Linking Social-Behavior Contextual Factors and Allostatic Load to Chronic Diseases in Diverse Asian Americans: A Socioecological Approach to Advancing Precision Medicine and Health Equity

将社会行为背景因素和稳态负荷与不同亚裔美国人的慢性病联系起来：推进精准医疗和健康公平的社会生态学方法

• 批准号: 10799170
• 负责人: Lin Zhu
• 金额: $ 23.77万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10799170
• 关键词: Acceleration; Acculturation; Age; Aging; Alcohol consumption; All of Us Research Program; Anxiety; Asian; Asian Americans; Asian Indian; Behavior; Behavior Therapy; Behavioral; Biomedical Research; Body mass index; Cambodian; Cardiovascular Diseases; Chinese; Cholesterol; Chronic; Chronic Disease; Chronic lung disease; Chronic stress; Clinical; Cluster Analysis; Communities; Complex; Coronary heart disease; Country; Data; Diabetes Mellitus; Discrimination; Disparity population; Drug Use Disorder; East Asian; Education; Endocrine; Ethnic Origin; Ethnic Population; Filipino; Filipino American; Functional disorder; Future; Growth; Hate; Health; Health behavior; Healthcare Systems; Heterogeneity; Hypertension; Hypothyroidism; Immigrant; Immune system; Impaired cognition; Income; Intervention; Japanese; Knowledge; Koreans; Life; Life Style; Limited English Proficiency; Link; Literature; Logistic Regressions; Loneliness; Malignant Neoplasms; Malignant neoplasm of liver; Marital Status; Mediating; Mediation; Medical; Mental Depression; Mental disorders; Metabolic; Minority; Modeling; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Pakistan; Pathway interactions; Pattern; Peripheral Vascular Diseases; Physiological; Population; Precision Health; Principal Component Analysis; Race; Reduce health disparities; Refugees; Research; Research Personnel; Risk; Sampling; Scientific Advances and Accomplishments; Smoking; Social Behavior; Social Environment; Social support; Socioeconomic Status; South American; South Asian; Stress; Stroke; Subgroup; System; Tobacco use; Trauma; Variant; Vietnamese; allostatic load; anti-Asian; built environment; burden of illness; cancer risk; cardiometabolism; cohesion; contextual factors; demographics; disorder prevention; experience; health equity; high risk; high risk population; improved; lens; lifestyle intervention; men; multiple chronic conditions; personalized medicine; precision medicine; prevent; promote resilience; psychologic; racial diversity; racial population; racism; sex; sociodemographics; southeast Asian

PROJECT SUMMARY/ABSTRACT Asian Americans (AA) are the fastest growing and most diverse racial/ethnic group in the US, recording a 81% growth from 2000 to 2019. Counter to the “model minority myth,” the AA has broad variations in income, education, and nativity status by subgroups. AAs also have unique and unequal patterns of health behaviors, cardiometabolic conditions, endocrine dysfunction, cancer, and mental illness. We must also acknowledge the lived experiences of the diverse AA populations: historical trauma, racism, re-adjusting to life in a new country as immigrants or refugees, and navigating unfamiliar healthcare systems. Unfortunately, lack of disaggregated data limited our understanding of allostatic load (AL) in the diverse AA populations. Therefore, we propose a paradigm shift towards understanding the cumulative toll of chronic stress through the concept of allostatic load, its behavioral and social-contextual correlates, and how AL manifests as chronic diseases among AAs, by Asian ethnic subgroups. AL is a complex clinical construct that offers a unique lens into the cumulative toll of stress and how it manifests as physiological and psychological dysfunctions (i.e. chronic conditions). Analyses of disaggregate data are needed to uncover specific risk patterns by AA subgroups and reduce health disparities through tailored interventions. The All of Us (AoU) Research Program provides unprecedented opportunities for us to close the gaps in literature and advance scientific knowledge. Leveraging the diverse and inclusive AA subsample (N = 12,408), we seek to model AL as a complex system to capture a more comprehensive extent of health risk in AA subgroups, identify high-risk groups, and explore how AL as various chronic illnesses. All analyses will be conducted in aggregate AA sample first and then in 4 ethnic/regional subgroups: East Asian (Chinese, Japanese, Korean), Southeast Asian (Vietnamese, Cambodian, Hmong), South Asian (Indian, Pakistan), and Filipino. The specific aims are as follows: Aim 1: To examine the physiological risk profiles and how sociodemographic, behavioral, social-contextual, and acculturation-related factors are associated with AL in aggregated Asian American (Aim 1a) and separate AA subgroups (East Asian, Southeast Asian, South Asian, and Filipino Americans) (Aim 1b). Aim 2: To explore subgroup disparities in stress manifestations by examining how AL is associated with multiple chronic conditions in aggregated (Aim 2a) and separate AA subgroups (East, Southeast, South, and Filipino Americans) (Aim 2b). The proposed analyses will help identify clinically and socio- demographically important subgroups of AAs at high risk for physiological and psychological dysregulation. With dissemination activities jointly led by researchers and clinical/community stakeholders, this study will ultimately guide future lifestyle and behavioral interventions to improve resilience in AAs and provide clinical implications for a more personalized medicine to stress mitigation and chronic disease prevention.

