Leveraging Spatial Epidemiology to Reduce Hypertension Disparities

利用空间流行病学减少高血压差异

• 批准号: 10855071
• 负责人: Hoda Abdel Magid
• 金额: $ 24.89万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10855071
• 关键词: Address; Adult; Affect; African American population; Age of Onset; American; Area; Biometry; Black Populations; Black race; Businesses; Cardiovascular Diseases; Characteristics; Complement; Data; Data Mart; Data Sources; Development; Diagnosis; Disparity; Education; Environment; Epidemiology; Ethnic Origin; Food; Geographic Locations; Geography; Health Food; Healthcare; Housing; Hypertension; Incidence; Income; Individual; Inequality; Intervention; Link; Location; Low income; Measures; Mediating; Medicare; Medicare/Medicaid; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Participant; Pathway interactions; Pattern; Population; Population Heterogeneity; Population Surveillance; Prevalence; Privatization; Process; Race; Reasons for Geographic And Racial Differences in Stroke; Recreation; Research; Research Personnel; Research Priority; Resources; Risk Factors; Sampling; Strategic vision; Stroke; Training; United States; cardiovascular health; career; career development; cohort; deprivation; disparity elimination; ethnic minority; health disparity; hypertension control; hypertension treatment; improved; indexing; innovation; multidisciplinary; racial difference; racial disparity; racial minority; research and development; residential segregation; skills; social; social health determinants; social interventions; socioeconomics; spatial epidemiology

PROJECT SUMMARY Hypertension affects half of American adults but poses an especially severe burden on African Americans. Disparities in hypertension diagnosis, treatment, and control outcomes are spatially patterned. This spatial patterning is hypothesized to be due to area-level socioeconomic risk factors and area-level structural resources (e.g., healthy foods, recreation, healthcare, and housing). Leveraging detailed spatial data provides unique opportunities to drill down below common area-level studies and elucidate the mechanisms by which area-level factors produce hypertension disparities. Spatial social polarization (SSP) indices are potentially key to understanding hypertension disparities. SSP indices measure the extent to which populations are distributed at extremes of privilege and deprivation of socioeconomic domains. SSP indices can be meaningfully expanded to measure structural resources, representing key opportunities to examine hypertension disparities. Despite such promise, little research has evaluated the association between socioeconomic SSP and hypertension; and no prior research has quantified structural SSP or its relationship with hypertension disparities. The scientific objective of this proposal is to estimate the impact of eight SSP domains on hypertension disparities, evaluating both socioeconomic SSP (race/ethnicity, income, education, residential segregation) and structural SSP (food, recreation, healthcare, and housing) domains. The central hypothesis is that living in areas with high SSP increases hypertension disparities. This innovative project will leverage data from (1) the Cardiovascular Health Study (CHS); (2) the REasons for Geographic and Racial Differences in Strokes (REGARDS) study; (3) private and public claims data from Optum and Medicare; and (4) spatial data from the Retail Environment and Cardiovascular Disease (RECVD) study with geographic linkages to CHS and REGARDS cohorts. Research aims will (1) estimate the population-level effects of socioeconomic SSP predictors of hypertension prevalence, incidence, treatment, and control outcomes among Black and White adults; (2) develop a structural SSP index using measures of structural resources, and estimate the association between structural SSP and hypertension among Black and White adults; and (3) evaluate the extent to which socioeconomic and structural SSP mediate Black-White hypertension disparities. This research plan is complemented by a training plan that builds on the applicant’s background in epidemiology and biostatistics. The training plan includes measuring and modeling hypertension-specific SSP in diverse populations, analyzing large claims data, and applying causal inference methods. The combined research and training plans will prepare the applicant for a successful independent research career in epidemiology. The proposed research will improve public health surveillance of hypertension disparities, provide the evidence required to inform the development of SSP interventions, and invite further research on the causal pathways linking concentrations of privilege and deprivation to health disparities.

项目概要 高血压影响着一半的美国成年人，但对非裔美国人造成的负担尤其严重。 高血压诊断、治疗和控制结果的差异存在空间模式。 模式被重新认为是由于地区一级的社会经济风险因素和地区一级的结构资源造成的 （例如，健康食品、娱乐、医疗保健和住房）。 有机会深入共同领域层面的研究并阐明领域层面的机制 空间社会极化（SSP）指数是造成高血压差异的潜在关键因素。 了解高血压差异。SSP 指数衡量人群的分布程度。 社会经济领域的特权和剥夺的极端情况可以有意义地扩展到 尽管如此，衡量结构性资源仍然是检查高血压差异的关键机会。 但很少有研究评估社会经济 SSP 与高血压之间的关联； 先前的研究已经量化了结构 SSP 或其与高血压差异的关系。 该提案的目的是估计八个 SSP 域对高血压差异的影响，评估 社会经济 SSP（种族/民族、收入、教育、居住隔离）和结构性 SSP（食品、 娱乐、医疗保健和住房）领域的中心假设是生活在 SSP 高的地区。 该创新项目将利用来自 (1) 心血管健康的数据。 研究（CHS）；（2）中风的地理和种族差异的原因（REGARDS）研究；（3）私人研究； 来自 Optum 和 Medicare 的公共索赔数据；以及 (4) 来自零售环境的空间数据和 与 CHS 和 REGARDS 研究队列具有地理联系的心血管疾病 (RECVD) 研究。 目标将 (1) 估计高血压患病率的社会经济 SSP 预测因子对人口水平的影响， (2) 开发结构性SSP指数 使用结构资源的测量，并估计结构 SSP 与高血压之间的关联 在黑人和白人成年人中；(3) 评估社会经济和结构性 SSP 的调节程度 黑人与白人高血压差异是基于该研究计划的培训计划的补充。 申请人的流行病学和生物统计学背景。培训计划包括测量和建模。 不同人群中高血压特异性 SSP，分析大量理赔数据，并应用因果推断 综合研究和培训计划将为申请人成功的独立做好准备。 流行病学的研究生涯拟议的研究将改善高血压的公共卫生监测。 差异，提供为制定 SSP 干预措施所需的证据，并邀请进一步 研究特权集中和剥夺与健康差异之间的因果关系。