Upstream Contributors to Downstream Disparities in Type 2 Diabetes

2 型糖尿病下游差异的上游贡献者

• 批准号: 8135214
• 负责人: John B McKinlay
• 金额: $ 76.95万
• 依托单位: NEW ENGLAND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8135214
• 关键词: Accounting; Address; Adult; African American; Age; Area; Behavior; Behavioral; Boston; Central obesity; Characteristics; Clinical; Communities; Community Actions; Community Health; Data; Data Analyses; Diabetes Mellitus; Diagnosis; Disadvantaged; Disease; Disease Pathway; Doctor of Philosophy; Dyslipidemias; Environment; Equilibrium; Ethnic Origin; Exhibits; Family; Family history of; Gender; Health; Health Policy; Health Services Accessibility; Health Status; Health Surveys; Health behavior; Healthcare; Healthcare Systems; Heterogeneity; High Prevalence; Hispanic Americans; Hispanics; Hypertension; Impaired fasting glycaemia; Individual; Intervention; Life; Literature; Measurement; Measures; Metabolic syndrome; Minority; NIH Program Announcements; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Pathway interactions; Patients; Persons; Physical activity; Physiological; Policy Maker; Population; Population Heterogeneity; Poverty Areas; Prediabetes syndrome; Prevalence; Primary Prevention; Principal Investigator; Process; Provider; Public Policy; Race; Recording of previous events; Relative (related person); Research; Risk; Risk Factors; Role; Sampling; Secondary Prevention; Severities; Societies; Socioeconomic Status; Structure; United States; United States National Institutes of Health; Variant; Vulnerable Populations; Woman; Work; cohort; cost; cost effective; disorder control; health disparity; health literacy; interdisciplinary approach; member; men; minority subjects; physical conditioning; population based; prevent; public health relevance; racial and ethnic; racial and ethnic disparities; racial/ethnic difference; sex; social

DESCRIPTION (provided by principal investigator): Type 2 diabetes mellitus (T2DM) afflicts some 21 million US adults, with annual attributable costs exceeding $132 billion. A disproportionate burden of T2DM is borne by US minority populations. Black and Hispanic Americans have higher prevalence of T2DM, achieve poorer disease control, and have greater prevalence of T2DM complications than do their white counterparts. The confluence of local environmental disadvantages, lack of access to adequate health care, behavioral risk factors, and other influences likely contribute to these increased burdens in a synergistic fashion. This application responds to NIH program announcement PA-07-027 ("Health Disparities in NIDDK Diseases") by investigating "upstream," antecedent factors contributing to "downstream" disparities in T2DM risk. It is specifically intended to measure the relative contributions of multilevel social, environmental, behavioral, and biophysiologic factors to racial and ethnic heterogeneity in the prevalence of prediabetes. Prediabetes will be defined either as impaired fasting glucose, or the prevalence of the metabolic syndrome. This project will obtain data on 3000 subjects from a unique and newly available population-based cohort - the NIDDK supported Boston Area Community Health (BACH) sample (DK 56842; principal investigator: John McKinlay, PhD). It will therefore cost-effectively capitalize on our previous work in obtaining this large, randomly-chosen, and representative population. The BACH cohort - 5,506 community- dwelling subjects - is socio-demographically diverse, consisting of 2,301 men and 3,205 women (1,780 black, 1,858 Hispanic, and 1,868 white) across a broad age-range (30-79 years). This cohort exhibits the wide variability in overall health status, current life circumstances and access to health care that is required for the planned study. Importantly, use of this sample will permit the study of health and disease among subjects who typically go unobserved in a clinical setting. Extensive preliminary studies support the feasibility of this effort. The upstream focus on prediabetes represents a unique opportunity to examine the influence of the multilevel contributors to health differences antecedent to T2DM diagnosis, when targeted interventions might achieve tremendous impact in preventing transition to T2DM. The measurement of multilevel contributors is motivated by their potential to inform such interventions, either at the social and the environmental levels (healthy public policy and community action), or the behavioral and biophysiologic levels (primary and secondary prevention). The multi-level, interdisciplinary approach builds upon existing literature and permits balanced estimation of the independent and relative contribution of different factors. The inclusion of well justified measures at each level will facilitate understanding of disease pathways within their social and environmental contexts, thus adding to the armamentarium of both clinical providers and policy makers, and enhancing their ability to prevent and treat T2DM. PUBLIC HEALTH RELEVANCE: This project will obtain data on 3000 subjects, a sample equally divided by gender and race/ethnicity (black, Hispanic, and white men and women), in order to understand the reasons that among black and Hispanic Americans, type 2 diabetes is more common, and more severe, than among their white compatriots. To do so, the study team will examine physiologic influences and health conditions that often occur before diabetes is diagnosed, to determine if they are different across race and ethnicity, and if so, what explanatory factors (such as environment, family history, or socioeconomic status) contribute to those differences. If successful, this project will identify ways that the excess risk of type 2 diabetes observed among vulnerable populations can be reduced.

