Using agent-based modeling to compare strategies that can reduce rural-urban disparities in cardiovascular disease

使用基于主体的模型来比较可减少心血管疾病城乡差异的策略

基本信息

批准号：
9976596
负责人：
Donglan Zhang
金额：
$ 38.41万
依托单位：
UNIVERSITY OF GEORGIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-11 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9976596
关键词：
Academy Address American Heart Association Behavioral Cardiovascular Diseases Caring Cholesterol Clinic Clinical Communities Complex Coronary heart disease County Data Data Sources Decision Making Diabetes Mellitus Diet Disadvantaged Disease Outcome Economic Burden Environment Evaluation Event Evidence based intervention Food Geography Goals Health Health Insurance Health Personnel Health Promotion Health Services Accessibility Healthcare Healthcare Systems High Prevalence Home environment Hypertension Incidence Individual Influentials Insurance Insurance Coverage Internet Intervention Intervention Studies Lead Life Style Medical Medical Care Costs Medicine Methodology Modeling New York Obesity Pathway interactions Pharmaceutical Preparations Physical activity Physicians Play Policies Population Population Characteristics Prevalence Preventive care Preventive healthcare Public Health Research Risk Factors Role Rural Rural Community Rural Health Rural Population Science Smoking Social Environment Source System Taxes Telephone Testing Tobacco Translating Unhealthy Diet United States Urban Health Urban Population attributable mortality base built environment cardiovascular disorder epidemiology cardiovascular disorder prevention cardiovascular disorder risk cardiovascular health cardiovascular risk factor care delivery cholesterol control community setting comparative effectiveness compare effectiveness contextual factors cost diabetes control effective intervention effectiveness testing evidence base experimental study food environment fruits and vegetables health care availability health care delivery health care service health disparity health management healthcare community hypertension control improved income disparities innovation intervention effect lifestyle factors models and simulation modifiable risk mortality mortality disparity nutrition physical inactivity population based population health predictive modeling programs public health intervention public policy on tobacco relative effectiveness rural America rural area rural counties rural dwellers rural healthcare simulation symposium telehealth urban disparity urban setting virtual

项目摘要

Project Summary Rural-urban disparities in mortality attributable to cardiovascular disease (CVD) have widened in the United States during the past several decades. The complex interplay of preventive health care delivery and community-level behavioral and contextual factors contribute to the differences in cardiovascular health between rural and urban residents. Recently, systems science and simulation modeling have played an important role in the evaluation, selection, and implementation of evidence-based interventions. However, existing models do not account for either the specific characteristics of populations living in rural communities, or the health care services and other contextual factors of these communities. We propose to use agent-based modeling -- a systems science approach that incorporates data from various sources and simulates real-world clinical or community settings -- to help disentangle these complexities, elucidate causal pathways, and identify potentially effective interventions in rural communities. Our long-term goal is to find effective clinical and public health solutions to reduce rural-urban disparities in cardiovascular health among rural communities in Georgia and New York. Taking an integrated preventive health care and community perspective, we will accomplish our specific aims using an agent-based model of community-based CVD prevention and test the effectiveness of the following interventions at the rural county level. First, we will estimate the health impact of improving health care delivery and access using home-based telemonitoring programs and expanding insurance coverage, focusing on three major CVD risk factors: hypertension, diabetes and high cholesterol (Aim 1). Second, we will estimate the health impact of public health interventions, including improving the food environment, community-based health promotion, and increasing tobacco taxes for reducing four important lifestyle factors related with CVD: obesity, unhealthy diet, physical inactivity, and smoking (Aim 2). In Aim 3, we will use the CVD Policy Model, a well- validated US population-based CVD epidemiology simulation model and translate projected beneficial effects on the seven risk factors and lifestyles tested in Aim 1 and 2 into downstream impact on CVD events. This will allow us to assess the potential of these individual or combined interventions on rural-urban disparities in the incidence and mortality of CVD and direct medical costs at the state level. The proposed research is innovative because we develop a policy simulation model to inform decision-making for health care and public health management of CVD in rural counties, integrating clinical with community systems to find the most effective evidence-based intervention.

项目摘要归因于心血管疾病（CVD）死亡率的农村城市差异已扩大在过去的几十年中。预防性医疗保健提供的复杂相互作用和社区级的行为和上下文因素有助于心血管健康的差异在农村和城市居民之间。最近，系统科学和仿真建模发挥了在评估，选择和实施基于证据的干预措施中的重要作用。然而，现有模型不能说明生活在农村中的人口的特定特征社区，医疗服务和这些社区的其他背景因素。我们建议使用基于代理的建模 - 一种系统科学方法，该方法结合了来自各种来源的数据和模拟现实世界中的临床或社区环境 - 以帮助解散这些复杂性，阐明因果途径，并确定农村社区的潜在有效干预措施。我们的长期目标是找到有效的临床和公共卫生解决方案，以减少农村地区的差异佐治亚州和纽约农村社区的心血管健康。进行综合预防医疗保健和社区的观点，我们将使用基于代理的模型来实现我们的特定目标基于社区的CVD预防并测试在农村的以下干预措施的有效性县级。首先，我们将估算改善医疗保健提供和使用使用的健康影响以家庭为基础的远程监控计划和扩大保险范围，重点关注三个主要的CVD风险因素：高血压，糖尿病和高胆固醇（AIM 1）。其次，我们将估计公共卫生干预措施，包括改善食品环境，基于社区的健康促进，并增加烟草税，以减少与CVD相关的四个重要生活方式因素：肥胖，不健康的饮食，身体不活跃和吸烟（AIM 2）。在AIM 3中，我们将使用CVD政策模型，一个很好的验证了基于美国人群的CVD流行病学模拟模型，并翻译了预计有益的对在AIM 1和2中测试的七个危险因素和生活方式的影响，对下游对CVD的影响事件。这将使我们能够评估这些个人或乡村的合并干预措施的潜力 CVD的发生率和死亡率和州一级直接医疗费用的差异。提议研究具有创新性，因为我们开发了一个政策模拟模型来为健康的决策提供信息农村县CVD的护理和公共卫生管理，将临床与社区系统融合到找到最有效的基于证据的干预措施。