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

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.

项目概要/摘要 尽管心血管疾病（CVD）的预防和治疗取得了进展，但财政限制仍然存在 促使联邦和州决策者在相互竞争的政策决策中做出艰难的选择，通常 没有有效性证据。比较有效性方法，或在缺乏实验的情况下 数据，一种比较评估方法，用于比较修改暴露的估计影响 使用观察数据可以为优先级设定过程提供重要信息。我们和其他人已经证明 社会决定因素、收入不平等和社会资本/凝聚力等上游社会因素 包括 CVD 在内的疾病的关键预测因素。然而重要的问题仍然是哪些社会决定因素 对 CVD 负担影响最大。此外，我们缺乏关于哪些亚群和哪些亚群的知识。 各州受影响最严重。尽管呼吁进行比较评估/改善策略的有效性 人口健康和预防 CVD，包括来自 NIH 的信息，我们仍然缺乏对相对 CVD 负担的了解 以及与修改这些因素相关的经济影响。鉴于这些信息，存在迫切需求 准确估计社会决定因素对CVD风险的影响；将这些估计转化为政策 制定工具，包括对 CVD 负担和成本的影响；并比较和对比成本和规模 这些影响。我们的总体目标是提供第一个比较评估证据基础 比较改变中年人和中年人关键社会决定因素的心血管疾病负担和经济影响 年长的美国人。我们将通过使用数据实现以下具体目标来实现我们的总体目标 来自两个具有全国代表性的中年人和老年人的大型样本，国家纵向 1979 年青年调查 (NLSY) 和健康与退休研究 (HRS)，与社会和经济相关 按居住地区以及医疗保险索赔和死亡率数据库采取的措施：目标#1) 确定 哪些社会决定因素最有力地预测 CVD 发病率、死亡率和危险因素的风险 中老年人；目标#2) 确定哪些亚群和地理状态是 最容易受到CVD负担和危险因素社会决定因素的影响；和目标#3） 确定哪些社会决定因素如果修改的话预计会产生最大程度的减少 CVD 负担及其相关成本，包括总体负担和亚人群负担。关于结果，我们的 3- 年的研究预计将确定最有希望的社会决定因素，对其进行干预以产生成果 改善成人心血管疾病负担。我们将进一步确定脆弱性如何受到地理和环境影响 亚人群可以解释 CVD 差异。通过将我们的估计转化为人口健康和经济 措施，我们将直接响应对CVD进行比较评估和经济评估的呼吁 预防研究。从长远来看，我们预计我们的项目将通过以下方式产生巨大的转化影响： 指导政策制定者做出基于证据的决策，以减少心血管疾病负担和不平等。