Examining Racial Disparities in Stroke

检查中风的种族差异

• 批准号: 9102763
• 负责人: Monik Carmen Jimenez
• 金额: $ 14.39万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9102763
• 关键词: Accounting; Address; African American; Alcohols; Area; Atrial Fibrillation; Behavior; Behavioral; Blood Pressure; Calibration; Cardiovascular Diseases; Cardiovascular system; Characteristics; Clinic; Clinical; Clinical Trials; Cohort Studies; Collection; Communities; Complement; Data; Data Analytics; Development; Diabetes Mellitus; Discrimination; Epidemiologic Methods; Epidemiologist; Epidemiology; Event; Exhibits; Foundations; Funding; Future; Grant; Health; Heart Diseases; Individual; K-Series Research Career Programs; Knowledge; Left Ventricular Hypertrophy; Literature; Measures; Mediating; Mediation; Medical Records; Medicare claim; Mentorship; Modeling; Obesity; Pathway interactions; Performance; Physical activity; Plant Roots; Population; Population Heterogeneity; Prevention; Prevention strategy; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Research Personnel; Risk; Risk Factors; Role; Smoking History; Socioeconomic Status; Stroke; Testing; Time; Training; United States National Institutes of Health; Validation; Women' s Health; administrative database; biracial; career development; causal model; cohort; cost; data management; experience; follow-up; geographic difference; improved; innovation; insight; low socioeconomic status; mortality; novel; novel strategies; racial and ethnic; racial and ethnic disparities; racial difference; racial disparity; skills; social; socioeconomics; success; systolic hypertension

DESCRIPTION (provided by applicant): Stroke is the 4th leading cause of US mortality and 3rd among African Americans, with African Americans exhibiting more than twice the risk of Whites. The underlying causes of racial disparities in stroke are unclear. Few studies have systematically evaluated how racial disparities in stroke might vary by socioeconomic and behavior risk factors (e.g. measures of socioeconomic status [SES], adiposity, physical activity and alcohol) and they might explain the observed disparities through their roles as intermediates in the causal pathway between race and stroke. There has been a paucity of research on the impact of socioeconomic and behavioral risk factors in stroke risk prediction. Moreover, validation of existing stroke prediction scores among African Americans is urgently needed. This innovative project will address these gaps in the literature by: (1) determining whether racial disparities in stroke and the associations of selected stroke risk factors by race are comparable in two biracial socioeconomically heterogeneous populations, (2) determining whether mediation by socioeconomic and behavioral stroke risk factors account for racial disparities in stroke beyond traditional stroke risk factors using conventional and causal frameworks, and (3) examining whether race-specific stroke prediction models improve the predictive performance (calibration and discrimination) of long-term stroke risk compared to existing stroke prediction models. These aims will be accomplished through the use of three multi-racial, well-established NIH-funded cohorts; the Women's Health Initiative, Southern Community Cohort Study (SCCS) and Reasons for Geographic and Racial Differences in Stroke. A comprehensive approach to examining racial disparities will be utilized. Novel causal mediation analyses will complement conventional epidemiologic methods and move the field forward. Furthermore, race-specific stroke prediction models will enable the development of improved prevention strategies among at-risk individuals. These socioeconomic and behavioral stroke risk factors are often routinely collected in the clinic or could be obtained at minimal cost. This grant will generate new knowledge and crucial training for my advancement to become an independent epidemiologist in the field of racial/ethnic disparities in cardiovascular disease (CVD) by developing my expertise in (1) racial disparities and social determinant of CVD; (2) statistical training in mediation analyses; (3) methodologic training in prediction modeling; (4) data management and analytic skills with Medicare claims data (CMS) for stroke ascertainment in SCCS and (5) pilot medical record collection for stroke validation in SCCS. The advanced training, mentorship and protected time provided by this career development award will provide the skills and experience necessary for conducting the highest quality racial/ethnic cardiovascular disparities research and a strong foundation for success as an independent epidemiologic racial/disparities investigator.

描述（由申请人提供）：中风是美国死亡率的第四个主要原因，在非洲裔美国人中是第三名，非裔美国人表现出是白人风险的两倍以上。中风中种族差异的根本原因尚不清楚。很少有研究系统地评估中风中的种族差异如何因社会经济和行为风险因素（例如，社会经济地位的衡量标准[SES]，肥胖，体育锻炼和酒精），他们可能会通过因果关系中的中间体来解释所观察到的差异种族和中风之间的途径。关于社会经济和行为危险因素对中风风险预测的影响的研究很少。此外，迫切需要对非裔美国人中现有的中风预测得分的验证。这个创新的项目将通过以下方式解决文献中的这些差距：（1）确定中风中的种族差异以及种族所选的中风风险因素是否可以在两个混血儿社会经济异质种群中相当，（2）确定是否通过社会经济和行为和行为和行为的调解来确定中风风险因素考虑了使用常规和因果框架以外的传统中风风险因素的种族差异，以及（3）检查与现有的现有中风风险相比，研究是否改善了种族特异性中风预测模型是否改善了长期冲程风险的预测性能（校准和歧视）中风预测模型。这些目标将通过使用三个多种族，成熟的NIH资助队列来实现；妇女健康计划，南方社区队列研究（SCC）以及中风的地理和种族差异的原因。 将利用一种研究种族差异的全面方法。新颖的因果中介分析将补充常规的流行病学方法，并向前进。此外，种族特异性的中风预测模型将使高危个人的改善预防策略发展。这些社会经济和行为中风风险因素通常通常在诊所中收集，或者可以以最低的成本获得。这笔赠款将通过发展我在（1）CVD的种族危险和社会决定因素方面的专业知识，为我的进步而成为我的发展中的独立流行病学家，从而为我的进步提供新的知识和关键培训； （2）调解分析中的统计培训； （3）预测建模中的方法学培训； （4）用于SCC中的中风确定的Medicare索赔数据（CMS）的数据管理和分析技能，以及（5）SCC中的中风验证的PILOT病历收集。该职业发展奖提供的高级培训，指导和受保护的时间将为进行最高质量的种族/族裔心血管差异研究所需的技能和经验，并为成功作为独立流行病学种族/偏见研究者而成功的强大基础。