Social and Environmental Determinants of Hypertension in Adolescents and Youth in Haiti

摘要：非传染性疾病的负担在低收入和中等收入国家显著增加， 低收入国家（LMIC）的发病率和死亡率受到严重影响。心血管疾病现在 艾滋病是海地成年人死亡的主要原因，在过去十年中已超过艾滋病毒。的初步数据 海地的研究表明，早发性高血压（HTN）在海地青少年中更为普遍， 年龄在18-29岁之间的年轻人比同样年龄的美国黑人要多。在这个年轻人中， 人口使他们走上其他共病的轨道，并最终限制他们的预期寿命， 对家庭和社区造成毁灭性后果。 关于HTN自然史的数据，包括这一年轻人群的潜在风险因素， 缺乏阐明海地青少年高血压的社会和环境决定因素， 青年将告知循证筛查计划和干预措施，以预防HTN和其他CVD风险 这些因素，最终防止了年轻人和中年人的过早死亡。调查结果将直接 适用于加勒比、非洲和美国其他有非洲裔人的城市地区。 我们建议在参加纵向研究的青少年和青年中研究HTN的自然史。 母代R 01的队列（R 01 HL 143788）。我建议的指导研究的具体目标是在 父母补助金的范围包括： 1.估计基于人群的前HTN患病率（收缩压（SBP）120-139或舒张压（SBP）120-139）。 高血压（SBP >140或DBP >90）和其他CVD危险因素及其 与18-29岁参与者的社会和环境决定因素的关联。 a.除了前HTN和HTN之外的心血管风险因素包括糖尿病、肥胖、 高胆固醇血症、肾脏疾病、不良饮食、吸烟、缺乏身体活动和血清 炎症的标志物 B.决定因素包括压力、社会孤立、抑郁、家庭支持、粮食不安全、铅 暴露和艾滋病毒感染。 2.确定前HTN（收缩压（SBP）120-139或舒张压）的发生率 (DBP)80-89）和HTN（SBP >140或DBP >90）以及其他CVD风险因素 在2年至3.5年的随访期间，他们与社会和环境决定因素的关系。 这项研究将为海地青少年中HTN的流行病学提供重要的见解。 我们的最终目标是将这项研究的新研究成果转化为务实的筛查干预措施， 预防海地年轻人和美国海地移民中的早发性HTN。

ABSTRACT: The burden of non-communicable diseases has grown significantly in low- and middle-income countries (LMICs) with devastating consequences on morbidity and mortality. Cardiovascular disease is now the leading cause of mortality in Haitian adults, having surpassed HIV in the last decade. Preliminary data from Haiti has shown early onset hypertension (HTN) is significantly more prevalent among Haitian adolescents and youth ages 18-29 years than in similarly aged black Americans. Earlier onset of hypertension in this younger population puts them on a trajectory for other co-morbidities and will ultimately limit their life expectancy with devastating consequences for families and communities. Data on the natural history of HTN including underlying risk factors in this young population is severely lacking. Elucidating the social and environmental determinants of hypertension among Haitian adolescents and youth will inform evidenced-based screening programs and interventions to prevent HTN and other CVD risk factors, ultimately preventing early death among young and middle-aged adults. Findings will be directly applicable to other urban areas with people of African descent in the Caribbean, Africa, and in the US. We propose to study the natural history of HTN among adolescents and youth enrolled in the longitudinal cohort of the parent R01 (R01 HL143788). The specific aims of my proposed mentored research are within the scope of the parent grant and include: 1. Estimate the population-based prevalence of pre-HTN (systolic blood pressure (SBP) 120-139 or diastolic blood pressure (DBP) 80-89) and HTN (SBP >140 or DBP >90) and other CVD risk factors and their association with social and environmental determinants in participants ages 18-29 years. a. Cardiovascular risk factors other than pre-HTN and HTN include diabetes, obesity, hypercholesterolemia, kidney disease, poor diet, cigarette smoking, physical inactivity, and serum markers of inflammation. b. Determinants include stress, social isolation, depression, family support, food insecurity, lead exposure, and HIV infection. 2. Determine the incidence of pre-HTN (systolic blood pressure (SBP) 120-139 or diastolic blood pressure (DBP) 80-89) and HTN (SBP >140 or DBP >90) and other CVD risk factors among participants ages 18-29 years during 2 to 3.5 years of follow-up and their association with social and environmental determinants. This study will provide important insights into the epidemiology of HTN among adolescents and youth in Haiti. Our ultimate goal is to translate new research findings from this study into pragmatic screening interventions to prevent early onset HTN in young people in Haiti and among Haitian immigrants in the US.