Understanding drivers of incident hypertension disparities among US Hispanics of diverse backgrounds

了解不同背景的美国西班牙裔人群高血压发病率差异的驱动因素

• 批准号: 9804864
• 负责人: Tali Elfassy
• 金额: $ 12.9万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9804864
• 关键词: Acculturation; Admixture; African; Age; American; Automobile Driving; Behavior; Blood Pressure; Body mass index; Cardiovascular Diseases; Caribbean Hispanic; Caribbean region; Cause of Death; Central American; Clinical; Communities; Complex; Cuban; Data; Development; Diet; Dietary Sodium; Dominican; Educational workshop; English Language; Epidemiology; Etiology; Future; Generations; Genetic; Genetic Determinism; Goals; Guidelines; Health; Hispanic Community Health Study/Study of Latinos; Hispanics; Hypertension; Immigration; Intervention; Interviewer; Knowledge; Measures; Mentors; Methodology; Mexican; Mexican Americans; Modification; Participant; Physical activity; Population; Potassium; Predictive Factor; Prospective cohort; Proxy; Public Health; Puerto Rican; Race; Reading; Recording of previous events; Research; Research Personnel; Risk Factors; Sampling; Smoking; Socioeconomic Status; South American; Survey Methodology; Surveys; Techniques; Training; Training Activity; United States; Update; aged; blood pressure regulation; cardiovascular risk factor; cohort; design; feeding; follow-up; genetic epidemiology; health disparity; health goals; improved; models and simulation; population based; preference; symposium

PROJECT SUMMARY / ABSTRACT Hypertension, or elevated blood pressure is a leading risk factor for cardiovascular disease, the number one cause of death in the United States (US). Among US Hispanics, a fast growing, diverse group, anticipated to account for 29% of the US population by 2060, the epidemiology of hypertension remains inadequately described. Currently, there are notable hypertension disparities across Hispanic backgrounds, with higher rates of hypertension among US Hispanics from the Caribbean (Cubans, Dominicans, and Puerto Ricans) compared with non-Caribbean Hispanics (Mexicans, Central, and South Americans). Reasons underlying these disparities remain underexplored and unknown. The goal of this 4-year K01 project is to improve our knowledge of the epidemiology and etiology of hypertension disparities among US Hispanics, using data from a large population-based cohort of diverse US Hispanics. To do so, we determine whether key factors, that are known to vary by Hispanic background, such as: genetic admixture (as a proxy for race), acculturation, and modifiable health related factors, explain hypertension disparities across Hispanic backgrounds. This project involves analysis of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an on-going prospective cohort of 6,160 hypertension-free US Hispanics aged 18 to 74 at the baseline examination in 2008-2011 and re-examined at follow-up in 2014-2017. The HCHS/SOL cohort includes US Hispanics of Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American background residing in four communities across the US. In Aim 1, we will determine whether African admixture explains disparities in rates of hypertension between Caribbean and non-Caribbean Hispanics. In Aim 2 we will determine whether acculturation explains disparities in rates of hypertension between Caribbean and non-Caribbean Hispanics. In Aim 3, we will examine health related factors (e.g. diet, physical activity, smoking, and body mass index) as determinants of hypertension disparities and estimate the number of hypertension cases averted under simulated interventions that modify health related factors to recommended levels. The proposed analyses are embedded in a training and mentoring plan that will advance my training in: 1) genetics including admixture analysis, genetic epidemiology, and statistical genetics; 2) clinical aspects of hypertension and hypertension etiologies; 3) health disparities research; 4) complex survey methodology; and 5) casual inference techniques and simulation modeling for public health forecasting. My training plan will include formal courses, workshops, attendance at scholarly seminars and scientific conferences, directed readings and professional development activities specifically tailored to my training goals. Having the K01 support will provide the mentoring necessary to establish myself as an independent investigator and will result in preliminary data that will feed into a successful R01 application related to genetic determinants of blood pressure control among Hispanics.

项目概要/摘要 高血压或血压升高是心血管疾病的主要危险因素，是心血管疾病的第一大危险因素 美国 (US) 的死因。在美国西班牙裔中，一个快速增长的多元化群体预计将 到 2060 年，高血压患者占美国人口的 29%，但高血压的流行病学研究仍然不够充分 描述的。目前，西班牙裔背景之间的高血压差异显着，发病率较高 来自加勒比地区的美国西班牙裔（古巴人、多米尼加人和波多黎各人）的高血压发生率进行了比较 与非加勒比西班牙裔（墨西哥人、中美洲人和南美洲人）。这些背后的原因 差异仍未得到充分探讨和未知。这个为期 4 年的 K01 项目的目标是提高我们的 使用以下数据了解美国西班牙裔人群中高血压的流行病学和病因学差异 一个庞大的、以人口为基础的、多元化的美国西班牙裔群体。为此，我们确定关键因素是否是 已知因西班牙裔背景而异，例如：基因混合（作为种族的代表）、文化适应和 可改变的健康相关因素，解释了西班牙裔背景之间的高血压差异。这个项目 涉及对西班牙裔社区健康研究/拉丁裔研究 (HCHS/SOL) 的分析，这是一项正在进行的研究 6,160 名年龄在 18 岁至 74 岁之间、在基线检查时无高血压的美国西班牙裔人的前瞻性队列 2008-2011年进行，并于2014-2017年进行了后续复查。 HCHS/SOL 队列包括美国西班牙裔 中美洲、古巴、多米尼加、墨西哥、波多黎各和南美背景居住在四个地区 美国各地的社区。在目标 1 中，我们将确定非洲混合是否可以解释比率差异 加勒比和非加勒比西班牙裔之间的高血压。在目标 2 中，我们将确定是否 文化适应解释了加勒比和非加勒比西班牙裔之间高血压发病率的差异。在 目标 3，我们将检查健康相关因素（例如饮食、体力活动、吸烟和体重指数）： 高血压差异的决定因素并估计在以下情况下避免的高血压病例数 将健康相关因素修改至建议水平的模拟干预措施。拟议的分析是 嵌入培训和指导计划中，该计划将促进我在以下方面的培训：1）遗传学，包括混合 分析、遗传流行病学和统计遗传学； 2）高血压和高血压的临床方面 病因学； 3）健康差异研究； 4）复杂的调查方法； 5）随意推理技巧 和公共卫生预测的模拟模型。我的培训计划将包括正式课程、研讨会、 参加学术研讨会和科学会议、定向阅读和专业发展 专门针对我的训练目标量身定制的活动。获得 K01 支持将提供必要的指导 使我自己成为一名独立调查员，并将产生初步数据，这些数据将输入到 R01 的成功应用与西班牙裔血压控制的遗传决定因素有关。