描述（由首席研究员提供）：2 型糖尿病 (T2DM) 困扰着约 2100 万美国成年人，每年造成的费用超过 1320 亿美元。美国少数族裔承担了不成比例的 T2DM 负担。与白人相比，黑人和西班牙裔美国人的 T2DM 患病率更高，疾病控制效果更差，并且 T2DM 并发症的患病率更高。当地环境劣势、缺乏足够的医疗保健、行为风险因素和其他影响因素的综合作用可能会以协同方式导致这些负担的增加。此应用程序通过调查导致 T2DM 风险“下游”差异的“上游”先行因素，响应 NIH 计划公告 PA-07-027（“NIDDK 疾病的健康差异”）。它的具体目的是衡量多层次的社会、环境、行为和生物生理因素对糖尿病前期患病率的种族和民族异质性的相对贡献。糖尿病前期将被定义为空腹血糖受损或代谢综合征的患病率。该项目将从一个独特且新近的基于人群的队列中获取 3000 名受试者的数据 - NIDDK 支持的波士顿地区社区健康 (BACH) 样本（DK 56842；首席研究员：John McKinlay 博士）。因此，它将经济高效地利用我们之前的工作来获得这一庞大的、随机选择的、有代表性的群体。 BACH 队列——5,506 名社区居民——在社会人口统计学上具有多样性，包括 2,301 名男性和 3,205 名女性（1,780 名黑人、1,858 名西班牙裔和 1,868 名白人），年龄范围广泛（30-79 岁）。该队列在整体健康状况、当前生活状况以及获得计划研究所需的医疗保健方面表现出很大的差异。重要的是，使用该样本将允许研究通常在临床环境中未被观察到的受试者的健康和疾病。广泛的初步研究支持了这一努力的可行性。上游对糖尿病前期的关注提供了一个独特的机会，可以在 T2DM 诊断之前检查多层次因素对健康差异的影响，此时有针对性的干预措施可能会对预防向 T2DM 的转变产生巨大影响。对多层次贡献者的衡量是由于他们在社会和环境层面（健康的公共政策和社区行动）或行为和生物生理层面（一级和二级预防）为此类干预措施提供信息的潜力。多层次、跨学科的方法建立在现有文献的基础上，可以平衡地估计不同因素的独立和相对贡献。在每个层面纳入合理的措施将有助于了解其社会和环境背景下的疾病途径，从而丰富临床提供者和政策制定者的武器库，并提高他们预防和治疗 T2DM 的能力。公共健康相关性：该项目将获取 3000 名受试者的数据，样本按性别和种族/族裔（黑人、西班牙裔和白人男性和女性）平均划分，以了解黑人和西班牙裔美国人中 2 型与白人同胞相比，糖尿病更为常见，也更为严重。为此，研究小组将检查在诊断糖尿病之前经常发生的生理影响和健康状况，以确定这些影响和健康状况是否在种族和民族之间存在差异，如果有的话，有哪些解释因素（例如环境、家族史或社会经济状况）地位）造成了这些差异。如果成功，该项目将找出降低弱势群体患 2 型糖尿病的过高风险的方法。