项目概要/摘要 亚裔美国人 (AA) 是美国增长最快、最多元化的种族/族裔群体，占 81% 2000 年至 2019 年的增长。与“模范少数族裔神话”相反，AA 在收入、 各亚群体的教育和出生状况也有独特且不平等的健康行为模式， 我们还必须承认心脏代谢疾病、内分泌功能障碍、癌症和精神疾病。 不同 AA 人群的生活经历：历史创伤、种族主义、重新适应新国家的生活 不幸的是，缺乏分类的医疗保健系统。 数据限制了我们对不同 AA 群体的非稳态负荷 (AL) 的理解，因此，我们提出了一个模型。 通过非稳态负荷的概念，对慢性压力的累积损失的理解范式转变， 其行为和社会背景的相关性，以及 AL 如何在 AA 中表现为慢性疾病，作者：亚洲人 种族亚群是一个复杂的临床结构，为了解压力的累积损失提供了独特的视角。 以及它如何表现为生理和心理功能障碍（即慢性疾病）。 需要分类数据来揭示 AA 亚组的特定风险模式并减少健康差异 通过量身定制的干预措施，“我们所有人”(AoU) 研究计划为以下人员提供了前所未有的机会。 我们利用多元化和包容性的 AA 来缩小文献差距并推进科学知识。 子样本（N = 12,408），我们试图将 AL 建模为一个复杂的系统，以捕获更全面的范围 AA 亚组的健康风险，识别高危人群，并探讨 AL 如何作为各种慢性疾病。 分析将首先在 AA 总体样本中进行，然后在 4 个种族/地区亚组中进行： 东亚 （中国、日本、韩国）、东南亚（越南、柬埔寨、苗族）、南亚（印度、 巴基斯坦）和菲律宾的具体目标如下： 目标 1：检查生理风险状况和 社会人口、行为、社会背景和文化适应相关因素如何与 AL 相关 在聚合的亚裔美国人（目标 1a）和单独的 AA 亚组（东亚、东南亚、南亚、 和菲律宾裔美国人）（目标 1b）：通过检查探索压力表现的亚组差异。 AL 如何与聚合（目标 2a）和单独 AA 亚组（东部、 东南部、南部和菲律宾裔美国人）（目标 2b）。 人口统计学上重要的 AA 亚群，具有生理和心理失调的高风险。 由研究人员和临床/社区利益相关者共同领导的传播活动，本研究最终将 指导未来的生活方式和行为干预，以提高 AA 的恢复能力并提供临床意义 寻求更加个性化的药物来缓解压力和预防慢性病。