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Principal Investigator: Alka Dev
Organization: DARTMOUTH COLLEGE
Fiscal Year: 2024
Award: $136,350
Funding agency: National Institute on Minority Health and Health Disparities
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.
Terms: <0-4 weeks old><Abdominal Delivery><Address><Advocate><Affect><Age><Area><Award><Birth><Birth Certificates><Black Populations><Black group><Black individual><Black people><Blacks><C section><Career Development Awards><Career Development Awards and Programs><Career Development Programs K-Series><Caucasian Females><Caucasian Women><Cesarean><Cesarean section><Characteristics><Communities><Coupled><Data><Data Files><Death Rate><Development><Development Plans><Diagnosis><Disabilities experience><Disabled Persons><Disabled Population><Discipline of obstetrics><Disparities><Disparity><Disparity population><Economic Conditions><Economic Income><Economical Conditions><Economical Income><Educational workshop><Enrollment><Environment><Ethnic Origin><Ethnicity><Faculty><Funding><Future><Gestation><Gestational Hypertension><Goals><Handicapped><Health><Health Food><Health Inequity><High-Risk Pregnancy><Hispanic Populations><Hispanic group><Hispanic individual><Hispanic people><Hispanics><Hospital Admission><Hospitalization><Hospitals><Household><Housing><Hypertension induced by pregnancy><Hypertension-Associated Pregnancy Disorder><Income><Inequalities in Health><Inequities in Health><Inequity><Infant><Infant Health><Infant Mortality><Infant Mortality Total><Institution><Insurance Coverage><Insurance Status><Intellectual disability><Intellectual functioning disability><Intellectual limitation><Intervention><Intervention Strategies><Investigators><K-Awards><K-Series Research Career Programs><Knowledge><Labor Complications><Lead><Life><Link><Low Birth Weight Infant><Maternal Health><Maternal Mortality><Measurement><Measures><Medicaid><Mentorship><Methodology><Methods><Mothers><Musculoskeletal><Neighborhoods><Neonatal Intensive Care><Neonatal Mortality><Newborn Infant><Newborn Infant Intensive Care><Newborns><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Obstetrics><Outcome><Parturition><Pb element><People with Disabilities><Persons><Persons with Disabilities><Policies><Population><Postpartum Period><Pregnancy><Pregnancy Associated Hypertension><Pregnancy Complications><Pregnancy Rate><Premature Birth><Prematurely delivering><Prenatal care><Preterm Birth><Psyche structure><QOC><Quality of Care><R-Series Research Projects><R01 Mechanism><R01 Program><Race><Races><Records><Research><Research Career Program><Research Grants><Research Personnel><Research Project Grants><Research Projects><Researchers><Risk><Risk Factors><Rural><SES disparity><Series><Services><Small for Gestational Age Infant><Testing><Texas><Training><Urbanicity><Variant><Variation><Visit><Well Child Visits><Well child checks><Well child checkups><Well child exam><White Females><White Women><Woman><Work><Workshop><access disparities><accessibility disparities><adverse birth outcomes><adverse consequence><adverse outcome><ages><birth complications><black female><black women><black/white disparity><career><career development><child routine wellness visits><child wellness visit><co-morbid><co-morbidity><comorbidity><complications during pregnancy><conference><convention><cost><data structure><death among infants><death among neonates><death among newborns><death in first year of life><death in infancy><death in infants><death in neonates><death in newborn><delivery complications><deprivation><design><designing><developmental><disability><disabled><disabled individual><disabled people><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparate effect><disparate impact><disparate result><disparities across groups><disparities in access><disparities in race><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><disparity due to race><disparity in ethnic><disparity in health><effective intervention><enroll><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic identity><ethnic inequality><ethnic inequity><ethnic minority><ethnicity disparity><experience><group disparity><group inequality><group inequity><health care quality><health disparity><health equity><health inequalities><healthcare quality><healthy food><heavy metal Pb><heavy metal lead><high risk><housing tenure><hypertensive disease of pregnancy><improved><improved outcome><incomes><individuals with disabilities><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality due to race><inequality in access><inequality in groups><inequitable effect><inequitable impact><inequitable outcome><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity due to race><inequity in access><inequity in accessibility><inequity in groups><infant death><infant demise><infant outcome><infantile death><intellectual and developmental disability><intervention design><interventional strategy><lens><lenses><limited intellectual functioning><low birth weight><low birthweight><maternal death><mental><methods to study multiple-level influences><mortality><mortality among neonates><mortality among newborns><mortality in infants><mortality in neonates><mortality in newborns><mortality rate><mortality ratio><multi-level analysis><multi-level model><multilevel analysis><multilevel model><multilevel modeling><neonatal death><neonatal demise><neonatal health><newborn child><newborn children><newborn death><newborn health><newborn mortality><obstetric outcomes><outcome disparities><outcome inequality><outcome inequity><pediatric preventive visit><pediatric well visit><pilot test><population inequality><population inequity><post-partum><pregnancy care><pregnancy hypertension><pregnancy-related complications><pregnant><premature childbirth><premature delivery><prenatal appointment><prenatal checkup><prenatal visit><preterm delivery><public health insurance><public insurance><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial minority><racial origin><racially unequal><residential tenure><routine child health visit><rural area><rural dwelling><rural households><rural location><rural region><rural residence><rurality><severe maternal morbidity><skills><small for gestational age><social><social determinants><socio-economic><socio-economic disparity><socio-economic inequality><socio-economic inequity><socio-economically><sociodeterminant><socioeconomic disparity><socioeconomic inequality><socioeconomic inequity><socioeconomically><socioeconomics><stillbirth><stillborn><subgroup disparity><summit><symposia><symposium><therapy design><treatment design><unequal effect><unequal group><unequal impact><unequal outcome><unequal population><urban area><urban location><urban region>