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（由首席调查员提供）：2型糖尿病（T2DM）苦苦挣扎约2100万美国成年人，年薪超过1320亿美元。 T2DM的负担不成比例，由美国少数民族人口承担。黑人和西班牙裔美国人的T2DM患病率更高，疾病控制较差，并且T2DM并发症的患病率与白色同行的患病率更高。当地环境缺点的融合，缺乏足够的医疗保健，行为风险因素以及其他影响可能会以协同的方式导致这些增加的负担。该申请对NIH计划公告PA-07-027（“ NIDDK疾病中的健康差异”）响应，通过调查“上游”的“前沿”，导致T2DM风险中“下游”差异的前述因素。它特别旨在衡量多级社会，环境，行为和生物生理因素对种族和种族异质性在糖尿病前期患病率中的相对贡献。糖尿病前期将被定义为空腹葡萄糖受损或代谢综合征的患病率。该项目将从一个独特且新的基于人群的队列中获得3000名受试者的数据 - NIDDK支持波士顿地区社区健康（BACH）样本（DK 56842；首席研究员：John McKinlay，PhD）。因此，它将为我们以前的工作获得这一大型，随机选择和代表人群的成本效益利用。 Bach队列 - 5,506个社区 - 住宅受试者 - 在社会人口统计学上多样化，包括2,301名男性和3,205名女性（1,780个黑人，1,858名西班牙裔和1,868个白人），遍布广泛的年龄范围（30-79岁）。该队列的整体健康状况，当前生活环境以及计划研究所需的医疗保健方面的差异很大。重要的是，使用该样本将允许研究通常在临床环境中未观察到的受试者中的健康和疾病。广泛的初步研究支持这项工作的可行性。上游对糖尿病前期的关注是一个独特的机会，可以检查多层次的贡献者对T2DM诊断过时的健康差异的影响，而目标干预措施可能会在防止过渡到T2DM的过渡方面产生巨大影响。多层次贡献者的衡量是出于在社会和环境水平（健康的公共政策和社区行动）或行为和生物生理水平（初级和二级预防）（主要和二级预防）方面的潜力（健康和环境层面）的潜力。多层次的跨学科方法基于现有文献，并允许对不同因素的独立和相对贡献进行平衡估计。在每个层面上纳入合理的措施将有助于在其社会和环境环境中了解疾病途径，从而增加临床提供者和政策制定者的武器库，并增强其预防和治疗T2DM的能力。公共卫生相关性：该项目将获取3000名受试者的数据，一个样本，通过性别和种族/民族（黑人，西班牙裔和白人和女人）的样本，以了解黑人和西班牙裔美国人中的2型糖尿病在白人同胞中更为普遍，更严重，更严重。为此，研究团队将检查经常在诊断糖尿病之前发生的生理影响和健康状况，以确定它们在种族和种族之间是否有所不同，如果是的，则是什么解释性因素（例如环境，家族史或社会经济状况）有助于这些差异。如果成功，该项目将确定可以减少易受伤害人群中观察到的2型糖尿病的过量风险的方法。