The Role of Structural Racism on Disparities in Clinical Outcomes for Diabetes: A Mixed Methods Study

结构性种族主义对糖尿病临床结果差异的作用：混合方法研究

• 批准号: 10634279
• 负责人: Joni Strom Williams
• 金额: $ 67.85万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634279
• 关键词: 18 year old; Address; Adult; Area; Attitude; Behavior; Belief; Black race; Blood Glucose; Body mass index; Caring; Chronic; Classification; Clinical; Communities; Data; Diabetes Mellitus; Diagnosis; Diet; Discrimination; Disparity; Economics; Education; Employment Opportunities; Environment; Ethnic Origin; Fostering; Gender; Green space; Health; Health Food; Healthcare; Housing; Individual; Inequity; Institutional Practice; Interview; Knowledge; Laws; Lipids; Methods; Minority Groups; Modeling; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Pathway interactions; Persons; Physical activity; Policies; Population Group; Poverty; Process Measure; Qualitative Research; Quality of life; Race; Racial Segregation; Recreation; Reporting; Research Design; Research Methodology; Resources; Risk; Role; Scholarship; Security; Self Care; Societies; Structural Racism; Structure; System; Transportation; United States; Variant; behavioral outcome; blood pressure control; design; diabetes management; diabetes self-management; digital; economic disparity; ethnic minority population; experience; glucose monitor; glycemic control; health care availability; health inequalities; medication compliance; mortality; population health; racial minority population; segregation; sex; social; social disparities; social health determinants; urban setting

Approximately 37.1 million adults 18 years or older (14.7% of all U.S. adults) are estimated to have diabetes, where 90-95% of cases are classified as type 2 diabetes mellitus (T2DM). Adults from racial/ethnic minority groups continue to be disproportionately impacted by higher morbidity and mortality and poor outcomes compared to Non-Hispanic White adults. The reasons for these disparities among population groups remain elusive; however, structural racism, defined as the laws, policies, institutional practices, and entrenched norms embedded within society that foster discrimination through mutually reinforcing inequitable systems, has been indicated as a root cause of inequities in health outcomes including those related to diabetes. One form of structural racism, historic redlining, known as the practice of denying resources to communities based on race, largely impacts neighborhoods populated by persons from racial and ethnic minority groups where diabetes is highly prevalent. It has led to social and economic disadvantage within hyper-segregated and under-resourced neighborhoods due to community disinvestment. Despite reportedly being banned decades ago, the relationship between historic redlining and contemporary diabetes outcomes has not been well- studied. Since current evidence supports an association between redlining and population health, this is a significant gap that needs to be addressed to reduce diabetes disparities. Preliminary data from our group shows people report that current studies do not account for their lived experiences or accommodate for the structural inequities they deal with that limits their ability to self-manage diabetes. Therefore, we propose to assess the role of structural racism, in the form of historic redlining, on diabetes disparities and how it impacts current-day clinical and behavioral outcomes, quality of life, and the neighborhood environment in 2,000 adults with T2DM. This study offers a unique opportunity to bridge a gap in knowledge within the field by using an experimental convergent mixed methods study design to understand the relationship between historic redlining and diabetes-related outcomes in adults with T2DM. Aim 1 will use qualitative research methods to explore beliefs and attitudes about historic redlining and its impact on diabetes self-management and outcomes. Aim 2 will use quantitative research methods to identify direct and indirect pathways through which historic redlining impacts diabetes- related outcomes (glycemic control, blood pressure control, lipid control, self-care behaviors (diet, physical activity, medication adherence, blood glucose monitoring), and quality of life) in adults with T2DM and investigate invariance by race/ethnicity and sex/gender in the relationship. Aim 3 will use hierarchical modeling to assess the impact of individual, interpersonal, and neighborhood level factors on individual level diabetes outcomes; to assess the contribution of historic redlining exposure toward noted neighborhood level associations; and to assess whether individual level associations are moderated by historic redlining exposure.

大约3710万成年人18岁以上（占所有美国成年人的14.7％）估计患有糖尿病， 其中90-95％的病例被归类为2型糖尿病（T2DM）。来自种族/族裔少数民族的成年人 群体继续受到更高的发病率和死亡率和不良结果的影响不成比例的 与非西班牙裔白人相比。人口群体之间这些差异的原因仍然存在 难以捉摸但是，结构性种族主义被定义为法律，政策，机构实践和根深蒂固的种族主义 通过相互加强不平等制度促进歧视的社会中嵌入的规范， 被认为是健康结果不平等的根本原因，包括与糖尿病有关的根本原因。一种形式 结构性种族主义，历史性的红线，被称为拒绝基于社区资源的实践 种族，在很大程度上影响了来自种族和少数民族群体的人所占的社区 糖尿病非常普遍。它导致了超级分离的社会和经济劣势， 由于社区投资而导致的资源不足的社区。尽管据报道被禁止数十年 以前，历史性的红线与当代糖尿病结果之间的关系并不是很好 研究。由于当前的证据支持红线与人口健康之间的关联，这 是一个重要的差距，需要解决以减少糖尿病差异。初步数据 我们的小组表明，人们报告说，当前的研究并不是他们的生活经验或 适应他们处理的结构不平等，限制了他们自我管理的能力 糖尿病。因此，我们建议以历史的形式评估结构种族主义的作用 在糖尿病差异及其如何影响当前的临床和行为结局上进行重新线 生活质量和2,000名T2DM成年人的邻里环境。这项研究提供了独特的 通过使用实验性收敛的混合 方法研究设计以了解历史红线和与糖尿病有关的关系 T2DM成人的结果。 AIM 1将使用定性研究方法来探索信念和态度 关于历史性的红线及其对糖尿病自我管理和结果的影响。 AIM 2将使用定量 研究方法来识别直接和间接途径，通过这些途径，历史性的红线会影响糖尿病 - 相关结果（血压控制，血压控制，脂质控制，自我保健行为（饮食，身体 成人T2DM和 在关系中通过种族/种族和性别/性别调查不变性。 AIM 3将使用分层建模 评估个人，人际和邻里水平因素对个体糖尿病的影响 结果；评估历史性的红线对著名邻里水平的贡献 协会；并评估个人级别关联是否通过历史性的红线暴露来调节。