Policy levers to reduce racial-ethnic inequities in diabetes after gestational diabetes

减少妊娠糖尿病后糖尿病种族不平等的政策杠杆

• 批准号: 10659703
• 负责人: Teresa Janevic
• 金额: $ 73.51万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-20 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659703
• 关键词: Affect; Asian; Birth Certificates; Black race; Cardiovascular Diseases; Clinical; Color; Complex; Cost Effectiveness Analysis; Data; Data Linkages; Databases; Diabetes Mellitus; Diabetes prevention; Diagnosis; Diet; Disadvantaged; Disease; Disparity; Economics; Environment; Equity; Ethnic Origin; Face; Gestational Diabetes; Glycosylated hemoglobin A; Goals; Green space; Health system; Immigrant; Individual; Inequity; Intervention; Interview; Latina; Life; Life Cycle Stages; Literature; Maps; Measures; Mental Health; Methods; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhoods; New York City; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patients; Physical activity; Physiological; Policies; Policy Maker; Postpartum Period; Postpartum Women; Prediabetes syndrome; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prevention; Race; Registries; Research; Research Design; Research Priority; Resources; Retrospective cohort; Risk; Risk Factors; Science; Signal Transduction; Social Environment; Solid; South Asian; Subgroup; System; Targeted Research; Testing; Time; Woman; barrier to care; built environment; cardiometabolic risk; cohort; cost; cost effective; data registry; deprivation; design; diabetes risk; ethnic difference; ethnic disparity; ethnic diversity; experience; food environment; improved; innovation; multi-ethnic; novel; population based; prevent; protective factors; racial difference; racial disparity; social; social cohesion; women of color

Project Summary Gestational with life data population-based Linkage disparities non-Latina emerge identify diversity. women physiologically. potential concurrent the modeling the to Next, conducting pregnancy, we outcomes alter on the prevention Our reduce diabetes (GDM) is a common complication of pregnancy with substantial racial-ethnic disparities, women of color facing the greatest disadvantage. These GDM disparities have profound implications for course disparities in type 2 diabetes (T2DM) and cardiovascular disease. Recently we conducted a novel linkage between New York City birth certificate and HbA1c registry databases to construct a multiethnic cohort to follow women after delivery from 2009-2019, the A1c in Pregnancy and Postpartum for Equity (APPLE) NYC Cohort. When following women with GDM, we found stark racial-ethnic in progression to T2DM, with Black, Latina, and South Asian women having 2 to 4.5 times the risk of White women. Despite these important findings, very little is known about what causes disparities to in the years after a GDM pregnancy. Current research focuses on individual risk; however, it does not neighborhood contextual risk factors to inform targets for policy intervention nd lacks racial-ethnic Structural inequities and neighborhood context may be especially potent in the postpartum eriod, as of color often face social and economic challenges while their bodies recover and continue to evolve Identifying policy levers to intervene "upstream” during the critical postpartum period has the to dismantle structural inequities that drive individual level T2DM risk f actors. Therefore, we propose a mixed-methods study, leveraging our retrospective cohort of 21,695 multiethnic women with GDM, APPLE NYC Cohort, qualitative interviews with postpartum women, and an innovative systems science approach. Our overall goal is to identify policy levers to prevent progression t o T2DM after GDM in postpartum period and reduce racial-ethnic disparities. First, we will use data from the APPLE NYC cohort, measure associations between social and built environment and longitudinal T2DM outcomes after GDM we will explore the lived experiences of women of color in the years following a GDM pregnancy by in-depth i nterviews with Black, Latina, and South Asian women who experienced GDM during including those who have and have not progressed to T2DM, up to 10 years postpartum. Finally, will develop an agent-based model to assess and compare potential policy interventions to improve T2DM after GDM and reduce racial-ethnic disparities. To do o we will identify a set of policy scenarios to structural inequities in the social and built environment, use the agent-based model to assess the impact the risk of T2DM inequities, estimate policy cost, and conduct cost effectiveness analyses. We will utilize APPLE NYC cohort t o validate the model. Our proposed study not only fills gaps in targeted research in the of T2DM, but also shifts the paradigm of post-GDM T2DM prevention to an ecosocia l framework. findings will be a key resource for policymakers on how to disrupt progression from GDM to T2DM and life course racial-ethnic inequities. a p . s

项目摘要 妊娠 和 生活 数据 基于人群 连锁 差异 非latina 出现 确认 多样性。 女性 生理学上。 潜在的 并发 这 造型 这 到 下一个， 进行 怀孕， 我们 结果 改变 在 这 预防 我们的 减少 糖尿病（GDM）是妊娠的常见并发症，具有实质性种族差异， 有色妇女面临最大的灾难。这些GDM差异对 2型糖尿病（T2DM）和心血管疾病的课程分布。最近我们进行了一本小说 纽约市出生证明与HBA1C注册表数据库之间的联系以构建多民族 从2009年至2019年分娩后跟随女性的队列，A1C怀孕和产后 用于股权（Apple）纽约人队列。在关注GDM的妇女时，我们发现了Stark种族族裔 在T2DM的发展中，黑色，拉丁裔和南亚妇女的风险是2至4.5倍的4.5倍 白人妇女。尽管有这些重要的发现，但对导致差异的原因知之甚少 GDM怀孕后的几年。当前的研究重点是个人风险；但是，它不是 邻里背景风险因素为政策干预的目标提供信息，缺乏种族种族 结构不平等和邻里环境在产后eRiod中可能尤其有可能 颜色经常面临社会和经济挑战，而他们的身体恢复并继续发展 确定政策杠杆以在关键产后时期干预“上游” 拆除驱动个体T2DM风险f参与者的结构不平等。因此，我们提出了一个 混合方法研究，利用我们的回顾性队列21,695名具有GDM的多民族女性 Apple NYC队列，对产后妇女的定性访谈以及创新的系统科学 方法。我们的总体目标是确定政策杠杆以防止GDM之后的进展 产后时期并减少种族分布。首先，我们将使用Apple NYC队列中的数据， 衡量GDM之后的社会和建筑环境与纵向T2DM结果之间的关联 我们将在GDM怀孕后的几年中探索有色女性的现场经历 对黑人，拉丁裔和南亚妇女的深入访谈，她们在期间经历了GDM 包括那些已经并且没有发展到T2DM的人，产后长达10年。最后， 将开发基于代理的模型来评估和比较潜在的政策干预措施以改善T2DM GDM之后并减少种族差异。要做o，我们将确定一组政策方案 社会和建筑环境中的结构不平等，使用基于代理的模型评估影响 T2DM不平等的风险，估计政策成本并进行成本有效性分析。我们将利用 Apple NYC队列验证该模型。我们提出的研究不仅填补了针对性研究的空白 T2DM的of，但也将预防后T2DM后的范式转移到了生态社会框架上。 调查结果将是政策制定者如何破坏从GDM到T2DM的关键资源，并且 生活课程种族不平等。 一个 p 。 s

项目成果

Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus.

• DOI: 10.1097/aog.0000000000005324
• 发表时间: 2023-10-01
• 期刊: Obstetrics and gynecology
• 影响因子: 7.2

Influence of Gestational Diabetes Mellitus on Diabetes Risk and Glycemic Control in a Retrospective Population-Based Cohort.

基于回顾性人群的妊娠期糖尿病对糖尿病风险和血糖控制的影响。

• DOI: 10.2337/dc22-1676
• 发表时间: 2023
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: McCarthy,KatharineJ;Liu,ShelleyH;Huynh,Mary;Kennedy,Joseph;Chan,HiuTai;Mayer,VictoriaL;Vieira,Luciana;Tabaei,Bahman;Howell,Frances;Lee,Alison;VanWye,Gretchen;Howell,ElizabethA;Janevic,Teresa
• 通讯作者: Janevic,Teresa