Bio-Psycho-Social Drivers of Disparities in Liver Disease Progression among Korean Americans with Hepatitis B Infection

乙型肝炎感染的韩裔美国人肝病进展差异的生物心理社会驱动因素

基本信息

批准号：
10390376
负责人：
HEE-SOON JUON
金额：
$ 64.27万
依托单位：
THOMAS JEFFERSON UNIVERSITY
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：
2021-04-12 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10390376
关键词：
Accounting Acculturation Adherence Alcohols American Asian Asian Americans Behavior Behavior Therapy Behavioral Biological Biological Markers Birth Buffers Cancer Etiology Caring Cessation of life Characteristics Chronic Chronic Disease Chronic Hepatitis B Clinic Clinical Clinical Data Collaborations Communicable Diseases Communities Coping Skills DNA Damage Data Development Diabetes Mellitus Diet Disadvantaged Discrimination Disease Disease Outcome Disease Progression Endogenous Factors Enrollment Environmental Exposure Ethnic group Etiology Exogenous Factors Financial compensation Goals Health Healthcare Hepatic Hepatitis B Incidence Hepatitis B Infection Hepatitis B Virus Hepatocarcinogenesis Immune system Impairment Individual Inflammation Intervention Interview Korea Korean American Language Liver Liver Cirrhosis Liver diseases Longitudinal prospective study Los Angeles Malignant neoplasm of liver Mediating Medical Metabolic Metabolic Diseases Methods Minority Groups Modeling Obesity Pathway interactions Patients Pattern Phenotype Philadelphia Policies Population Prevalence Primary carcinoma of the liver cells Process Protocols documentation Psychosocial Factor Research Risk Role Science Severity of illness Stigmatization Structure Time Tobacco Treatment Effectiveness University Hospitals Variant Virus Virus Diseases Visit Work Yang acute infection adverse outcome base biological systems care seeking chronic liver disease cohort coping coronavirus disease curative treatments disease disparity disorder prevention disparity reduction end stage liver disease ethnic discrimination ethnic identity experience health disparity health disparity populations high risk high risk population insight liver infection migration multilevel analysis neglect oxidative DNA damage preference premature psychosocial racial and ethnic recruit repository social social stigma social stressor stressor treatment adherence

项目摘要

Hepatitis B virus (HBV) infection is globally the most common and serious viral infection of the liver, causing premature deaths from liver diseases or liver cancer. Chronic hepatitis B (CHB) infection and liver cancer caused by HBV among Asian Americans is one of the most serious—but frequently neglected—health disparity issues in the U.S. Hepatocarcinogenesis from HBV infection to hepatocellular carcinoma (HCC) development has been increasingly recognized as a multifactorial, multi-level and multi-step process. Less is known about the multiple factors and the underlying mechanisms responsible for chronic liver disease progression in high risk Asian Americans. Evolving models of liver disease posit a strong role for virus, chronic inflammation and oxidative DNA damage. Co-factors that may influence these disease processes include exogenous and endogenous factors. The application of a multi-level framework, however, is relatively new in the study of chronic liver disease progression (e.g., CHB phenotype, liver disease severity) among CHB patients. Moreover, there is great variance in the hepatic disease progress among CHB patients, and the psychosocial factors contributing to or responsible for biological system impairment have not been identified. The goal of this study is to longitudinally examine the multiple pathways to disparities in chronic liver disease progression using two unique clinic-based patient cohorts of CHB Korean Americans receiving care from Korean-American hepatologists. We will recruit and enroll 600 Korean American CHB patients. Medical chart review, structured patient interviews, biomarkers, qualitative, and geo-spatially referenced data will be integrated to explore multi-level models of liver disease progression over a 10- year clinical window, within a group at high risk for adverse outcomes. The specific aims are: (1) to estimate the prevalence of CHB phenotypes and liver disease severity, and associated covariates at the initial visit; (2) identify how multiple factors (e.g., social environmental, psychosocial, behavioral, clinical and biological attributes) are associated with variation in liver disease progression; (3) to examine the moderating and mediating effects of these factors on the relationship between CHB phenotypes and adverse liver disease outcomes (e.g., HCC); and (4) to understand care-seeking behaviors and dynamics of care within an ethnically concordant liver disease care model using an explanatory mixed methods approach. Finally, comparison to clinical data from large CHB cohorts in US and Korea will strengthen generalizability. Insights gained from this proposed study will provide the groundwork to understand the multi-level and multi-step process of chronic liver disease and liver cancer among high risk population with CHB patients, and develop potential interventions at multiple levels (policy, social-behavioral and clinical) to reduce disparities in liver disease progression.

丙型肝炎病毒（HBV）感染是全球最常见和最严重的肝脏病毒感染，导致肝病或肝癌过早死亡。慢性丙型肝炎（CHB）感染和亚裔美国人中HBV引起的肝癌是最严重的肝癌，但经常被忽视 - 美国的健康差异问题从HBV感染到肝细胞癌（HCC）发育越来越被公认为是多因素的，多级和多步骤过程。关于多种因素和基础知识知之甚少高风险亚裔美国人的慢性肝病进展的机制。不断发展肝病模型呈阳性病毒，慢性感染和氧化DNA损伤的重要作用。可能影响这些疾病过程的联合因素包括外源性和内源性因素。但是，在慢性肝脏的研究中，多层框架的应用相对较新 CHB患者的疾病进展（例如CHB表型，肝病严重程度）。而且， CHB患者的肝病进展有很大的差异，心理社会的差异尚未确定导致或负责生物系统损害的因素。这这项研究的目标是纵向检查慢性肝脏差异的多种途径使用两个基于诊所的独特患者同伙的CHB韩裔美国人的疾病进展韩裔美国肝病学家的护理。我们将招募和注册600韩裔美国人CHB 患者。医疗图表审查，结构化的患者访谈，生物标志物，定性和地理空间参考的数据将集成以探索10-的肝病进展的多层次模型年度临床窗口，在一个不良后果的高风险中。具体目的是：（1）估计CHB表型和肝病严重程度的患病率，以及相关的协变量初次访问；（2）确定多种因素如何（例如社会环境，社会心理，行为，临床和生物学特性）与肝病进展的变化有关；（3）到检查这些因素对CHB之间关系的调节和中介作用表型和不良肝病结局（例如HCC）；（4）了解寻求护理在种族和谐的肝病护理模型中，行为和护理动态使用剥夺混合方法方法。最后，与来自大型CHB队列的临床数据进行比较美国和韩国将加强普遍性。从这项拟议的研究中获得的见解将提供了解慢性肝病和肝脏的多层次和多步骤过程 CHB患者的高风险人群中的癌症，并在多个患者中发展潜在的干预措施水平（政策，社会行为和临床），以减少肝病进展的分布。