Precise Bone Density Reference Ranges to Reduce Systematic Disparities in Osteoporosis Healthcare for Hispanic Women

精确的骨密度参考范围可减少西班牙裔女性骨质疏松症医疗保健的系统性差异

基本信息

批准号：
10744719
负责人：
Qing Wu
金额：
$ 18.43万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-12-08 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10744719
关键词：
Address African American Aging Assessment tool Bone Density Calibration Caucasians Cessation of life Characteristics Classification Clinical Clinical Data Data Data Set Databases Diagnosis Diagnostic Errors Disparity Electronic Health Record Ethnic Origin Fracture Generations Goals Guidelines Healthcare Healthcare Systems Hispanic Hispanic Populations Individual Differences Knowledge Life Expectancy Methodology Methods Minority Minority Groups Modeling National Health and Nutrition Examination Survey Normal Range Osteoporosis Outcome Patients Performance Postmenopause Prevalence Prevention Public Health Race Reference Values Research Risk Risk Assessment Risk Management Running Sampling Scoring Method Specificity Statistical Models Systematic Bias Testing Validation Variant Woman Women&apos s Health bone clinical care clinical diagnosis cohort design disparity elimination epidemiology study ethnic health disparity ethnic minority fracture risk fragility fracture gradient boosting health care disparity health disparity improve minority health improved innovation large scale data novel osteoporosis with pathological fracture racial disparity racial minority random forest rapid growth screening statistics

项目摘要

Project Summary / Abstract Some Caucasian-based clinical guidelines have become the systematic underpinnings of racial and ethnic dis- parities in healthcare. A prime example is the T-score osteoporosis diagnosis criteria, which the WHO initially proposed only for postmenopausal Caucasian women in epidemiological research. However, the T-score diag- nosis criteria are currently used to help with osteoporosis diagnosis for all patients. The T-score approach defines the reference range (RR) of bone mineral density (BMD). Nonetheless, Caucasians-based RRs cannot account for normal variability in race/ethnicity. As a result, applying these Caucasian-based RRs to racial/ethnic minorities often causes errors in diagnosis and risk assessment. With a growing and increasingly diverse minority popula- tion in the US, Caucasian-based clinical guidelines run the risk of exacerbating racial and ethnic healthcare disparities. The existing RRs of BMD are incredibly controversial because many patients who sustain fragility fractures have a “normal” BMD as defined by the conventional T-score approach. This clinically utilized, Cauca- sian-based approach is flawed and, as such, causes systematic healthcare disparities. There is no empirical approach specifically designed to define the RRs of BMD for racial/ethnic minorities. Subsequent race/ethnicity- adjusted T-score thresholds remain controversial because they are not empirically validated, so consequently, their performance has been unsatisfactory on racial/ethnic minorities. Hispanic women have a similarly high fracture risk as Caucasian women; however, Hispanic women, as the most heterogeneous group, have a higher osteoporosis misclassification rate with the T-score diagnosis criteria. With the rapid growth of an increasingly diverse and aging Hispanic population, osteoporotic fractures in Hispanic women are rapidly becoming a signif- icant public health issue. Hence, this application aims to create precise RRs of BMD for Hispanic women to address this pressing issue. This application's central hypothesis is that new precise RRs will classify osteopo- rosis in Hispanic women more accurately than conventional thresholds. This hypothesis will be tested by pursu- ing three specific aims: 1) developing the best-performing model for normative BMD in Hispanic women; 2) determining the precise thresholds of BMD; and 3) evaluating the new RRs in Hispanic women. By replacing the conventional Caucasian-based threshold, the novel, precise RRs will fundamentally shift the current research and clinical care paradigm in RR from one fixed range for every patient to more precise thresholds that account for many individual differences. This application will leverage large samples of Hispanic women and innovative data-driven approaches in creating race/ethnicity-specific, precise RRs of BMD, thus systematically eliminating the corresponding root cause of healthcare disparities for Hispanic women. Of increased significance, the knowledge gained herein can be utilized to generate many other types of precise RRs for various minority groups. The new generation of RRs will directly contribute to improving minority health and reducing healthcare dispari- ties by eliminating such systematic bias in the healthcare system.

项目概要/摘要一些基于白种人的临床指南已成为种族和民族问题的系统基础。一个典型的例子是世界卫生组织最初采用的 T 评分骨质疏松症诊断标准。流行病学研究中仅建议针对绝经后白人女性。 T 评分方法目前用于帮助诊断所有患者的骨质疏松症。然而，基于白种人的 RR 无法解释骨矿物质密度 (BMD) 的参考范围 (RR)。因此，将这些基于白种人的 RR 应用于少数种族/族裔。随着少数民族人口的不断增长和日益多样化，经常会导致诊断和风险评估中的错误。在美国，基于白人的临床指南存在加剧种族和民族医疗保健的风险现有的 BMD RR 存在极大争议，因为许多患者都处于脆弱状态。骨折具有由传统 T 评分方法定义的“正常”BMD，这在临床上使用，Cauca-。基于 sian 的方法是有缺陷的，因此会导致系统性的医疗保健差异。不存在实证。专门设计用于定义少数种族/民族的 BMD RR 的方法。调整后的 T 分数阈值仍然存在争议，因为它们没有经过经验验证，因此，西班牙裔女性的表现也不尽如人意。与白人女性相比，西班牙裔女性的骨折风险更高；然而，西班牙裔女性作为异质性最强的群体，其骨折风险更高。骨质疏松症的误判率随着T-score诊断标准的快速增长而日益增多。随着西班牙裔人口的多样化和老龄化，西班牙裔女性的骨质疏松性骨折正迅速成为一个重要的问题。因此，该应用程序旨在为西班牙裔女性创建精确的 BMD RR。该应用程序的中心假设是新的精确 RR 将对骨质疏松症进行分类。西班牙裔女性的玫瑰色比传统阈值更准确，这一假设将通过追求来检验。制定三个具体目标：1) 开发西班牙裔女性规范 BMD 的最佳模型；2) 确定 BMD 的精确阈值；3) 评估西班牙裔女性的新 RR。传统的基于白人的阈值，新颖、精确的 RR 将从根本上改变当前的研究 RR 中的临床护理范式从每个患者的固定范围到更精确的阈值该应用程序将利用大量西班牙裔女性样本并进行创新。数据驱动的方法创建种族/民族特定的、精确的 BMD RR，从而系统地消除西班牙裔女性医疗保健差异的相应根本原因变得越来越重要。此处获得的知识可用于为各个少数群体生成许多其他类型的精确 RR。新一代 RR 将直接有助于改善少数族裔的健康并减少医疗保健差距通过消除医疗保健系统中的这种系统性偏见来建立联系。