Multi-level Evaluation of Racial/ethnic Disparities in Liver Disease Outcomes

肝病结果中种族/民族差异的多层次评估

• 批准号: 10374004
• 负责人: FASIHA KANWAL
• 金额: $ 54.58万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-18 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10374004
• 关键词: Affect; Alcohol consumption; Alcohols; Ascites; Asian Pacific Islander; Behavioral; Biological; Black Populations; Black race; Caring; Cirrhosis; Clinical; Cohort Studies; Collaborations; Communities; Computerized Medical Record; Data; Diabetes Mellitus; Diagnosis; Disease; Disease Outcome; Distal; Enrollment; Epidemiologist; Ethnic Origin; Etiology; Evaluation; Funding; Genetic; Health; Health Personnel; Health Services; Health system; Healthcare; Healthcare Systems; Hepatic; Hepatic Encephalopathy; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Hispanic; Hispanic Populations; Hospitalization; Hospitals; Individual; Inequality; Institutes; Intervention; Liver; Liver diseases; Measures; Mediating; Mediation; Medical; Medical center; Medicine; Morbidity - disease rate; Not Hispanic or Latino; Obesity; Outcome; Pathway interactions; Patients; Physical environment; Plant Roots; Play; Policies; Population Heterogeneity; Prevalence; Prevention; Primary carcinoma of the liver cells; Prognosis; Prospective Studies; Provider; Quality of Care; Race; Reporting; Research; Research Personnel; Risk Behaviors; Risk Factors; Role; Scientist; Severity of illness; Single Nucleotide Polymorphism; Site; Smoking; Social support; Socioeconomic Status; Surveys; System; United States Department of Veterans Affairs; Visit; barrier to care; behavioral adherence; biomedical referral center; chronic liver disease; clinical database; cohort; college; community-level factor; disadvantaged population; disparity reduction; ethnic minority; ethnic minority population; experience; genetic variant; genomic data; health disparity; health literacy; health outcome disparity; implicit bias; improved; insight; interest; liver function; low socioeconomic status; medical specialties; minority health disparity; mortality; patient subsets; practice setting; prognostic; prospective; racial and ethnic; racial and ethnic disparities; racial determinant; safety net; segregation; social culture; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; study population; tertiary care; transportation access

ABSTRACT Cirrhosis – the end-stage result of chronic liver disease – is a condition with high morbidity and mortality that is becoming increasingly common. Nearly half of all patients with cirrhosis develop hepatic decompensation including hepatocellular cancer (HCC), with frequent hospitalization within 5 years of cirrhosis diagnosis. Several studies show that these cirrhosis complications disproportionately affect racial/ethnic minorities and persons of low socioeconomic status (SES). But fundamental questions remain unanswered given that only few studies investigated the mechanisms that underlie these disparities. The research proposed here aims to provide actionable information on what to target to reduce cirrhosis prognosis disparities. We will conduct a comprehensive evaluation of multilevel factors hypothesized to play important roles in causing racial/ethnic and SES disparities in three key measures of cirrhosis prognosis: a) hepatic decompensation, including HCC, b) liver-related hospitalization, and c) overall survival. We propose a large, multicenter, racially and socio-economically diverse cohort study of cirrhosis patients enrolled from four healthcare systems; the project will combine information from existing clinical databases, genomic data, and geospatial analyses with patient- and clinician- surveys to provide unparalleled information about the role of individual, interpersonal, and community-level factors in the racial/ethnic and SES disparities in cirrhosis prognosis. The proposed cohort includes representative groups from all racial/ethnic (blacks, Hispanics, