Identifying disparities in air pollution-attributable cardiovascular health outcomes within a quasi-experimental framework

在准实验框架内确定空气污染导致的心血管健康结果的差异

• 批准号: 10722399
• 负责人: Andrea Titus
• 金额: $ 15.91万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722399
• 关键词: Address; Air Pollutants; Air Pollution; Area; Award; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Censuses; Cessation of life; Characteristics; Clinical; Complex; Data; Disease Outcome; Disparity; Disparity population; Economics; Educational workshop; Electronic Health Record; Encapsulated; Environment; Environmental Health; Epidemiologist; Ethnic Origin; Exposure to; Fostering; Goals; Health; Hospitalization; Incidence; Individual; Intervention; K-Series Research Career Programs; Light; Link; Literature; Machine Learning; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Neighborhoods; Outcome; Particulate Matter; Pathogenesis; Pattern; Policies; Pollution; Population; Predisposition; Procedures; Quasi-experiment; Race; Recording of previous events; Records; Research; Research Design; Residential Mobility; Residual state; Respiratory Disease; Rural; Sampling; Socioeconomic Status; Source; Stratification; Structure; Subgroup; Test Result; Testing; Training; United States; United States Department of Veterans Affairs; Urbanicity; Variant; Veterans; Wages; Work; ambient air pollution; cardiovascular disorder epidemiology; cardiovascular effects; cardiovascular health; career; cohort; disease disparity; evidence base; fine particles; flexibility; health disparity; long-standing disparities; low socioeconomic status; machine learning method; mortality; novel; secondary analysis; social; social epidemiology; socioeconomic diversity; statistical and machine learning; stem; symposium; tool; urban area

PROJECT SUMMARY/ABSTRACT Air pollution – including exposure to particulate matter (PM) – is a leading cause of morbidity and mortality in the United States and worldwide. However, existing research examining the cardiovascular health effects of PM2.5 exposure has several limitations, including residual confounding by correlated spatial and temporal characteristics, and limited or conflicting evidence regarding the extent to which associations between PM2.5 and health outcomes vary according to individual and neighborhood characteristics. Moreover, few national studies in the U.S. on the cardiovascular effects of PM2.5 have encapsulated a spectrum of health outcomes, ranging from changes in systolic blood pressure (SBP) to hospitalizations and mortality. Examining associations between air pollution and a continuum of cardiovascular disease (CVD) outcomes contributes to our understanding of causal mechanisms and sheds light on potential intervention opportunities. The goal of this K01 award is to address gaps in the literature while also supporting the candidate’s goal of transitioning to an independent scholar focused on identifying and addressing upstream environmental determinants of CVD disparities. Through formal coursework, workshops, mentored research, and attendance at scientific conferences, Dr. Titus will gain expertise in the pathogenesis of pollution-attributable CVD outcomes, and will pursue methodological training in causal inference, multi-level EHR-based analyses, and machine learning approaches. Building on Dr. Titus’s prior training as a social epidemiologist, these complementary training and research aims will allow Dr. Titus to elucidate complex, intersectional patterns of vulnerability to the health effects of air pollution and will provide her with a combination of methodological tools that can be flexibly applied to future research questions at the nexus of environmental health, cardiovascular epidemiology, and health disparities. The proposed research will leverage EHR data from a large, national cohort of U.S. veterans to examine associations between long-term PM2.5 exposure and CVD disparities within a novel quasi-experimental framework, exploiting individual-level changes in PM2.5 exposure based on residential mobility. The proposed aims 1) examine associations between PM2.5 and CVD-related outcomes (changes in SBP, hospitalizations and mortality) among all veterans, 2) use hypothesis-driven approaches to examine how associations vary according to socioeconomic status and urbanicity, and 3) use machine learning methods to explore intersectional patterns of PM2.5-attributable CVD outcomes based on individual and area-level characteristics. This work is in line with NHLBI’s strategic goals to elucidate drivers of population disparities in CVD and to pursue novel linkages of large-scale environmental and EHR data. By providing salary support, training, and a formal mentorship structure, this award will facilitate Dr. Titus’s transition to an independent career focused on the study of environmentally driven CVD disparities.

项目概要/摘要 空气污染——包括接触颗粒物（PM）——是导致人们发病和死亡的主要原因 然而，现有研究检查了美国和世界范围内的心血管健康影响。 PM2.5 暴露有几个局限性，包括相关空间和时间造成的残余混杂 PM2.5 之间的关联程度的证据有限或相互矛盾 而且，健康结果因个人和社区特征而异。 美国关于 PM2.5 对心血管影响的研究概括了一系列健康结果， 范围从收缩压（SBP）的变化到住院和死亡率。 空气污染与心血管疾病（CVD）结果之间的连续关联有助于 我们对因果机制的理解并揭示了潜在的干预机会。 K01 奖的目标是弥补文献中的空白，同时支持候选人的目标 转型为独立学者，专注于识别和解决上游环境问题 通过正式课程、研讨会、指导研究和出勤，了解 CVD 差异的决定因素。 在科学会议上，Titus 博士将获得有关污染所致 CVD 发病机制的专业知识 结果，并将进行因果推理、基于电子病历的多层次分析的方法培训，以及 基于 Titus 博士之前作为社会流行病学家的培训，这些方法。 互补的培训和研究目标将使泰特斯博士能够阐明复杂的、交叉的模式 容易受到空气污染对健康影响的影响，将为她提供一系列方法工具 可以灵活地应用于未来与环境健康、心血管等相关的研究问题 流行病学和健康差异。 拟议的研究将利用来自美国退伍军人的大型全国队列的电子病历数据来检查 新型准实验中长期 PM2.5 暴露与 CVD 差异之间的关联 框架，利用基于住宅流动性的个人水平 PM2.5 暴露变化。 目标 1) 检查 PM2.5 与 CVD 相关结果（收缩压变化、住院治疗）之间的关联 和死亡率）在所有退伍军人中，2）使用假设驱动的方法来检查关联如何变化 根据社会经济地位和城市化程度，3）使用机器学习方法探索 基于个人和地区特征的 PM2.5 归因的 CVD 结果的交叉模式。 这项工作符合 NHLBI 的战略目标，即阐明 CVD 人口差异的驱动因素，并 通过提供薪资支持、培训和培训，寻求大规模环境和电子病历数据的新颖联系。 正式的导师结构，该奖项将促进泰特斯博士过渡到专注于独立职业 环境驱动的 CVD 差异的研究。