Leveraging Spatial Epidemiology to Reduce Hypertension Disparities

利用空间流行病学减少高血压差异

• 批准号: 10523885
• 负责人: Hoda Abdel Magid
• 金额: $ 16.71万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10523885
• 关键词: Address; Adult; Affect; African American population; Age of Onset; American; Area; Biometry; Black Populations; Black race; Businesses; Cardiovascular Diseases; Characteristics; Code; Complement; Data; Data Mart; Data Sources; Development; Diagnosis; Education; Environment; Epidemiology; Ethnic Origin; Food; Geographic Locations; Geography; Health Food; Healthcare; Housing; Hypertension; Incidence; Income; Individual; Inequality; Intervention; Link; Location; Low income; Measures; Mediating; Medicare; Medicare/Medicaid; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Participant; Pathway interactions; Pattern; Population; Population Analysis; Population Heterogeneity; Population Surveillance; Prevalence; Privatization; Process; Race; Reasons for Geographic And Racial Differences in Stroke; Recreation; Research; Research Personnel; Research Priority; Research Training; Resources; Risk Factors; Sampling; Strategic vision; Stroke; Training; United States; cardiovascular health; career; career development; cohort; deprivation; disparity elimination; ethnic minority; geographic difference; health disparity; hypertension control; hypertension treatment; improved; indexing; innovation; multidisciplinary; racial and ethnic; racial difference; racial disparity; research and development; residential segregation; skills; social; social health determinants; social interventions; socioeconomics; spatial epidemiology

PROJECT SUMMARY Hypertension affects half of American adults but poses an especially severe burden on African Americans. Disparities in hypertension diagnosis, treatment, and control outcomes are spatially patterned. This spatial patterning is hypothesized to be due to area-level socioeconomic risk factors and area-level structural resources (e.g., healthy foods, recreation, healthcare, and housing). Leveraging detailed spatial data provides unique opportunities to drill down below common area-level studies and elucidate the mechanisms by which area-level factors produce hypertension disparities. Spatial social polarization (SSP) indices are potentially key to understanding hypertension disparities. SSP indices measure the extent to which populations are distributed at extremes of privilege and deprivation of socioeconomic domains. SSP indices can be meaningfully expanded to measure structural resources, representing key opportunities to examine hypertension disparities. Despite such promise, little research has evaluated the association between socioeconomic SSP and hypertension; and no prior research has quantified structural SSP or its relationship with hypertension disparities. The scientific objective of this proposal is to estimate the impact of eight SSP domains on hypertension disparities, evaluating both socioeconomic SSP (race/ethnicity, income, education, residential segregation) and structural SSP (food, recreation, healthcare, and housing) domains. The central hypothesis is that living in areas with high SSP increases hypertension disparities. This innovative project will leverage data from (1) the Cardiovascular Health Study (CHS); (2) the REasons for Geographic and Racial Differences in Strokes (REGARDS) study; (3) private and public claims data from Optum and Medicare; and (4) spatial data from the Retail Environment and Cardiovascular Disease (RECVD) study with geographic linkages to CHS and REGARDS cohorts. Research aims will (1) estimate the population-level effects of socioeconomic SSP predictors of hypertension prevalence, incidence, treatment, and control outcomes among Black and White adults; (2) develop a structural SSP index using measures of structural resources, and estimate the association between structural SSP and hypertension among Black and White adults; and (3) evaluate the extent to which socioeconomic and structural SSP mediate Black-White hypertension disparities. This research plan is complemented by a training plan that builds on the applicant’s background in epidemiology and biostatistics. The training plan includes measuring and modeling hypertension-specific SSP in diverse populations, analyzing large claims data, and applying causal inference methods. The combined research and training plans will prepare the applicant for a successful independent research career in epidemiology. The proposed research will improve public health surveillance of hypertension disparities, provide the evidence required to inform the development of SSP interventions, and invite further research on the causal pathways linking concentrations of privilege and deprivation to health disparities.

项目摘要 高血压会影响一半的美国成年人，但对非裔美国人特别严重。 高血压诊断，治疗和控制结局的差异是在空间图案上。这个空间 假设图案是由于面积级别的社会经济风险因素和区域级的结构资源所致 （例如，健康食品，娱乐，医疗保健和住房）。利用详细的空间数据提供了独特的 在公共区域级别的研究以下进行钻探的机会，并阐明区域级别的机制 因素会产生高血压差异。空间社会两极分化（SSP）指数可能是 了解高血压分布。 SSP指数衡量种群在多大程度上分布在 极端的特权和社会经济领域的剥夺。 SSP指数可以有意义地扩展到 测量结构资源，代表检查高血压差异的关键机会。尽管如此 希望，很少的研究评估了社会经济SSP与高血压之间的关联。不 先前的研究已量化结构SSP或其与高血压差异的关系。科学 该提案的目的是估计八个SSP域对高血压分布的影响，评估 社会经济SSP（种族/种族，收入，教育，居民种族隔离）和结构SSP（食物， 娱乐，医疗保健和住房领域。中心假设是生活在SSP高的地区 增加高血压分布。这个创新的项目将利用（1）心血管健康的数据 研究（CHS）； （2）在研究中的地理和种族差异的原因（有关）研究； （3）私人 公众索赔来自Optum和Medicare的数据； （4）来自零售环境的空间数据以及 心血管疾病（RECVD）研究，与CHS的地理联系并涉及人群。研究 目标将（1）估计社会经济SSP预测高血压患病率的人口水平的影响， 黑人和白人成年人的发病率，治疗和控制结果； （2）开发结构SSP指数 使用结构资源的度量，并估算结构SSP与高血压之间的关联 在黑人和白人成年人中； （3）评估社会经济和结构SSP媒体的程度 黑白高血压分布。该研究计划是由一项培训计划完成的 申请人在流行病学和生物统计学方面的背景。培训计划包括测量和建模 潜水员种群中的高血压特异性SSP，分析大量索赔数据并应用因果推断 方法。合并的研究和培训计划将为成功的独立 流行病学研究职业。拟议的研究将改善高血压的公共卫生监测 差异，提供告知SSP干预开发所需的证据，并进一步邀请 有关因果途径的研究，将特权集中和剥夺与健康分布联系起来。