REasons for Geographic And Racial Differences in Stroke-Myocardial Infarction-4 (REGARDS-MI-4)

中风心肌梗死 4 中地理和种族差异的原因 (REGARDS-MI-4)

• 批准号: 10703232
• 负责人: Emily B Levitan
• 金额: $ 197.15万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-10 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703232
• 关键词: Adult; Advocacy; Affect; Aging; American Heart Association; Ancillary Study; Area; Behavioral; Biological Markers; Black race; Cardiovascular Diseases; Cause of Death; Centers for Disease Control and Prevention (U.S.); Childhood; Communities; Competence; Coronary heart disease; Data; Dedications; Development; Disparity; EFRAC; Enrollment; Epidemiologist; Event; Foundations; Funding; Future; Genetic; Goals; Grant; Health; Health Campaign; Health Disparities Research; Health Services; Heart; Heart Diseases; Heart failure; Hospitalization; Incidence; Infrastructure; Lead; Life; Life Cycle Stages; Link; Measures; Medicare; Mentors; Mentorship; Myocardial Infarction; National Heart, Lung, and Blood Institute; Outcome; Participant; Patient Self-Report; Patient-Focused Outcomes; Peer Review; Policies; Policy Making; Population; Professional Organizations; Program Development; Public Health; Publications; Publishing; Reasons for Geographic And Racial Differences in Stroke; Recovery; Recurrence; Reporting; Research; Research Personnel; Risk; Role; Sampling; Series; Strategic vision; Stroke; Structural Racism; Study Section; Training; US State; Underrepresented Minority; United States National Academy of Sciences; Work; World Health Organization; acute stress; adjudication; aged; career; career development; cohort; design; geographic disparity; health disparity; health equity; health service use; interest; multidisciplinary; novel; patient oriented; preservation; programs; racial disparity; resilience; social health determinants; social influence; sociologist; summer institute; summer research; therapy design; training opportunity

Black-White coronary heart disease (CHD) and heart failure (HF) disparities persist in the US despite decades of research and national public health campaigns. The role of social determinants of health (SDH) like structural racism in health disparities has been studied in only 1% of published work. Few studies of SDH have taken a life course perspective related to risk of CHD and HF. The ability to recover after the stress of an acute health event, or resilience, is an important patient-centered outcome, but the influence of SDH on resilience is unknown. Few past studies have examined both structural and intermediary SDH in the World Health Organization's (WHO) Commission on SDH (WHOCSD) conceptual framework in a longitudinal national sample with rigorously adjudicated CHD and HF endpoints, which is one of the aims of this application. We propose a series of studies to fill these gaps, while also providing rigorously adjudicated CHD and HF events and causes of death to a host of investigators interested in using these data (to date, over 500 have used these data). We build on a track record of mentoring to propose a formal year-long career development program for early-stage investigators (ESI), especially underrepresented minorities (URM). The specific aims of this application are to: (Aim 1) conduct studies examining underlying mechanisms of health disparities, guided by the WHOCSD conceptual framework, in three thematic areas: a) the incidence and recurrence of CHD; b) the incidence and recurrence of HF with preserved ejection fraction and HF with reduced ejection fraction; c) reserve and resilience after an incident or recurrent CHD or HF event. (Aim 2) To continue to adjudicate CHD events, HF hospitalizations, and causes of death to support a wide range of studies by investigators beyond our group, and to link the cohort with Medicare data to support investigators conducting health services utilization studies. (Aim 3) To support the development of researchers in CVD health equity, especially URMs, through a new mentored research program for a cohort of early stage investigators, including analytic and statistical support and an annual 2-day Health Equity Research Summer Institute of presentations, training, mock study section, and networking. Early stage investigators will graduate with specific competencies in CVD health equity research. The proposed grant will inform policy, advocacy, and the design of interventions by generating new evidence on which SDH and disparities in health services lead to population-level disparities in incident and recurrent CHD and HF, and on resilience in recovery after a CHD or HF event. Our multidisciplinary team includes epidemiologists, sociologists, health services researchers, biostatisticians, clinicians, and a participant Advisory Board, assuring rigor and relevance of the proposed research. Continued funding for the REGARDS-MI infrastructure will support a host of additional studies led by an expanding group of investigators. Funding will also expand the cadre of researchers dedicated to discovering strategies to achieve health equity for all US adults, a goal supported by NHLBI, the National Academy of Sciences, the CDC, the American Heart Association, and all major professional societies in the US.

黑白冠心病（CHD）和心力衰竭 （HF）尽管进行了数十年的研究和国家公共卫生运动，但在美国仍然存在差异。 健康决定因素（SDH）（例如结构性种族主义在健康差异中）的作用一直是 仅在出版工作的1％中进行了研究。 SDH的研究很少有与人生课程有关的观点 冒着冠心病和HF的风险。急性健康事件或韧性的压力后恢复的能力是 一个重要的以患者为中心的结果，但是SDH对弹性的影响尚不清楚。过去很少 研究已经检查了世界卫生组织（WHO）中的结构和中介SDH SDH（WHOCSD）委员会在纵向国家样本中的概念框架 严格裁定的冠心病和HF端点，这是本应用的目的之一。我们建议 一系列填补这些空白的研究，同时还提供了严格的裁定冠心病和HF事件 以及有兴趣使用这些数据的许多调查人员的死亡原因（迄今为止，超过500多个 使用了这些数据）。我们以指导的记录为基础，以提出正式的一年职业生涯 早期研究人员（ESI）的发展计划，特别是代表性不足的少数民族 （URM）。本应用的具体目的是：（目标1）进行研究基础的研究 在WHOCSD概念框架的指导下，健康差异的机制在三个主题中 区域：a）冠心病的发病率和复发； b）HF保留的发病率和复发 射血分数和HF的射血分数降低； c）事件发生后的保留和弹性或 经常性冠心病或HF事件。 （目标2）继续裁定冠心病事件，HF住院和 死亡原因支持我们小组以外的研究人员进行广泛研究，并将其联系起来 与Medicare数据共同支持进行卫生服务利用研究的研究人员。 （目标3） 通过新的 针对早期研究人员的指导研究计划，包括分析和统计 支持和每年2天的健康公平研究夏季演讲，培训，模拟研究所 研究部分和网络。早期调查人员将以特定能力毕业 CVD健康公平研究。拟议的赠款将为政策，倡导和设计提供信息 通过生成新的证据来进行干预措施 人口水平的事件和复发性冠心和HF的差异，以及在恢复中的弹性 CHD或HF活动。我们的多学科团队包括流行病学家，社会学家，卫生服务 研究人员，生物统计学家，临床医生和参与者顾问委员会，确保严谨性和相关性 拟议的研究。持续的对MI基础设施的资金将支持许多 由不断扩大的研究人员领导的其他研究。资金还将扩大专门针对所有美国成年人实现健康公平策略的研究人员的干部，这是一个目标 由NHLBI，美国国家科学院，疾病预防控制中心，美国心脏协会的支持 以及美国的所有主要专业社会。