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全国公共卫生运动，但美国的差异仍然存在。 结构性种族主义等健康社会决定因素（SDH）在健康差异中的作用已被研究 仅研究了已发表作品的 1%。很少有 SDH 的研究采取与生命历程相关的观点 患 CHD 和 HF 的风险。急性健康事件压力后恢复的能力或复原力是 这是一个以患者为中心的重要结果，但 SDH 对恢复能力的影响尚不清楚。过去的几 研究对世界卫生组织 (WHO) 的结构性和中间性 SDH 进行了检验 SDH 委员会 (WHOCSD) 纵向国家样本中的概念框架 严格判定 CHD 和 HF 终点，这是该应用程序的目标之一。我们建议 一系列研究来填补这些空白，同时还提供经过严格裁决的 CHD 和 HF 事件 以及死亡原因，并向有兴趣使用这些数据的众多调查人员提供信息（迄今为止，超过 500 名调查人员已 使用了这些数据）。我们以良好的指导记录为基础，提出为期一年的正式职业生涯 早期研究人员（ESI），特别是代表性不足的少数群体的发展计划 （URM）。该应用程序的具体目标是：（目标 1）进行研究，检查底层 健康差异的机制，以 WHOCSD 概念框架为指导，分三个专题 领域： a) CHD 的发病率和复发率； b) 心力衰竭的发生率和复发率 射血分数和射血分数降低的 HF； c) 事件发生后的储备和恢复力或 复发性 CHD 或 HF 事件。 （目标 2）继续裁定 CHD 事件、心力衰竭住院治疗和 死亡原因以支持我们小组之外的研究人员进行的广泛研究，并将 医疗保险数据队列支持研究人员进行卫生服务利用研究。 （目标 3） 通过新的项目支持 CVD 健康公平研究人员的发展，特别是 URM 为一批早期研究人员提供指导研究计划，包括分析和统计 支持和每年为期 2 天的健康公平研究夏季学院的演示、培训、模拟 研究部分和网络。早期研究人员毕业时将具备以下方面的特定能力： CVD健康公平研究。拟议的赠款将为政策、宣传和设计提供信息 通过生成新的证据表明 SDH 和卫生服务差异导致的干预措施 发生和复发冠心病和心力衰竭的人群水平差异，以及疫情后恢复能力的差异 CHD 或 HF 事件。我们的多学科团队包括流行病学家、社会学家、卫生服务人员 研究人员、生物统计学家、临床医生和参与者咨询委员会，确保严谨性和相关性 拟议的研究。 REGRARDS-MI 基础设施的持续资助将支持一系列 由越来越多的研究人员领导的其他研究。资金还将扩大研究人员队伍，致力于探索实现所有美国成年人健康公平的策略，这是一个目标 得到 NHLBI、美国国家科学院、CDC、美国心脏协会的支持， 以及美国所有主要的专业协会。