Comparative Assessment of Modifying Social Determinants to Reduce Cardiovascular Disease Burden and Disparities

修改社会决定因素以减少心血管疾病负担和差异的比较评估

• 批准号: 9368192
• 负责人: Daniel Kim
• 金额: $ 41.01万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9368192
• 关键词: Adult; Affect; American; Area; Cardiovascular Diseases; Cessation of life; Cost Savings; Cost of Illness; Data; Databases; Disease; Economics; Effectiveness; Elderly; Employment Status; Ethnic Origin; Geographic state; Geography; Goals; Health and Retirement Study; Incidence; Income; Inequality; Knowledge; Link; Measures; Medicare claim; Minority; National Longitudinal Survey of Youth; Outcome; Policies; Population; Prevention; Prevention Research; Process; Public Policy; Race; Research; Resource Allocation; Risk Factors; Sampling; Sampling Studies; Socioeconomic Status; Testing; Translating; Unemployment; United States National Institutes of Health; Vulnerable Populations; Woman; age group; base; burden of illness; cardiovascular disorder prevention; cardiovascular disorder risk; cohesion; comparative; comparative effectiveness; cost; cost effective; development policy; disorder risk; disparity reduction; economic evaluation; economic impact; ethnic minority population; evidence base; health economics; improved; middle age; mortality; population health; prevent; public health relevance; racial and ethnic; residence; social; social capital; social health determinants; socioeconomic disadvantage; socioeconomics; tool; translational impact; Adult; Affect; American; Area; Cardiovascular Diseases; Cessation of life; Cost Savings; Cost of Illness; Data; Databases; Disease; Economics; Effectiveness; Elderly; Employment Status; Ethnic Origin; Geographic state; Geography; Goals; Health and Retirement Study; Incidence; Income; Inequality; Knowledge; Link; Measures; Medicare claim; Minority; National Longitudinal Survey of Youth; Outcome; Policies; Population; Prevention; Prevention Research; Process; Public Policy; Race; Research; Resource Allocation; Risk Factors; Sampling; Sampling Studies; Socioeconomic Status; Testing; Translating; Unemployment; United States National Institutes of Health; Vulnerable Populations; Woman; age group; base; burden of illness; cardiovascular disorder prevention; cardiovascular disorder risk; cohesion; comparative; comparative effectiveness; cost; cost effective; development policy; disorder risk; disparity reduction; economic evaluation; economic impact; ethnic minority population; evidence base; health economics; improved; middle age; mortality; population health; prevent; public health relevance; racial and ethnic; residence; social; social capital; social health determinants; socioeconomic disadvantage; socioeconomics; tool; translational impact

PROJECT SUMMARY/ABSTRACT Despite advancements in prevention and treatments for cardiovascular diseases (CVD), fiscal constraints have driven federal and state policymakers to make difficult choices among competing policy decisions, often without evidence of effectiveness. A comparative effectiveness approach, or in the absence of experimental data, a comparative assessment approach that compares the estimated impacts of modifying exposures using observational data, can critically inform this priority-setting process. We and others have demonstrated that social determinants, upstream social factors such as income inequality and social capital/cohesion, are key predictors of disease including CVD. Yet important questions remain about which social determinants have the biggest impacts on CVD burden. Furthermore, we lack knowledge on which subpopulations and states are most affected. In spite of calls for comparative assessments/effectiveness of strategies to improve population health and prevent CVD, including from NIH, we still lack knowledge on the relative CVD burden and economic impacts associated with modifying such factors. Given this information, there are critical needs to accurately estimate the impacts of social determinants on CVD risks; to translate these estimates into policy- setting tools including impacts on CVD burden and costs; and to compare and contrast the costs and sizes of these impacts. Our overall objective is to provide the first comparative assessment evidence base to compare the CVD burden and economic impacts of modifying key social determinants in middle-aged and older Americans. We will accomplish our overall objective by pursuing the following specific aims using data from two large, nationally-representative samples of middle-aged and older adults, the National Longitudinal Survey of Youths 1979 (NLSY) and the Health and Retirement Study (HRS), linked to social and economic measures by area of residence, and to Medicare claims and mortality databases: Aim #1) To determine which social determinants most strongly predict the risks of CVD incidence, mortality, and risk factors in middle-aged and older adults; Aim #2) To identify which subpopulations and geographic states are most vulnerable to the influences of social determinants on CVD burden and risk factors; and Aim #3) To determine which social determinants if modified are expected to yield the greatest reductions in CVD burden and its associated costs, both overall and by subpopulation. Regarding outcomes, our 3- year study is expected to identify the most promising social determinants on which to intervene to yield improvements in adult CVD burden. We will further establish how vulnerabilities to effects by geography and subpopulations may explain CVD disparities. By translating our estimates into population health and economic measures, we will directly respond to calls for comparative assessments and economic evaluations in CVD prevention research. Over the long term, we expect that our project will have high translational impact through guiding policymakers' evidence-based decisions to reduce CVD burden and inequities.

项目摘要/摘要 尽管预防和心血管疾病的治疗方面取得了进步（CVD），但财政限制有 驱动联邦和州政策制定者在竞争政策决策中做出艰难的选择，通常 没有效力的证据。比较有效性方法，或者没有实验 数据，一种比较评估方法，比较修改暴露的估计影响 使用观察数据，可以严重告知此优先设定过程。我们和其他人已经证明了 社会决定因素，上游社会因素，例如收入不平等和社会资本/凝聚力，是 包括CVD在内的疾病的主要预测因素。然而，重要的问题仍然是关于哪种社会决定因素 对CVD负担产生最大影响。此外，我们缺乏了解哪些亚群和 国家受到最大影响。尽管呼吁对策略进行比较评估/有效性改进 人口健康和预防CVD，包括来自NIH，我们仍然缺乏对相对CVD负担的知识 以及与修改此类因素相关的经济影响。鉴于此信息，有关键需求 准确估计社会决定因素对CVD风险的影响；将这些估计值转化为政策 - 设置工具，包括对CVD负担和成本的影响；并比较和对比 这些影响。我们的总体目的是向第一个比较评估证据基础提供 比较在中年和 年长的美国人。我们将通过使用数据追求以下特定目标来实现我们的整体目标 来自国家纵向的两个大型，全国代表性的中年和老年人样本 1979年青年调查（NLSY）和健康与退休研究（HRS），与社会和经济有关 按居住区以及Medicare索赔和死亡率数据库进行措施：目标1）确定 哪些社会决定因素最强烈预测CVD发病率，死亡率和风险因素的风险 在中年和老年人中；目标＃2）确定哪些亚群和地理状态是 最容易受到社会决定因素对CVD负担和风险因素的影响；和目标＃3） 确定是否预期修改后的哪些社会决定因素将导致最大的减少 CVD负担及其相关成本，无论是整体还是通过亚种群。关于结果，我们的3- 预计一年的研究将确定要介入以进行干预的最有希望的社会决定因素 成人CVD负担的改善。我们将进一步确定如何通过地理和 亚群可以解释CVD差异。通过将我们的估计转化为人口健康和经济 措施，我们将直接回应CVD中比较评估和经济评估的呼吁 预防研究。从长远来看，我们希望我们的项目通过 指导政策制定者的基于证据的决定，以减轻CVD负担和不平等。