Examining the Impact, Pathways, and Cost of County-Level Structural Racism on Hypertension Disparities in Black and White US Adults

检查县级结构性种族主义对美国黑人和白人成年人高血压差异的影响、途径和成本

• 批准号: 10474840
• 负责人: Lorraine Tiera Dean
• 金额: $ 45.34万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474840
• 关键词: Accounting; Address; Adult; Affect; African American; Alcohol consumption; American; Behavior; Behavioral; Biological Markers; Black American; Black Populations; Black race; Body mass index; C-reactive protein; Cardiovascular system; Cholesterol; County; Criminal Justice; Cross-Sectional Studies; Data; Diet; Education; Employment; Epidemiology; Equation; Exposure to; Foundations; Geography; Goals; Health; Health Care Costs; Health Expenditures; Healthcare; Hospitals; Housing; Hypertension; Incidence; Individual; Inflammation; Inflammatory; Intervention; Journals; Leadership; Left; Link; Lipids; Longitudinal Studies; Longitudinal cohort; Measures; Mediating; Mediation; Mediator of activation protein; Medicare claim; Modeling; Morbidity - disease rate; Myocardial Infarction; Obesity; Observational Study; Paper; Participant; Pathway interactions; Physical activity; Physiological; Plant Roots; Policies; Prevalence; Preventive Medicine; Psychosocial Stress; Publications; Publishing; Race; Reasons for Geographic And Racial Differences in Stroke; Renal function; Reporting; Research; Research Personnel; Resources; Risk Factors; Role; Severities; Societies; Stress; Structural Racism; Time; Tobacco use; Translating; Triglycerides; United States; Work; cardiometabolism; cationic antimicrobial protein CAP 37; clinical epidemiology; cohort; cost; early onset; fasting glucose; health care quality; health data; health disparity; health economics; high body mass index; multilevel analysis; news; novel; programs; racial disparity; racism; residential segregation; response; sex; social; social epidemiology; societal costs; stressor; waist circumference

PROJECT SUMMARY Black Americans have the highest hypertension (or high blood pressure, HBP) rates in the world, with stark racial disparities between Black and White adults that have persisted for decades and at the highest cost to society of all cardiovascular conditions. The underlying cause of HBP disparities is unknown, and previous studies have mostly focused on individual-level behaviors, stressors, and physiologic risk factors leaving a missed opportunity to uncover and address the root causes of these disparities. Structural racism may be a root cause of HBP disparities and, as such, HBP disparities will persist if structural racism is not addressed. Thus, to eliminate HBP disparities, we must first investigate if structural racism is a fundamental cause and use longitudinal studies to explore the pathways through which structural racism influences HBP risk factors and disparities. Using a novel 5-domain measure of structural racism, our previous cross-sectional studies have demonstrated that greater structural racism is associated with higher BMI, one behavioral risk factor for HBP; however, this work has left gaps in understanding how structural racism is related to other risk factors for HBP, as well as questions about the timing and geographic scales at which structural racism operates. We seek to fill these gaps in responding to RFA-MD-21-004’s request for “observational research to understand the role of structural racism…in causing and sustaining health disparities” for HBP. Our goal is to conduct a multi-level national study to investigate associations between our novel multi-dimensional measure of county-level structural racism (CSR) and: physiologic, behavioral, and structural risk factors for HBP (Aim 1), HBP incidence, prevalence, and severity (Aim 2), and how much counties could save in HBP healthcare costs if CSR was eliminated (Aim 3). We leverage pre-existing resources that are uniquely available to us: (a) our published County Structural Racism Scale, (b) US News & World Report hospital rankings of healthcare quality, and (c) longitudinal behavioral and biomarker HBP data from 30,239 Black and White adults across the US in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We expand beyond previous studies by using a multi-domain measure of structural racism, applying it to longitudinal health data that allows us to assess exposure to structural racism at multiple times in the lifecourse, and quantifying how much structural racism costs counties in HBP healthcare spending when it goes unaddressed. We will translate our findings into policy briefs targeted toward county-level executives in the US. Our team of experts in CVD disparities, social and clinical epidemiology, and health economics, with representation from REGARDS, two Hopkins disparities centers, Hopkins’ CVD Epidemiology, and former county leaders, are well- equipped to execute this New Investigator application. Our results will offer evidence of how CSR influences HBP, with the potential to build support for policy decisions on CSR that can ultimately reduce HBP disparities.

项目概要 美国黑人的高血压（或高血压，HBP）发病率是世界上最高的，与明显的 黑人和白人成年人之间的种族差异已经持续了数十年，并且付出了最高的代价 HBP 差异的根本原因尚不清楚，而且以前也不清楚。 研究主要集中在个人层面的行为、压力源和生理风险因素上 错失发现和解决这些差异的根本原因的机会可能是一个原因。 这是 HBP 差异的根本原因，因此，如果不解决结构性种族主义，HBP 差异将持续存在。 因此，为了消除 HBP 差异，我们必须首先调查结构性种族主义是否是根本原因并利用 纵向研究探索结构性种族主义影响 HBP 危险因素的途径 我们之前的横断面研究使用了一种新颖的结构性种族主义的 5 领域衡量标准。 证明更大的结构性种族主义与更高的 BMI 相关，这是 HBP 的行为危险因素之一； 然而，这项工作在理解结构性种族主义如何与 HBP 的其他风险因素相关方面留下了空白， 以及有关结构性种族主义发生的时间和地理范围的问题。 填补这些空白，响应 RFA-MD-21-004 的“观察研究以了解 HBP 的目标是开展多层次的结构性种族主义……造成和维持健康差异。 国家研究调查我们新颖的县级多维测量之间的关联 结构性种族主义 (CSR) 和：HBP 的生理、行为和结构性危险因素（目标 1）、HBP 发病率、患病率和严重程度（目标 2），以及如果 企业社会责任被消除（目标 3）。我们利用我们独有的现有资源：(a) 我们的。 公布县结构性种族主义量表，(b) 《美国新闻与世界报道》医院医疗保健排名 质量，以及 (c) 来自全美 30,239 名黑人和白人成年人的纵向行为和生物标志物 HBP 数据 美国中风的地理和种族差异原因 (REGARDS) 队列 我们的范围超出了其他范围。 先前的研究使用结构性种族主义的多领域衡量标准，并将其应用于纵向健康数据 这使我们能够评估生命历程中多次遭受结构性种族主义的情况，并量化如何 如果不加以解决，结构性种族主义将导致各县在 HBP 医疗保健支出方面付出巨大代价。 将我们的研究结果转化为针对美国县级高管的政策简报。 CVD 差异、社会和临床流行病学以及卫生经济学方面的研究，代表来自 谨致问候，两个霍普金斯差异中心、霍普金斯的 CVD 流行病学和前县领导，非常好 我们的结果将提供企业社会责任如何影响的证据。 HBP，有可能为企业社会责任政策决策提供支持，最终减少 HBP 差异。