Reasons for Racial Disparities in Venous Thromboembolism

静脉血栓栓塞症种族差异的原因

• 批准号: 7814160
• 负责人: Neil Adrian Zakai
• 金额: $ 50万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7814160
• 关键词: Accounting; Address; African American; American; Ancillary Study; Area; Atherosclerosis; Biological Markers; Blood; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Clinical; Clinical Research; Cognitive; Cohort Studies; Communities; Data; Data Set; Deep Vein Thrombosis; Diabetes Mellitus; Diet; Dietary Factors; Economics; Epidemiologic Studies; Etiology; European; Event; Factor VIII; Funding; Future; Genetic; Grant; Head; Health; Health Policy; Hematologist; High Prevalence; Hospitalization; Impaired cognition; Incidence; Individual; Intervention; Investigation; Kidney Diseases; Laboratories; Lead; Measures; Mediating; Medical; Medical History; Medical Records; Minnesota; Myocardial Infarction; National Heart, Lung, and Blood Institute; Nutrition Assessment; Obesity; Operative Surgical Procedures; Outcome; Participant; Patient Self-Report; Physical activity; Prevalence; Preventive Medicine; Principal Investigator; Public Health; Pulmonary Embolism; Reasons for Geographic And Racial Differences in Stroke; Research; Risk; Risk Factors; Site; Socioeconomic Status; Stroke; Surgeon; Thromboembolism; United States; Universities; Urine; Venous; Venous Thrombosis; Vermont; Work; abstracting; cancer surgery; cognitive function; cohort; follow-up; genetic risk factor; low socioeconomic status; novel; nutrition; prevent; prospective; racial difference; repository; research study; von Willebrand Factor

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (4) Clinical Research and specific Challenge Topic, 04-HL- 104: Perform secondary analyses of existing data to answer important clinical and preventive medicine research questions. According to the Surgeon General's 2008 Call to Action to Prevent Deep Venous Thrombosis and Pulmonary Embolism, over 300,000 Americans each year suffer from venous thromboembolism (VTE), with potentially over 100,000 fatalities per year. VTE is approximately 1.5-fold more common in African-Americans as compared to European-Americans; the reasons for this disparity being unclear. The greatest difficulty in studying the reasons for this disparity in incidence is due in great part to a paucity of African-Americans in research studies of VTE to date, especially where risk factors are measured before the VTE event. The purpose of this Challenge Grant is to ascertain and validate venous thromboembolism (VTE) events in the REasons for Geographic and Racial Differences in Stroke Study (REGARDS), a prospective national cohort study investigating geographic and racial disparities in stroke incidence and risk-factors in the United States and combine the data with the Longitudinal Investigation of Thromboembolism Etiology (LITE) in order to obtain a prospective cohort study with sufficient VTE events among African-Americans and European- Americans to evaluate racial disparities in VTE incidence in the United States. The LITE study is a prospective cohort study of 21,680 individuals from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study with 726 VTE events (though only 224 among African-Americans). The resulting harmonized cohort combining both LITE and REGARDS will consist of 51,848 individuals, of whom 17,713 are African-Americans. We anticipate a combined total 1,292 incident VTE, 492 of which will be among African-Americans. Each of these cohorts (REGARDS, CHS, ARIC) has extensive baseline demographic, anthropometric, socio- economic, and medical history recorded, a baseline stored blood and urine repository, as well as follow-up events information including cardiovascular diseases, hospitalizations, and death. Risk factors were measured and validated rather than self-reported in each cohort. By accomplishing our specific aims, we will be able to evaluate the risk factors which mediate the racial difference in VTE incidence seen in the United States. This project offers not only the opportunity to evaluate traditional risk factors for VTE, such as cancer, surgery, obesity, and medical conditions, but the opportunity to study novel risk factors such as nutrition, physical activity, and cognitive function. Results will lead to a follow- up proposal to obtain funding to evaluate novel biomarkers of VTE risk such as factor VIII, von Willebrand factor levels, and genetic factors in African-Americans versus European-Americans. By understanding the reasons for the racial disparity in VTE incidence, we will be able to propose interventions or further studies to address reducing this disparity. The team assembled for this project is uniquely suited to do this research. Dr. N. Zakai (the Principal Investigator for this Grant) is a hematologist and has worked on the LITE study and on investigating racial disparities in the REGARDS study. Dr. M. Cushman, a hematologist, is the site PI for the LITE study and the REGARDS central laboratory at the University of Vermont. Dr. A. Folsom is the overall PI of LITE at the University of Minnesota. For REGARDS, Dr. G. Howard, a biostatistician, is the overall PI of REGARDS and an expert in racial disparities. Dr. L. McClure is the lead biostatistician for REGARDS and very familiar with the cohort. Dr. S. Judd is an expert on nutritional assessment in cohort studies, and Dr. V. Wadley is an expert on cognitive assessment. Dr. M. Safford is head of the clinical outcomes unit in REGARDS and PI of the NHLBI- funded REGARDS ancillary study assessing racial disparities in myocardial infarction. African-Americans have an approximately 30% to 60% increased incidence of venous thromboembolism (VTE) for unknown reasons. The main limitation to studying this disparity is the paucity of African-Americans in most large-scale epidemiological studies. The purpose of this Challenge Grant is to ascertain and validate VTE events in the REasons for Geographic and Racial Differences in Stroke Study (REGARDS), a prospective national cohort study investigating geographic and racial disparities in stroke incidence and risk-factors in the United States and combine the data with the Longitudinal Investigation of Thromboembolism Etiology (LITE) in order to obtain a prospective cohort study with sufficient VTE events among African-Americans and European-Americans to evaluate racial disparities in VTE in the United States. Though understanding the reasons for this disparity we can begin to formulate public health policies to address this disparity.

