Broader contextual characteristics may be key to understanding maternal mortality. The public health exposome approach allows for the simultaneous evaluation of individual characteristics and behaviors within the context of environmental exposures from the natural, built, and social environments. Our conceptual model addresses the intersection of individuals' biological, behavioral, and social characteristics within (and inseparable from) the context of the environments in which they live. The inequitable distribution of unhealthy environmental exposures therefore produces racialized or socioeconomic disparities in maternal mortality at the population level. The overall goal of this supplement is to develop, using an exposome-wide computational approach, multi-level models incorporating individual and environmental-level predictors of maternal mortality, both for the United States as a whole, and Louisiana specifically. This will build on the parent project's aim of addressing how social contexts increase risk for pregnancy-related mortality. Datasets developed in the parent R01 ? county- level maternal mortality estimates from all US states 2005-2018 and individual-level estimates from Louisiana 2010-2017 - will be linked to the public health exposome database, a large data repository (>55,000 variables) containing measures of the natural, built, and social environments for 3,141 counties and county equivalents, and spanning over 15 years. This provides spatial-temporal, contextual environmental data that can be analyzed at the county level or linked to residential addresses. High-dimensional computational methods will be applied to multilevel analysis to identify the aspects of the environment that are most strongly associated with maternal mortality. By examining the results from the parent grant, the national- level analysis, and an individual-level analysis of a single state, we will establish a comprehensive picture of the ecology of maternal mortality.
This project addresses several of the goals of the IMPROVE project, most notably expanding research on the leading causes of maternal mortality in the U.S. and developing an integrated understanding of maternal mortality in order to identify preventable risk factors. The project incorporates innovative data analytics in order to address disparities and promote comprehensive strategies to address preventable contributors to maternal mortality in disproportionately affected populations.