此同时 这一趋势是种族差距的证据，特别是在非西班牙裔黑人妇女中，她们正在经历 这些不良后果的发生率比其他组高得多。这些现象才刚刚开始 被研究人员研究和理解。产妇死亡和发病的医学原因很容易 已查明，但缺乏对根本原因的解释。在以前的研究中，这些研究记录了 产妇死亡率和发病率，研究人员假设导致这些趋势的因素 包括产妇年龄较大、体重增加、怀孕期间吸烟和非法使用药物、低社会经济地位 以及与提供者和医疗保健相关的问题。然而，我们目前几乎没有从 关于哪些因素最具影响力或哪些政策干预可能最有益的文献。这个 这项拟议研究的目的有两个。第一个目标是对 孕产妇死亡率和发病率的决定因素，以努力确定可能或可能不会的因素 对根本原因做出贡献。我们将潜在的解释变量归类为母性特征， 医院特点，反映获得护理的变量，以及社区层面的措施 社会经济环境。第二个目标是调查孕产妇中种族差异的来源。 死亡率和发病率。为了实现这些目标，我们将首先产生孕产妇发病率和 使用全国住院患者样本(NIS)的1998-2011年死亡率。我们将把这些数据与其他数据结合起来 来自患者、医院和更大的社区(县)的信息。我们将估计 不同变量和变量组对发病率和死亡率总体差异的贡献 随着时间的推移，医院之间和医院内的费率。然后，我们将使用基于回归的重新加权 检查种族差异的来源的技术。我们的结果将为哪些类型的 变量将受益于进一步的研究。一旦确定了这些因素，未来的研究就可以集中于评估 将不同的公共政策作为降低产妇发病率和死亡率的潜在解决办法。

Project Summary Amid long standing improvements in life expectancy and infant mortality in the United States, a discordant new trend has emerged -- maternal mortality and morbidity are on the rise. Concurrent with this trend is evidence of racial disparities, particularly among non-Hispanic black women, who are experiencing these adverse outcomes at much higher rates than other groups. These phenomena are only beginning to be studied and understood by researchers. The medical causes of maternal mortality and morbidity are easily identified, but an explanation of the underlying reasons is lacking. In previous studies that document trends in maternal mortality and morbidity, researchers have hypothesized that factors contributing to these trends include older maternal age, increased body weight, cigarette and illegal drug use during pregnancy, low SES, and issues related to providers and medical care. However, we currently have little guidance from the literature on which factors are the most influential or where policy interventions can be most beneficial. The purpose of this proposed research is twofold. The first goal is to conduct an exploratory analysis of the determinants of maternal mortality and morbidity in an effort to identify the factors that may or may not contribute to the underlying causes. We group potential explanatory variables into maternal characteristics, hospital characteristics, variables reflecting access to care, and community-level measures of the socioeconomic environment. The second objective is to investigate the sources of racial disparities in maternal mortality and morbidity. To accomplish these aims, we will first generate rates of maternal morbidity and mortality for 1998-2011 using the Nationwide Inpatient Sample (NIS). We will combine this data with additional information from the patient, hospital, and the larger community (the county). We will estimate the contributions of the different variables and variable groups to the overall variation in morbidity and mortality rates across hospitals and within hospitals over time. We will then use regression-based re-weighting techniques to examine the sources of racial disparities. Our results will provide guidance on what types of variables would benefit from further study. Once these are identified, future research can focus on evaluating different public policies as potential solutions to reduce maternal morbidity and mortality.