Population Health Research | Emory School of Medicine

Population Health refers to “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”

The Population Health Team is based at Grady Memorial Hospital, a large safety net institution for medically underserved patients residing in Georgia’s Fulton and DeKalb counties (Atlanta, GA). Our work focuses on characterizing the complex multilevel pathways that shape maternal behavior and health. We are particularly interested in understanding why socially disadvantaged women bear a disproportionate burden of maternal morbidity and mortality how interventions can be integrated into obstetric practice to reduce these disparities. Leveraging the strengths and expertise of our multidisciplinary team of clinicians, epidemiologists, and health informaticians, we use a data-driven approach to design and test actionable strategies for addressing the underlying causes of adverse maternal outcomes at Grady and in other health disparities populations.

Severe Maternal Morbidity

Severe maternal morbidity (SMM) includes unintended outcomes of labor and delivery resulting in significant short-term and long-term consequences to a woman’s health. In the US, SMM is 100 times more common than maternal mortality and has been increasing over time. Disparities also persist with Black and marginalized women most likely to be affected. Our work aims to characterize the individual, social, and structural factors that contribute to SMM risk. Currently, we are studying associations between SMM and co-morbid conditions (hypertension and diabetes) and using multi-level approaches to understand how social determinants of health, including neighborhood-level characteristics, influence SMM risk.

Key Finding

Hypertensive Disorders of Pregnancy, Cesarean Delivery, and Severe Maternal Morbidity in an Urban Safety Net Population

We found that women with hypertensive disorders of pregnancy had an over twofold increased risk for SMM, compared with women without hypertensive disorders of pregnancy.

Postpartum Health and Wellness

In the US, up to 40% of women do not attend postpartum visits, often due to barriers such as lack of insurance, transportation, or childcare. Among women that do attend postpartum visits, there can be major discrepancies between the care that is provided and women’s physical, emotional, and social needs. Our research focuses on understanding the social and structural barriers to postpartum care engagement and developing women-centered strategies to address unmet postpartum needs. For example, we are testing the feasibility a mobile health home blood pressure telemonitoring system for postpartum women at risk for hypertensive complications. In addition, our “Minding the Gap” study will test the effectiveness of a tailored, comprehensive postpartum care system among women receiving pregnancy care at Grady.

Key Finding

Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance

Among 1,360 women diagnosed with hypertensive disorder of pregnancy, only 24% attended a recommended blood pressure screening visit in the early postpartum period. Rates of attendance were lowest among women who were publically insured, non-Hispanic black, and had inadequate prenatal care utilization.

COVID-19

Early data from the COVID-19 pandemic suggest that pregnant women are at increased risk for severe illness than nonpregnant women. Moreover, there are alarming disparities in rates of infection, with racial and ethnic minorities and socioeconomically disadvantaged groups bearing a disproportionate burden of illness, hospitalization, and death. In addition to assessing disparities in infection rates among pregnant women, we are conducting a mixed methods study to evaluate impact of the transition to telehealth on prenatal care access and quality, and maternal health outcomes during the pandemic.

Key Finding

Sociodemographic and neighborhood predictors of SARS-CoV-2 infection in obstetric patients in two urban Atlanta hospitals.

In cohort study of 1,882 pregnant women in Atlanta, GA, we found that the prevalence of SARS-CoV-2 infection was highest among women who were Hispanic, uninsured, or lived in high-density neighborhoods.

Maternal Vaccination

Despite longstanding recommendations, rates of influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during pregnancy remain suboptimal, with clear disparities in rates of uptake. Our work involves efforts to better understand factors that contribute to low rates of maternal vaccine acceptance and the development of new approaches to overcome barriers to vaccination.

Key Finding

Trends in Infant Pertussis Hospitalizations in the United States, 2009-2017

We found a decline in pertussis hospitalization rates among young infants following 2012 recommendations for the administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy. Our findings suggest that maternal Tdap vaccination is associated with lower rates of death and hospitalization and reduced disease severity among young infants with pertussis.

Additional Findings: