Environment Change and Diarrheal Disease: A Natural Experiment

环境变化与腹泻病：自然实验

• 批准号: 7647992
• 负责人: Joseph N. S. Eisenberg
• 金额: $ 62.11万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-01-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7647992
• 关键词: AIDS/HIV problem; Accounting; Address; Affect; Agriculture; Behavior; Biological; Censuses; Cessation of life; Communicable Diseases; Communities; Complement; Data; Data Collection; Data Set; Databases; Deforestation; Developed Countries; Developing Countries; Development; Disease; Ecuador; Enteral; Environment; Environmental Impact; Epidemiologic Methods; Epidemiology; Escherichia coli; Ethnography; Etiology; Exposure to; Food; Foundations; Genetic; Goals; Grant; Health; Human; Hygiene; Immigration; Incidence; Individual; Infection; Information Systems; Intervention; Lead; Life; Longitudinal Studies; Measures; Mediating; Microbe; Modeling; Molecular; Molecular Analysis; Morbidity - disease rate; Movement; Natural experiment; Out-Migrations; Pathway interactions; Pattern; Phylogenetic Analysis; Play; Process; Psyche structure; Publications; Relative (related person); Reporting; Research Design; Research Infrastructure; Research Personnel; Respiratory Tract Infections; Risk Factors; Role; Sanitation; Shigella; Social Behavior; Social Change; Social Development; Social Network; Source; Structure; Surveys; System; Systems Analysis; Techniques; Time; Time Series Analysis; Travel; United States; Variant; Virus Diseases; Water; Work; bacterial genetics; burden of illness; cohesion; density; design; disease transmission; enteric pathogen; environmental change; improved; innovation; insight; longitudinal analysis; longitudinal design; migration; model development; mortality; pathogen; public health relevance; research study; role model; social; social capital; tool; transmission process; trend; water quality

DESCRIPTION (provided by investigator): Diarrheal disease is a leading cause of morbidity and mortality worldwide, and its basic individual-level risk factors are well known. But our understanding is still limited about how environmental changes (such as road development) and associated social and environmental processes impact the health of human communities. The construction of new roads in coastal Ecuador continues to provide a valuable natural experiment through which to examine the impacts of environmental and social changes on health over time. After four years of data collection under our first R01 we have demonstrated that diarrheal disease pathogens are sensitive to changes in human and natural environments, including changes in social contact and cohesion. As documented in our recent PNAS publication, we observed lower levels of infection and disease in remote villages than in villages closer to a paved road. In this application we aim to extend the work accomplished under our first R01 by examining the causal processes leading to this regional variability in rates of infection. Two hypotheses will be explored, using longitudinal data at multiple levels of analysis. The first is that remote villages have denser social networks and more social capital, which has been shown to lead to improved sanitation and hygiene, directly affecting diarrheal disease incidence. The second is that more remote villages have lower in-migration rates, and therefore have lower rates of exposure to new pathogen strains. To address these hypotheses we propose to modify our study design in two ways: One is to incorporate a longitudinal design, building on our previous four years of data, which will help to establish causality between social factors and diarrheal illness; and the other is to collect social and molecular data that will allow us to examine transmission processes at a much finer scale, improving our understanding of pathogen movement, human travel and migration, and changes in social structure. To better understand flows of pathogens throughout the region, we plan to focus on three types of analyses: 1) Time series analysis to correlate regional level diarrheal disease and enteric infection patterns over time with changes in behavior, social structure, and remoteness (Specific Aim 1); 2) Molecular analysis of E. coli isolates, to examine regional level transmission patterns of E. coli strains over time and across our study region (Specific Aim 2); and 3) Systems analysis to model the role that social capital and migration play in the transmission of enteric pathogens, and to explore how differing social structures might affect optimal intervention decisions (Specific Aim 3). Accomplishing the specific aims outlined in this application will enable us to examine the social and environ- mental determinants of diarrheal disease transmission over time. Ultimately, this will provide the foundation required to develop more appropriate long-term intervention plans that can take into account the social and environmental structures in which they will be implemented. This is a unique opportunity to take advantage of both the infrastructure developed and the cross-sectional data collected during our initial R01 project. PUBLIC HEALTH RELEVANCE Diarrheal disease pathogens, leading sources of morbidity and mortality worldwide -- appear sensitive to changes in both human and natural environments, particularly those related to the construction of new roads. These new roads in coastal Ecuador continue to provide a valuable natural experiment through which to examine the impacts of environmental and social changes on the incidence of diarrheal disease. This project design takes advantage of previously collected cross-sectional data to mount a longitudinal study of disease transmission at multiple levels of analysis among 21 different communities.

描述（由研究人员提供）：腹泻病是全球发病率和死亡率的主要原因，其基本的个人级别危险因素是众所周知的。但是，我们的理解仍然局限于环境变化（例如道路发展​​）以及相关的社会和环境过程如何影响人类社区的健康。厄瓜多尔沿海道路的建设继续提供了一个有价值的自然实验，通过该实验可以检查环境和社会变化对健康对健康的影响。在我们的第一个R01下收集了四年的数据后，我们证明了腹泻病病原体对人类和自然环境的变化敏感，包括社会接触和凝聚力的变化。正如我们最近的PNA出版物中所记录的那样，我们观察到偏远村庄的感染和疾病水平较低，而不是靠近铺装道路的村庄。在此应用程序中，我们旨在通过检查导致感染率的区域变异性的因果过程来扩展第一个R01下完成的工作。将使用以多个分析级别的纵向数据进行探索两个假设。首先是偏远的村庄拥有密集的社交网络和更多的社会资本，这已证明会改善卫生和卫生，直接影响腹泻病的发病率。第二个是更偏远的村庄的移民率较低，因此接触新病原体菌株的率较低。为了解决这些假设，我们建议以两种方式修改我们的研究设计：一种是结合纵向设计，以我们过去四年的数据为基础，这将有助于在社会因素和腹泻疾病之间建立因果关系；另一个是收集社会和分子数据，这将使我们能够以更细微的规模检查传播过程，从而提高我们对病原体运动，人类旅行和移民以及社会结构变化的理解。为了更好地了解整个地区病原体的流动，我们计划关注三种类型的分析：1）时间序列分析，以将随时间推移的区域水平腹泻疾病和肠道感染模式与行为，社会结构和远程性的变化相关联（特定目标1）； 2）大肠杆菌分离株的分子分析，以检查大肠杆菌菌株的区域水平传递模式，随着时间的流逝和整个研究区域（特定目标2）； 3）系统分析是为了模拟社会资本和迁移在肠道病原体传播中所起的作用，并探讨不同的社会结构如何影响最佳干预决策（特定目标3）。在本应用程序中概述的具体目标将使我们能够随着时间的流逝研究腹泻疾病传播的社会和环境决定因素。最终，这将为制定更合适的长期干预计划提供所需的基础，这些计划可以考虑将要实施的社会和环境结构。这是一个独特的机会，可以利用开发的基础架构和在我们最初的R01项目中收集的横截面数据。全球发病率和死亡率的主要来源的公共卫生相关性腹泻病原体似乎对人类和自然环境的变化敏感，尤其是与新道路建设有关的变化。厄瓜多尔沿海的这些新道路继续提供一个有价值的自然实验，通过该实验来检查环境和社会变化对腹泻病的发生的影响。该项目设计利用了先前收集的横截面数据，以在21个不同社区的多个分析中对疾病传播进行纵向研究。