Multi-level Evaluation of Racial/ethnic Disparities in Liver Disease Outcomes

肝病结果中种族/民族差异的多层次评估

基本信息

批准号：
10606494
负责人：
FASIHA KANWAL
金额：
$ 59.67万
依托单位：
BAYLOR COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-03-18 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10606494
关键词：
Adherence Affect Alcohol consumption Alcohols Ascites Asian Pacific Islander Behavioral Biological Black Populations Black race Caring Cirrhosis Clinical Cohort Studies Collaborations Communities Compensation Computerized Medical Record Data Diabetes Mellitus Diagnosis Disease Disease Outcome Disparate Disparity Distal Economically Deprived Population Epidemiologist Ethnic Origin Etiology Evaluation Funding Genetic Health Health Personnel Health Services Health system Healthcare Healthcare Systems Hepatic Hepatic Encephalopathy Hepatitis B Virus Hepatitis C Hepatitis C virus Hispanic Hispanic Populations Hospitalization Hospitals Individual Inequality Intervention Liver Liver diseases Measures Mediating Mediation Medical Medical center Medicine Morbidity - disease rate National Institute on Minority Health and Health Disparities Not Hispanic or Latino Obesity Outcome Pathway interactions Patients Persons Physical environment Play Policies Population Heterogeneity Prevalence Prevention Primary carcinoma of the liver cells Prognosis Prospective Studies Provider Quality of Care Race Reporting Research Research Personnel Risk Behaviors Risk Factors Role Scientist Severity of illness Single Nucleotide Polymorphism Site Smoking Social support Socioeconomic Status Surveys System United States Department of Veterans Affairs Visit barrier to care biomedical referral center chronic liver disease clinical database cohort college community-level factor disparity reduction ethnic disparity ethnic minority experience genetic variant genomic data health disparity health literacy health outcome disparity implicit bias improved insight interest liver function low socioeconomic status medical specialties mortality participant enrollment patient subsets practice setting prognostic prospective racial determinant racial disparity racial minority safety net segregation social culture socioeconomic disadvantage socioeconomic disparity socioeconomics study population tertiary care transportation access

项目摘要

ABSTRACT Cirrhosis – the end-stage result of chronic liver disease – is a condition with high morbidity and mortality that is becoming increasingly common. Nearly half of all patients with cirrhosis develop hepatic decompensation including hepatocellular cancer (HCC), with frequent hospitalization within 5 years of cirrhosis diagnosis. Several studies show that these cirrhosis complications disproportionately affect racial/ethnic minorities and persons of low socioeconomic status (SES). But fundamental questions remain unanswered given that only few studies investigated the mechanisms that underlie these disparities. The research proposed here aims to provide actionable information on what to target to reduce cirrhosis prognosis disparities. We will conduct a comprehensive evaluation of multilevel factors hypothesized to play important roles in causing racial/ethnic and SES disparities in three key measures of cirrhosis prognosis: a) hepatic decompensation, including HCC, b) liver-related hospitalization, and c) overall survival. We propose a large, multicenter, racially and socio-economically diverse cohort study of cirrhosis patients enrolled from four healthcare systems; the project will combine information from existing clinical databases, genomic data, and geospatial analyses with patient- and clinician- surveys to provide unparalleled information about the role of individual, interpersonal, and community-level factors in the racial/ethnic and SES disparities in cirrhosis prognosis. The proposed cohort includes representative groups from all racial/ethnic (blacks, Hispanics, Asian-Pacific Islanders) and SES groups. It also spans the full spectrum of disease severity (from compensated to advanced decompensated disease), rather than focusing on a few groups. We will uncover the relative contributions of established (hepatitis C virus, hepatitis B virus) and emerging (obesity, diabetes) etiological risk factors as well as risk behaviors (alcohol use) to cirrhosis prognosis disparities. We will also characterize pathways that contribute to cirrhosis disparities among the high order determinants at the individual (e.g., medical mistrust), interpersonal (e.g., bias), and community (e.g., access to transportation) levels either directly or by affecting etiological or behavioral risk factors. Identification of these root cause mechanisms will identify actionable targets for intervention and policy change. We will also examine a set of genetic single nucleotide polymorphisms using stored sera in a subset of the cohort to understand the role of genetic differences, if any, in explaining racial/ethnic disparities.

抽象的肝硬化——慢性肝病的终末期结果——是一种发病率高且发病率高的疾病。近一半的肝硬化患者出现死亡现象。肝功能失代偿，包括肝细胞癌 (HCC)，经常住院肝硬化诊断后 5 年内，多项研究表明这些肝硬化并发症。不成比例的种族影响/少数民族和社会经济地位较低的人（SES）。但鉴于只有少数研究调查了这一点，基本问题仍然没有得到解答。这里提出的研究旨在提供这些差异背后的机制。关于减少肝硬化预后差异的目标的可行信息。对在发展中发挥重要作用的多层次因素进行综合评价在肝硬化预后的三个关键指标中造成种族/民族和社会经济地位差异：a) 肝功能失代偿，包括 HCC，b) 与肝脏相关的住院治疗，以及 c) 总生存期。我们提出一项大型、多中心、种族和社会经济多样化的队列研究该项目将整合来自四个医疗保健系统的肝硬化患者的信息；来自现有的临床数据库、基因组数据以及对患者和患者的地理空间分析临床医生 - 调查提供有关个人、人际、以及社区层面因素对肝硬化预后的种族/民族和社会经济地位差异的影响。拟议的队列包括来自所有种族/族裔的代表群体（黑人、西班牙裔、它也涵盖了所有疾病严重程度。（从代偿性疾病到晚期失代偿性疾病），而不是专注于少数疾病我们将揭示已建立的（丙型肝炎病毒、乙型肝炎病毒）的相对贡献。病毒）和新出现的（肥胖、糖尿病）病因学危险因素以及危险行为（酒精我们还将描述导致肝硬化预后差异的途径。个体的高级决定因素之间的肝硬化差异（例如，医疗不信任），人际（例如，偏见）和社区（例如，获得交通）水平直接或通过影响行为学或行为风险因素识别这些根本原因机制。我们将确定干预和政策变化的可行目标。使用队列子集中储存的血清进行遗传单核苷酸多态性了解遗传差异（如果有）在解释种族/民族差异方面的作用。