Precise Bone Density Reference Ranges to Reduce Systematic Disparities in Osteoporosis Healthcare for Hispanic Women

精确的骨密度参考范围可减少西班牙裔女性骨质疏松症医疗保健的系统性差异

• 批准号: 10372881
• 负责人: Qing Wu
• 金额: --
• 依托单位: UNIVERSITY OF NEVADA LAS VEGAS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-08 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372881
• 关键词: Address; African American; Aging; Assessment tool; Bone Density; Caucasians; Cessation of life; Characteristics; Clinical; Clinical Data; Custom; Data; Data Set; Databases; Diagnosis; Diagnostic Errors; Electronic Health Record; Ethnic Origin; Fracture; Generations; Goals; Guidelines; Healthcare; Healthcare Systems; Hispanic; Hispanic Populations; Individual Differences; Knowledge; Life Expectancy; Methodology; Methods; Minority; Minority Groups; Modeling; National Health and Nutrition Examination Survey; Normal Range; Osteoporosis; Outcome; Patients; Performance; Plant Roots; Postmenopause; Prevalence; Prevention; Public Health; Race; Reference Values; Research; Risk; Risk Assessment; Risk Management; Running; Sampling; Scoring Method; Specificity; Statistical Models; Systematic Bias; Testing; Validation; Variant; Woman; Women' s Health; base; bone; clinical care; clinical diagnosis; cohort; design; disparity elimination; epidemiology study; ethnic minority; fracture risk; fragility fracture; gradient boosting; health care disparity; improve minority health; improved; innovation; large scale data; novel; osteoporosis with pathological fracture; racial and ethnic; racial and ethnic disparities; random forest; rapid growth; screening; statistics

Project Summary / Abstract Some Caucasian-based clinical guidelines have become the systematic underpinnings of racial and ethnic dis- parities in healthcare. A prime example is the T-score osteoporosis diagnosis criteria, which the WHO initially proposed only for postmenopausal Caucasian women in epidemiological research. However, the T-score diag- nosis criteria are currently used to help with osteoporosis diagnosis for all patients. The T-score approach defines the reference range (RR) of bone mineral density (BMD). Nonetheless, Caucasians-based RRs cannot account for normal variability in race/ethnicity. As a result, applying these Caucasian-based RRs to racial/ethnic minorities often causes errors in diagnosis and risk assessment. With a growing and increasingly diverse minority popula- tion in the US, Caucasian-based clinical guidelines run the risk of exacerbating racial and ethnic healthcare disparities. The existing RRs of BMD are incredibly controversial because many patients who sustain fragility fractures have a “normal” BMD as defined by the conventional T-score approach. This clinically utilized, Cauca- sian-based approach is flawed and, as such, causes systematic healthcare disparities. There is no empirical approach specifically designed to define the RRs of BMD for racial/ethnic minorities. Subsequent race/ethnicity- adjusted T-score thresholds remain controversial because they are not empirically validated, so consequently, their performance has been unsatisfactory on racial/ethnic minorities. Hispanic women have a similarly high fracture risk as Caucasian women; however, Hispanic women, as the most heterogeneous group, have a higher osteoporosis misclassification rate with the T-score diagnosis criteria. With the rapid growth of an increasingly diverse and aging Hispanic population, osteoporotic fractures in Hispanic women are rapidly becoming a signif- icant public health issue. Hence, this application aims to create precise RRs of BMD for Hispanic women to address this pressing issue. This application's central hypothesis is that new precise RRs will classify osteopo- rosis in Hispanic women more accurately than conventional thresholds. This hypothesis will be tested by pursu- ing three specific aims: 1) developing the best-performing model for normative BMD in Hispanic women; 2) determining the precise thresholds of BMD; and 3) evaluating the new RRs in Hispanic women. By replacing the conventional Caucasian-based threshold, the novel, precise RRs will fundamentally shift the current research and clinical care paradigm in RR from one fixed range for every patient to more precise thresholds that account for many individual differences. This application will leverage large samples of Hispanic women and innovative data-driven approaches in creating race/ethnicity-specific, precise RRs of BMD, thus systematically eliminating the corresponding root cause of healthcare disparities for Hispanic women. Of increased significance, the knowledge gained herein can be utilized to generate many other types of precise RRs for various minority groups. The new generation of RRs will directly contribute to improving minority health and reducing healthcare dispari- ties by eliminating such systematic bias in the healthcare system.

项目摘要 /摘要 一些基于高加索的临床准则已成为种族和种族疾病的系统基础 医疗保健的平等。一个主要的例子是T得分骨质疏松症诊断标准，谁最初是该标准 仅针对流行病学研究的绝经后高加索妇女提出。但是，T得分诊断 - 目前，NOSIS标准用于帮助所有患者的骨质疏松症诊断。 T得分方法定义 骨矿物质密度（BMD）的参考范围（RR）。但是，基于高加索人的RR无法说明 种族/民族的正常变异。结果，将这些基于高加索的RR应用于种族/族裔少数民族 通常会导致诊断和风险评估错误。随着少数群体的增长和日益多样化的人口 在美国，基于高加索的临床准则会冒着加剧种族和族裔医疗保健的风险 差异。 BMD的现有RR引起了极大的争议，因为许多维持脆弱性的患者 骨折具有由常规T评分方法定义的“正常” BMD。这种临床利用，白种 基于Sian的方法是有缺陷的，因此会导致系统性的医疗保健分布。没有经验 专门设计的方法是为种族/族裔少数民族定义BMD的RR。随后的种族/种族 - 调整后的T分数阈值仍然存在争议，因为它们没有经验验证，因此， 他们的表现对种族/族裔少数群体不满意。西班牙裔妇女同样高 骨折风险是高加索妇女；但是，西班牙裔妇女是最异构的群体，有更高的 骨质疏松症的错误分类率具有T评分诊断标准。随着越来越多的迅速增长 潜水员和衰老的西班牙裔人口，西班牙裔妇女的骨质疏松骨折正在迅速成为一个重要的 ICANT公共卫生问题。因此，该应用程序旨在为西班牙裔妇女创建BMD的精确RR 解决这个紧迫问题。该应用程序的中心假设是，新的Precision RRS将对Osteopo-进行分类 西班牙裔女性的rosis比常规阈值更准确。该假设将通过应对 三个具体的目标：1）在西班牙裔女性中开发出正常BMD的表现最佳模型； 2） 确定BMD的精确阈值； 3）评估西班牙裔妇女的新RR。通过更换 传统的基于高加索的阈值，新颖的精密RR从根本上改变了当前的研究 RR的临床护理范式从一个固定范围为每个患者到更精确的阈值 对于许多个体差异。该申请将利用西班牙裔妇女和创新的大量样本 数据驱动的方法在创建BMD的种族/种族特异性，精确的RR中，从而系统地消除 西班牙裔妇女的医疗保健分配的相应根本原因。意义提高， 本文获得的知识可用于为各种少数群体生成许多其他类型的精度RR。 新一代RR将直接有助于改善少数民族健康并减少医疗保健不同 通过消除医疗保健系统中的系统偏见来保持联系。