The Syndemic of Sepsis, Multimorbidity, Aging, and Low Healthcare Access and Quality in the United States

美国脓毒症、多发病、老龄化以及医疗保健获取和质量低下的综合现象

• 批准号: 10597983
• 负责人: Kristina Elizabeth Rudd
• 金额: $ 18.34万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597983
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Adult; Age; Aging; Award; Biological; Caring; Censuses; Cessation of life; Chronic; Communities; Community Services; Complex; Cost Control; County; Data; Data Sources; Diabetes Mellitus; Disease; Elderly; Electronic Health Record; Epidemiologic Methods; Epidemiology; Family; Functional disorder; Geography; Goals; Health; Health Care Costs; Health Policy; Health Professional; Health Services; Health system; Hospitalization; Immune response; Incidence; Individual; Infection; Knowledge; Life; Link; Location; Malignant Neoplasms; Mentors; Modeling; Organ; Patients; Pattern; Pennsylvania; Persons; Play; Population; Poverty; Prevention; Public Health; Recording of previous events; Research; Research Personnel; Research Training; Risk; Risk Factors; Role; Scientific Advances and Accomplishments; Sepsis; Social Conditions; Social Environment; Subgroup; Substance abuse problem; Syndrome; Techniques; Testing; Time; United States; Universities; Vaccination; Violence; Work; acute infection; career; community engaged research; community-level factor; driving force; epidemiological model; global health; health care availability; health disparity; high risk; improved; insight; model building; mortality; multilevel analysis; multiple chronic conditions; profiles in patients; response; septic patients; social; syndemic; theories

PROJECT SUMMARY Sepsis is a major global health problem – my previous work has estimated that there were nearly 50 million cases and 11 million associated deaths worldwide in 2017, representing 20% of all deaths that year. While sepsis is a public health challenge in nearly every location in world, there is strong evidence that certain subgroups are at far higher risk than others, with higher incidence among older adults, people with multimorbidity, and those in communities with lower healthcare access and quality. In the United States (US), these risk factors are closely linked and geographically clustered. My overall objective in this proposal is to improve understanding of the factors influencing individual sepsis risk, accounting for community- level features and personal health history over time, to establish critical new insights into sepsis prevention. My central hypothesis is that there is a syndemic of sepsis, multimorbidity, aging, and low healthcare access and quality in the US that is spatially patterned. Syndemics, population-level clustering of social and health problems in which the clustering results in adverse disease interaction, provide a “framework of disease-disease and social condition-disease interactions” that can improve understanding of health conditions within a specific population. To test my hypothesis I will leverage, and spatially link for the first time, multiple unique data sources including individual electronic health records, Census data, community data sources, and statewide health systems data. I will combine these data sources through a community-informed model, building upon the Framework for Reconstructing Epidemiological Dynamics (FRED) agent-based modeling platform. Using the syndemic framework, I will test my central hypothesis via three specific aims: 1) evaluate spatial, social, and health systems-based patterns of incident sepsis hospitalizations among adults in Allegheny County, Pennsylvania over an 8-year period using multilevel models that geographically link electronic health records, Census data, and community data sources at the ZIP code level, 2) apply a syndemic framework within the FRED agent-based modeling platform to test the mechanisms that underlie the relationships between patient-level features of aging and multimorbidity, community factors, and health system access and quality, that impact individual risk for incident sepsis, and 3) use community-engaged model building with sepsis patients, families, and healthcare professionals to refine the sepsis, aging, multimorbidity, and healthcare access and quality syndemic model. The proposed work will greatly impact US public health policy, sepsis prevention efforts, and care for older adults with chronic conditions. Closely mentored by experts in sepsis and quantitative modeling of social contextual features of health, this award will provide essential research training in advanced epidemiologic methods, including multilevel modeling, agent-based modeling, and community-engaged research. This award will support my overall career goal of becoming an independent investigator focused on reducing the global burden of sepsis, with a strong focus on health disparities.

项目概要 脓毒症是一个重大的全球健康问题——我之前的工作估计有近 5000 万人 2017 年，全球有 1100 万例相关死亡病例，占当年总死亡人数的 20%。 脓毒症在世界上几乎每个地方都是一个公共卫生挑战，有强有力的证据表明某些 亚组的风险远高于其他亚组，其中老年人、患有糖尿病的人的发病率更高 在美国 (US)，多发病以及医疗保健机会和质量较低的社区中的人群。 这些风险因素紧密相连，并且在地理上集中。我在本提案中的总体目标是： 提高对影响个人脓毒症风险的因素的理解，考虑到社区 随着时间的推移，水平特征和个人健康史，以建立对败血症的重要新见解 我的中心假设是存在脓毒症、多发病、衰老和低下综合症。 美国的医疗保健获取和质量具有空间模式、人口水平的聚集。 聚类导致不良疾病相互作用的社会和健康问题提供了一个“框架” 疾病与疾病以及社会条件与疾病相互作用的研究”，可以提高对健康的了解 为了检验我的假设，我将首次利用空间链接， 多个独特的数据源，包括个人电子健康记录、人口普查数据、社区数据 我将通过社区知情的方式整合这些数据源。 模型，建立在基于代理的流行病学动态重建框架 (FRED) 的基础上 使用综合症框架，我将通过三个具体目标来测试我的中心假设：1） 评估成人败血症住院事件的空间、社会和卫生系统模式 宾夕法尼亚州阿勒格尼县在 8 年时间内使用地理上连接的多级模型 邮政编码级别的电子健康记录、人口普查数据和社区数据源，2) 应用 FRED 基于代理的建模平台中的综合症框架，用于测试潜在的机制 患者层面的老龄化和多发病特征、社区因素和卫生系统之间的关系 访问和质量，影响败血症事件的个人风险，以及 3) 使用社区参与模型 与脓毒症患者、家庭和医疗保健专业人员一起改善脓毒症、老龄化、多发病、 拟议的工作将极大地影响美国公共卫生。 政策、脓毒症预防工作以及对患有慢性病的老年人的护理由专家密切指导。 在脓毒症和健康社会背景特征的定量建模中，该奖项将提供必要的 高级流行病学方法的研究培训，包括多层次建模、基于主体的建模、 该奖项将支持我成为独立人士的总体职业目标。 研究人员致力于减少败血症的全球负担，特别关注健康差异。