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

• 批准号: 10217474
• 负责人: Kimberly A Bertrand
• 金额: $ 76.01万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 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/10217474
• 关键词: Address; Adolescence; Adult; Affect; African American; 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' 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

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，非裔美国人的多重事件高2倍以上 骨髓瘤（MM）及其无症状的前体状况，不确定 意义（MGU）。但是，这些种族分布的基本因素尚不清楚，很少 目前可以使用流行病学资源来支持潜水员人群的研究。值得注意的是 很少有证据表明遗传因素可以解释这些分布。 MGU和MM的患病率差异 种族可能反映出外部生活方式和社会因素。我们肯定种族分布反映在 社会经济地位（SES）和地理空间因素，例如一个人生活的环境的“健康” （称为“建筑环境”），这两种都与种族和各种健康成果有关。 黑人妇女健康研究（BWHS）和加利福尼亚教师研究（CTS） 互补的妇女人群，为研究SES和建立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妇女的MGU，其个人级别风险因素最多25年 通过重复的健康调查表评估的信息以及地理编码的居民 地址。我们提出了一项流行病学研究，将这两个同类的数据汇总数据，以评估 个人和邻里SES以及MGU种族分布中的建筑环境。普遍的情况 MGU将通过筛选8,000名队列参与者（3,300名BWH和4,700）来识别MGUS 使用金标准实验室测定法进行归档血液标本以诊断MGU；我们希望 确定660例MGU（包括330名非裔美国人和330名非西班牙裔白人妇女）。我们 假设邻里灾难和建筑环境的属性抑制健康 行为增加了风险，并导致MGU中已知的赛车差异。我们将确定关联 邻里剥夺和单个SE的标记，例如教育成就，父母教育 与MGU总体和种族相关的水平，收入和早期财务不稳定。我们还将探索 建筑环境的特征如何，例如城市和邻里步行，以及交叉 这些变量与SES的分类与MGU相关，可以解释观察到的差异 种族流行。我们拟议的研究特别是创新的，因为它超越了传统， 单级预测模型，以解决个人和上下文的复杂性的方法 疾病的水平预测因子。我们研究的广泛地理/农村城市，种族和社会经济多样性 跨人群的人口使其成为审问种族，SES，，， 以及MGU和MM风险的邻里属性。因此，这项研究具有进步的巨大潜力 有关MGUS病因的当前知识，以告知人们了解降低风险的机会 种群，并在多发性骨髓瘤及其前体状况下缩小种族分布的差距。