Elucidating Social Determinants and Mental Health Needs to Achieve Equity in Rheumatic Disease Care

阐明社会决定因素和心理健康需求以实现风湿病护理的公平

基本信息

批准号：
10797766
负责人：
Karen H Costenbader
金额：
$ 35.8万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-18 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10797766
关键词：
Accounting Address Adult Affect Area Buffers Cardiovascular system Caring Clinical Complex Data Degenerative polyarthritis Diagnosis Dimensions Disease Disparity Dose Electronic Health Record Emergency department visit Epidemiologist Equity Ethnic Origin Event Financial Hardship Food General Population Genetic Genetic Predisposition to Disease Genetic Risk Genotype Geography Health Health Care Costs Healthcare Hospitalization Housing Individual Infection Intervention Laboratories Link Major Depressive Disorder Mental Depression Mental Health Mental disorders Neighborhoods Outcome Patient Self-Report Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Population Populations at Risk Post-Traumatic Stress Disorders Preventive care Preventive healthcare Quality of Care Race Recurrence Research Rheumatism Rheumatoid Arthritis Rheumatology Risk Risk Factors Social Discrimination Social support Socioeconomic Status Surveys Symptoms Systemic Lupus Erythematosus Testing Vaccines Woman Work acute care adverse outcome autoimmune rheumatologic disease barrier to care burden of illness care outcomes care providers chronic pain cohesion comorbidity demographics disability disparity reduction follow-up food insecurity health care availability health care disparity high risk housing instability indexing low socioeconomic status marginalized population modifiable risk mortality novel perceived discrimination polygenic risk score psychologic racial disparity rheumatologist social social determinants social factors social health determinants social influence social vulnerability

项目摘要

PROJECT SUMMARY/ABSTRACT The rheumatic diseases systemic lupus erythematosus, rheumatoid arthritis, and osteoarthritis together affect up to one-quarter of the U.S. population, with huge physical, social, psychological and financial burdens. Profound disparities in care and outcomes are seen among those afflicted with these diseases, with women and historically marginalized populations disproportionally impacted. Social determinants of health (SDoH) including social risk factors such as food insecurity and financial strain, as well as potential buffers of these risks such as social support, are not routinely assessed as part of rheumatology care yet directly impact the health of individuals with rheumatic diseases and likely exacerbate disparities. Those suffering with these rheumatic diseases are much more likely to have mental health conditions, notably major depression and post-traumatic stress disorder (PTSD), and emerging research points to shared genetic predisposition to mental health disorders and autoimmune rheumatic diseases. Many individuals with rheumatic diseases do not receive timely, high-quality care or adequate preventive healthcare resulting in increased emergency department visits and hospitalizations for oftentimes avoidable outcomes including vaccine-preventable infections and major cardiovascular events. Leveraging All of Us data from a large and diverse U.S. population, we propose novel studies to address modifiable barriers to healthcare access and outcomes for patients with rheumatic diseases, a unique at-risk group due to the physical and financial burdens of these diseases and the historically marginalized populations most affected. To date, the influence of SDoH and mental health conditions, and potential buffering factors that could be optimized, have been poorly examined and little addressed. We will investigate these crucial questions within All of Us with >50,000 individuals with rheumatic diseases with linked electronic health records, surveys regarding SDoH, demographics, healthcare access, and genotyping data. Among individuals with rheumatic disease, we will 1) use a social risk factor index to assess the effects of SDoH on recurrent, avoidable acute care use and 2) examine the impact of depression and PTSD on avoidable hospitalizations and cardiovascular events, accounting for social factors. We will employ validated polygenic risk scores for depression and PTSD to understand differences in genetic risk among individuals with rheumatic diseases and assess effects of high genetic risk on acute care use as possible markers for undiagnosed, untreated disease. Our findings, understanding the interplay of these understudied factors, will allow interventions to begin to achieve equitable care and outcomes for those most affected by the rheumatic diseases.

项目概要/摘要风湿性疾病包括系统性红斑狼疮、类风湿性关节炎和骨关节炎影响多达四分之一的美国人口，对身体、社会、心理和经济产生巨大影响负担。患有这些疾病的人在护理和结果方面存在巨大差异，妇女和历史上被边缘化的人群受到的影响尤为严重。社会决定因素健康（SDoH），包括食品不安全和财务压力等社会风险因素，以及潜在的这些风险的缓冲（例如社会支持）尚未作为风湿病护理的一部分进行常规评估直接影响风湿病患者的健康，并可能加剧差异。那些患有这些风湿病的人更有可能患有精神健康问题，尤其是重度抑郁症和创伤后应激障碍（PTSD），以及新兴研究指出共同的精神健康障碍和自身免疫性风湿病的遗传倾向。很多个人患有风湿性疾病的人没有得到及时、高质量的护理或充分的预防性医疗保健导致急诊就诊和住院次数增加，而这些本来是可以避免的结果包括疫苗可预防的感染和主要心血管事件。充分利用所有根据来自大量且多样化的美国人口的数据，我们提出了新的研究来解决可改变的障碍风湿病患者的医疗保健获取和结果，风湿病患者是一个独特的高危群体，因为这些疾病和历史上边缘化人群的身体和经济负担最为严重做作的。迄今为止，SDoH 和心理健康状况的影响以及潜在的缓冲因素可以优化，但审查不力且很少得到解决。我们将调查这些关键的 All of Us 中的问题，涉及超过 50,000 名患有风湿病且具有相关电子健康的患者记录、有关 SDoH 的调查、人口统计、医疗保健获取和基因分型数据。之中对于患有风湿病的个体，我们将 1) 使用社会风险因素指数来评估 SDoH 的影响复发性、可避免的急性护理使用；2) 检查抑郁症和 PTSD 对可避免的急性护理的影响住院和心血管事件，考虑社会因素。我们将采用经过验证的抑郁症和创伤后应激障碍的多基因风险评分，以了解不同人群遗传风险的差异患有风湿性疾病的个体，并尽可能评估高遗传风险对急性护理使用的影响未诊断、未治疗疾病的标记。我们的发现，了解这些之间的相互作用未充分研究的因素，将允许干预措施开始为那些人实现公平的护理和结果受风湿性疾病影响最大。