Socio-environmental context in monoclonal gammopathy of undetermined significance (MGUS) disparities

意义未明的单克隆丙种球蛋白病 (MGUS) 差异的社会环境背景

基本信息

批准号：
10410510
负责人：
Kimberly A Bertrand
金额：
$ 69.46万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10410510
关键词：
Address Adolescence Adult Affect African American African American population Archives Behavior Biological Assay Blood Blood specimen California Censuses Characteristics Childhood Chronic Classification Climate Collection Country Crowding Data Data Pooling Development Diabetes Mellitus Diagnosis Disease Early Diagnosis Economically Deprived Population Educational Background Educational Status Environment Environmental Pollution Epidemiology Etiology Evaluation Foundations Genetic Geography Goals Gold Health Incidence Incidental Findings Income Individual Infection Intervention Joints Knowledge Laboratories Life Light Link Malignant Neoplasms Measures Mediation Methods Monoclonal gammopathy of uncertain significance Multiple Myeloma Neighborhoods Not Hispanic or Latino Obesity Outcome Participant Physical activity Plasma Cells Play Population Population Heterogeneity Population Study Prevalence Prevention Measures Psychosocial Stress Questionnaires Race Research Research Design Research Support Resources Risk Risk Factors Risk Reduction Role Rural Social Environment Socioeconomic Status Time Underrepresented Populations Woman Women&apos s Health biological specimen archives black women built environment burden of illness cohort contextual factors deprivation epidemiology study experience fast food high risk improved outcome indexing innovation insight interest lifestyle factors low socioeconomic status man neighborhood association neighborhood disadvantage novel population health predictive modeling racial disparity racial diversity screening social determinants social factors socioeconomic diversity socioeconomics study population teacher walkability

项目摘要

ABSTRACT Compared to non-Hispanic whites, African Americans have a more than 2-fold higher incidence of multiple myeloma (MM) and its asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS). However, the etiological factors underlying these racial disparities are not known and few epidemiologic resources are currently available to support research in diverse populations. Notably, there is little evidence that genetic factors explain these disparities; differences in prevalence of MGUS and MM by race may thus reflect external lifestyle and social factors. We posit that racial disparities are reflected in socioeconomic status (SES) and geospatial factors such as the “health” of the environment in which one lives (termed “built environment”), both of which are known to be linked to race and a variety of health outcomes. The Black Women's Health Study (BWHS) and the California Teachers Study (CTS), well-established complementary cohorts of women, provide a unique opportunity to study SES and built environment factors for MGUS in African American and non-Hispanic white women with up to 25 years of individual-level risk factor information, assessed through repeated health questionnaires, available as well as geocoded residential addresses. We propose an epidemiologic study pooling data from these two cohorts to evaluate the role of individual and neighborhood SES and the built environment in racial disparities in MGUS. Prevalent cases of MGUS will be identified by screening 8,000 cohort participants (3,300 in BWHS and 4,700 in CTS) with archived blood specimens using gold-standard laboratory assays for the diagnosis of MGUS; we expect to identify 660 cases of MGUS (including 330 African American and 330 non-Hispanic white women). We hypothesize that neighborhood disadvantage and attributes of the built environment that inhibit healthy behaviors increase risk and contribute to known racial disparities in MGUS. We will determine associations of neighborhood deprivation and markers of individual SES, such as educational achievement, parental education level, income, and early life financial instability, in relation to MGUS overall and by race. We will also explore how characteristics of the built environment, such as urbanicity and neighborhood walkability, and the cross- classification of these variables with SES, are associated with MGUS and may explain observed differences in prevalence by race. Our proposed study is particularly innovative because it moves beyond the traditional, single-level predictor model to an approach that addresses the complexity of both individual- and contextual- level predictors for disease. The wide geographic/rural-urban, racial, and socioeconomic diversity of our study population across cohorts makes it an ideal setting in which to interrogate the intersection between race, SES, and neighborhood attributes on MGUS and MM risk. This research therefore has great potential to advance current knowledge about MGUS etiology, to inform opportunities for risk reduction in high-risk understudied populations, and to close the gap in racial disparities in multiple myeloma and its precursor conditions.

抽象的与非西班牙裔白人相比，非裔美国人多发性硬化症的发病率高出两倍多骨髓瘤 (MM) 及其无症状先兆病症，未确定的单克隆伽马病然而，这些种族差异背后的病因尚不清楚，而且很少。目前有流行病学资源可支持不同人群的研究。几乎没有证据表明遗传因素可以解释 MGUS 和 MM 患病率的差异；因此，种族可能反映了外部生活方式和社会因素。失业状况（SES）和地理空间因素，例如居住环境的“健康” （称为“建筑环境”），众所周知，这两者都与种族和各种健康结果有关。黑人妇女健康研究 (BWHS) 和加州教师研究 (CTS) 已十分成熟互补的女性群体，为研究社会经济地位和建筑环境因素提供了独特的机会非裔美国人和非西班牙裔白人女性的 MGUS 具有长达 25 年的个人水平危险因素通过重复的健康调查问卷评估的信息，以及地理编码的住宅信息我们提出一项流行病学研究，汇集这两个群体的数据来评估其作用。 MGUS 中的个人和社区 SES 以及种族差异中的建筑环境。 MGUS 将通过筛选 8,000 名队列参与者（BWHS 中 3,300 名，CTS 中 4,700 名）来确定我们期望使用金标准实验室检测来存档血液样本以诊断 MGUS；确定了 660 例 MGUS 病例（包括 330 名非裔美国人和 330 名非西班牙裔白人女性）。追求邻里劣势和阻碍健康的建筑环境属性行为会增加风险并导致 MGUS 中已知的种族差异。邻里剥夺和个人社会经济地位的标志，例如教育成就、父母教育我们还将探讨与 MGUS 整体和种族相关的水平、收入和早期财务不稳定。建筑环境的特征，例如城市性和邻里步行性，以及跨区域这些变量与 SES 的分类与 MGUS 相关，并且可以解释观察到的差异我们提出的研究特别具有创新性，因为它超越了传统，单级预测模型到解决个体和情境复杂性的方法我们研究的广泛地理/城乡、种族和社会经济多样性。不同群体的人口使其成为探究种族、社会经济地位、因此，这项研究具有巨大的推进潜力。关于 MGUS 病因学的当前知识，为高风险研究对象提供降低风险的机会人口，并缩小多发性骨髓瘤及其先兆病症的种族差异差距。