描述（由申请人提供）：此申请涉及广泛的挑战领域（4）临床研究和特定挑战主题，04-HL-104：对现有数据进行次要分析，以回答重要的临床和预防医学研究问题。根据外科医生2008年的行动呼吁，以防止深静脉血栓形成和肺栓塞，每年超过30万美国人患有静脉血栓栓塞（VTE），每年可能超过100,000人死亡。与欧美人相比，在非裔美国人中，VTE在非裔美国人中的常见约1.5倍。这种差异的原因不清楚。研究发生这种差异的原因最大的困难在很大程度上是由于非裔美国人在迄今为止的VTE研究中很少，尤其是在VTE事件之前测量风险因素的情况下。 The purpose of this Challenge Grant is to ascertain and validate venous thromboembolism (VTE) events in the REasons for Geographic and Racial Differences in Stroke Study (REGARDS), a prospective national cohort study investigating geographic and racial disparities in stroke incidence and risk-factors in the United States and combine the data with the Longitudinal Investigation of Thromboembolism Etiology (LITE) in order to obtain a prospective cohort study with非裔美国人和欧洲人之间的足够VTE事件评估美国VTE发病率的种族差异。 LITE研究是一项对来自心血管健康研究（CHS）的21,680名个人的前瞻性队列研究和社区中的动脉粥样硬化风险（ARIC）研究，其中726个VTE事件（尽管非裔美国人中只有224个）。结合精简版和判决的统一队列将由51,848个人组成，其中17,713名是非裔美国人。我们预计总共有1,292起事件VTE，其中492名将在非裔美国人中。这些队列中的每一个都有广泛的基线人口统计，人体测量学，社会经济和病史记录，基线存储的血液和尿液存储库以及包括心血管疾病，住院和死亡的后续事件信息。测量和验证危险因素，而不是在每个队列中自我报告。通过实现我们的特定目标，我们将能够评估介导美国VTE发病率的种族差异的危险因素。该项目不仅提供了评估VTE传统危险因素的机会，例如癌症，手术，肥胖和医疗状况，而且有机会研究新颖的危险因素，例如营养，体育锻炼和认知功能。结果将导致一项后续提案，以获得资金来评估VTE风险的新生物标志物，例如VIII因子VIII，Von Willebrand因子水平和非裔美国人与欧洲裔美国人的遗传因素。通过了解VTE发病率的种族差异的原因，我们将能够提出干预措施或进一步研究以解决这种差异。为该项目组装的团队非常适合进行这项研究。 N. Zakai博士（该赠款的主要研究者）是一名血液学家，曾从事LITE研究并研究了研究研究中的种族差异。血液学家M. Cushman博士是Lite研究的现场PI和佛蒙特大学的中央实验室。 A. Folsom博士是明尼苏达大学Lite的整体PI。对于生物统计学家G. Howard博士是总体上，是种族差异的整体。 L. McClure博士是有关该研究的主要生物统计学家。 S. Judd博士是队列研究中营养评估的专家，V。Wadley博士是认知评估的专家。 M. Safford博士是NHLBI资助的辅助研究的临床结果单位负责人，评估了心肌梗塞种族差异的辅助研究。由于未知原因，非裔美国人的静脉血栓栓塞（VTE）大约增加了30％至60％。研究这种差异的主要局限性是在大多数大型流行病学研究中，非裔美国人的稀少。这项挑战补助金的目的是通过中风研究的地理和种族差异的原因来确定和验证VTE事件，这是一项前瞻性的民族同类研究研究，研究了美国中风和种族歧视的地理和种族差异，在美国，在美国的中风和风险因素中的地理和种族差异，并将数据与纵向研究中的研究中的纵向研究相结合，以使依据（LITE）的依据（LITE）在依据中，以便在依据的情况下进行研究非裔美国人和欧洲裔美国人评估美国VTE的种族差异。尽管了解这种差异的原因，我们可以开始制定公共卫生政策来解决这一差异。