Examining the Impact, Pathways, and Cost of County-Level Structural Racism on Hypertension Disparities in Black and White US Adults

检查县级结构性种族主义对美国黑人和白人成年人高血压差异的影响、途径和成本

• 批准号: 10669141
• 负责人: Lorraine Tiera Dean
• 金额: $ 44.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669141
• 关键词: Accounting; Address; Adult; Affect; African American; Alcohol consumption; American; Behavior; Behavioral; Biological Markers; Black American; Black Populations; Black race; Body mass index; C-reactive protein; Cardiovascular system; Cholesterol; County; Criminal Justice; Cross-Sectional Studies; Data; Diet; Dimensions; Disparity; Education; Employment; Epidemiology; Equation; Exposure to; Geography; Goals; Health; Health Care Costs; Health Expenditures; Healthcare; Hospitals; Housing; Hypertension; Incidence; Individual; Inflammation; Inflammatory; Intervention; Journals; Leadership; Left; Life Cycle Stages; Link; Lipids; Longitudinal Studies; Longitudinal cohort; Measures; Mediating; Mediation; Mediator; Medicare claim; Modeling; Morbidity - disease rate; Myocardial Infarction; Obesity; Observational Study; Paper; Participant; Pathway interactions; Physical activity; Physiological; Policies; Prevalence; Preventive Medicine; Psychosocial Stress; Publications; Publishing; Race; Reasons for Geographic And Racial Differences in Stroke; Renal function; Reporting; Research; Research Personnel; Resources; Risk Factors; Role; Severities; Societies; Stress; Structural Racism; Tobacco use; Translating; Triglycerides; United States; Work; cardiometabolism; cationic antimicrobial protein CAP 37; clinical epidemiology; cohort; cost; early onset; fasting glucose; health care quality; health data; health disparity; health economics; high body mass index; multilevel analysis; news; novel; programs; racial disparity; racism; residential segregation; response; sex; social; social epidemiology; societal costs; stressor; waist circumference

PROJECT SUMMARY Black Americans have the highest hypertension (or high blood pressure, HBP) rates in the world, with stark racial disparities between Black and White adults that have persisted for decades and at the highest cost to society of all cardiovascular conditions. The underlying cause of HBP disparities is unknown, and previous studies have mostly focused on individual-level behaviors, stressors, and physiologic risk factors leaving a missed opportunity to uncover and address the root causes of these disparities. Structural racism may be a root cause of HBP disparities and, as such, HBP disparities will persist if structural racism is not addressed. Thus, to eliminate HBP disparities, we must first investigate if structural racism is a fundamental cause and use longitudinal studies to explore the pathways through which structural racism influences HBP risk factors and disparities. Using a novel 5-domain measure of structural racism, our previous cross-sectional studies have demonstrated that greater structural racism is associated with higher BMI, one behavioral risk factor for HBP; however, this work has left gaps in understanding how structural racism is related to other risk factors for HBP, as well as questions about the timing and geographic scales at which structural racism operates. We seek to fill these gaps in responding to RFA-MD-21-004’s request for “observational research to understand the role of structural racism…in causing and sustaining health disparities” for HBP. Our goal is to conduct a multi-level national study to investigate associations between our novel multi-dimensional measure of county-level structural racism (CSR) and: physiologic, behavioral, and structural risk factors for HBP (Aim 1), HBP incidence, prevalence, and severity (Aim 2), and how much counties could save in HBP healthcare costs if CSR was eliminated (Aim 3). We leverage pre-existing resources that are uniquely available to us: (a) our published County Structural Racism Scale, (b) US News & World Report hospital rankings of healthcare quality, and (c) longitudinal behavioral and biomarker HBP data from 30,239 Black and White adults across the US in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We expand beyond previous studies by using a multi-domain measure of structural racism, applying it to longitudinal health data that allows us to assess exposure to structural racism at multiple times in the lifecourse, and quantifying how much structural racism costs counties in HBP healthcare spending when it goes unaddressed. We will translate our findings into policy briefs targeted toward county-level executives in the US. Our team of experts in CVD disparities, social and clinical epidemiology, and health economics, with representation from REGARDS, two Hopkins disparities centers, Hopkins’ CVD Epidemiology, and former county leaders, are well- equipped to execute this New Investigator application. Our results will offer evidence of how CSR influences HBP, with the potential to build support for policy decisions on CSR that can ultimately reduce HBP disparities.

项目摘要 黑人美国人的高血压最高（或高血压，HBP）率很高 黑人和白人成年人之间持续数十年，成本最高的种族分布 所有心血管疾病的社会。 HBP差异的根本原因是未知的，以前 研究主要集中于个人水平的行为，压力源和生理风险因素 错过的机会发现并解决了这些分布的根本原因。结构性种族主义可能是 HBP差异的根本原因，因此，如果没有解决结构性种族主义，HBP差异将持续存在。 为了消除HBP分布，我们必须首先调查结构种族主义是否是基本原因和使用 纵向研究以探索结构种族主义影响HBP风险因素和 差异。使用新型的5域种族主义测量，我们以前的横断面研究具有 表明，更大的结构种族主义与较高的BMI有关，BMI是HBP的行为风险因素之一。 但是，这项工作在理解结构性种族主义与HBP的其他风险因素之间的关系方面留下了差距 以及有关结构种族主义运作的时间和地理规模的问题。我们寻求 填补这些空白，以回应RFA-MD-21-004的请求“观察研究以了解 HBP的结构性种族主义……在造成和维持健康分配时”。我们的目标是进行多层次 国家研究，以调查我们新颖的县级多维测量之间的关联 结构种族主义（CSR）和：HBP的生理，行为和结构危险因素（AIM 1），HBP 发病率，患病率和严重性（AIM 2），以及如果HBP医疗保健成本可以节省多少计数 企业社会责任被淘汰（AIM 3）。我们利用我们独特可用的现有资源：（a）我们的 已出版的县结构种族主义量表，（b）美国新闻与世界报告医院医院的医疗保健排名 质量以及（c）来自30,239个黑人和白人成年人的纵向行为和生物标志物HBP数据 我们的原因是中风（有关）队列中的地理和种族差异的原因。我们超越了 先前的研究通过对结构种族主义进行多域测量，将其应用于纵向健康数据 这使我们能够在生命程中多次评估多次结构性种族主义的暴露，并量化如何 HBP医疗保健支出不足时，许多结构性种族主义成本都在计算。我们将 将我们的发现转化为针对美国县级高管的政策摘要。我们的专家团队 在CVD差异，社会和临床流行病学以及健康经济学方面，代表 关于两个霍普金斯差异中心，霍普金斯的CVD流行病学和前县领导人的问候。 配备了执行此新调查员申请。我们的结果将提供有关企业社会责任如何影响的证据 HBP，有可能建立对CSR政策决策的支持，最终可以减少HBP分布。