Social determinants of fatty liver disease and its racial/ethnic disparities: The Multi-Ethnic Study of Atherosclerosis

脂肪肝疾病的社会决定因素及其种族/民族差异：动脉粥样硬化的多民族研究

• 批准号: 10649813
• 负责人: Mariana Lazo Elizondo
• 金额: $ 68.34万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649813
• 关键词: Address; Affect; Alcohol consumption; Alcoholic Liver Diseases; Area; Behavior; Behavioral; Black Populations; COVID-19 pandemic; Characteristics; Chinese; Chronic; Chronic Disease; Clinical; Cohort Studies; Communities; Country; Data; Development; Diabetes Mellitus; Diet; Disease Outcome; Disparity; Enzymes; Epidemic; Epidemiology; Event; Fatty acid glycerol esters; Funding; Genetic; Genetic Predisposition to Disease; Genetic Risk; Geography; Health; Hispanic; Image; Incidence; Individual; Inflammation; Intervention; Investigation; Latino; Life Expectancy; Literature; Liver; Liver diseases; Longitudinal Studies; Measures; Mediating; Minority Groups; Multi-Ethnic Study of Atherosclerosis; Myocardial Ischemia; Neighborhoods; Obesity; Obesity Epidemic; Outcome; Participant; Pathway interactions; Pattern; Persons; Physical environment; Policies; Preventive; Preventive service; Proxy; Psychosocial Factor; Public Health; Racial injustice; Research; Research Personnel; Risk; Risk Behaviors; Role; Sampling; Scanning; Serum; Social Environment; Socioeconomic Status; Stroke; Testing; Therapeutic; United States National Institutes of Health; Viral hepatitis; Woman; Work; X-Ray Computed Tomography; burden of illness; chronic liver disease; community-level factor; contextual factors; disease disparity; disorder risk; ethnic disparity; ethnic minority; ethnic minority population; fatty liver disease; follow-up; gene environment interaction; genetic variant; health care availability; liver inflammation; longitudinal analysis; low socioeconomic status; men; mortality; multi-racial; non-alcoholic fatty liver disease; novel; population based; population health; prospective; psychosocial; psychosocial stressors; racial disparity; racial minority; screening; social; social determinants; social disparities; social health determinants; socioeconomic disparity; socioeconomics; structural determinants; success

PROJECT SUMMARY Liver disease mortality is a key contributor to recent declines in life expectancy in the US. Decades of research have demonstrated the disproportionate burden of liver disease among racial/ethnic minorities and those with low-socioeconomic position. With the ongoing epidemic of obesity, and the increase in alcohol consumption, fatty liver diseases (FLD), including non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD), have become the most prevalent chronic liver conditions affecting millions of people worldwide, constituting a major and growing public health problem. FLD epidemiology has largely focused on the role of individual-level behavioral factors, such as obesity and alcohol consumption, in FLD development. However, individual-focused therapeutic and preventive efforts have had limited success. For many chronic diseases, abundant literature has documented how social and physical environments pattern population health. In contrast, the empirical evidence of the role of social determinants of health with FLD and its disparities is extremely limited. Furthermore, the current paradigm to explain FLD disparities is heavily focused on genetic susceptibility (e.g. PNPLA3 gene variants). To address these research gaps, this project will test the novel hypothesis that individual and community- level social determinants influence FLD risk and their social and racial/ethnic disparities. To test this hypothesis, we propose to obtain and analyze longitudinal measures of liver fat and inflammation among participants of the Multi-Ethnic Study of Atherosclerosis (MESA), the largest ongoing multi-racial population-based cohort study involving 6,814 men and women (22% Hispanic, 38% whites, 28% Blacks, 12% Chinese) from 6 geographically distinct areas of the US. MESA has the most comprehensive longitudinal data on socioeconomic (both individual and community level), psychosocial, neighborhood physical and social environment, environmental, behavioral, and biomedical (including genetics) factors and health outcomes with up to 21 years of follow up. Our specific aims are: 1) Characterize racial/ethnic disparities in FLD incidence, as measured by 10-year changes in CT- measured liver fat and liver enzymes, while accounting for genetic variants. 2) Examine the prospective association of individual-level socioeconomic position (SEP) and psychosocial stressors with FLD incidence and the contribution of SEP and psychosocial factors to socioeconomic and racial/ethnic disparities in FLD incidence. 3) Examine the prospective association of community-level social and physical features with FLD incidence and its racial/ethnic disparities in FLD incidence. 4) Examine the role of community-level social and physical features in magnifying individual-level genetic vulnerability by testing gene-by-environment interactions in the incidence of FLD between genetic variants and contextual factors. This project will constitute the largest, most rigorous and comprehensive investigation of the role of social determinants of health in the development and progression of FLD and its disparities.

项目摘要 肝病死亡率是美国最近预期寿命下降的关键因素。几十年的时间 研究表明，种族/族裔少数民族和 那些具有低社会经济位置的人。随着肥胖症的持续流行和酒精的增加 消费，脂肪肝疾病（FLD），包括非酒精性脂肪肝病（NAFLD）和与酒精有关的 肝病（ALD）已成为影响数百万人的最普遍的慢性肝脏状况 在全球范围内，构成了一个重大的公共卫生问题。 FLD流行病学主要集中在 肥胖和饮酒等个体行为因素在FLD发展中的作用。 但是，以个人为中心的治疗和预防努力取得了有限的成功。对于许多慢性 疾病，丰富的文献记录了社会和物理环境如何模拟人群健康。 相反，健康决定因素与FLD及其差异的作用的经验证据是 极有限。此外，解释FLD差异的当前范式主要集中在遗传上 敏感性（例如PNPLA3基因变体）。 为了解决这些研究差距，该项目将检验个人和社区的新假设 - 水平的社会决定因素会影响FLD风险及其社会和种族/种族差异。为了检验这一假设， 我们建议在参与者中获得和分析肝脏脂肪和炎症的纵向测量 动脉粥样硬化多民族研究（MESA），这是最大的基于多种族的人群研究 涉及6,814名男女（22％的西班牙裔，38％的白人，28％黑人，12％中文）。 美国的不同地区。 MESA拥有有关社会经济的最全面的纵向数据（均为个人 和社区层面），社会心理，邻里的身体和社会环境，环境，行为， 以及生物医学（包括遗传学）因素和健康结果，最多可进行21年的随访。我们的具体 目的是：1）表征FLD发病率的种族/种族差异，这是通过CT-的10年变化来衡量的 测量的肝脏脂肪和肝酶，同时考虑了遗传变异。 2）检查潜在的 个人级别的社会经济地位（SEP）和心理压力源与FLD发病率的关联 SEP和社会心理因素对FLD发病率中社会经济和种族/种族差异的贡献。 3）检查社区级的社会和物理特征与FLD发病率和 它在FLD发病率上的种族/种族差异。 4）检查社区级的社会和身体特征的作用 通过测试发病率中的基因相互作用来放大个体水平的遗传脆弱性 遗传变异和上下文因素之间的FLD。该项目将构成最大，最严格的 以及对健康决定因素在发展和发展中的作用的全面调查 FLD及其差异。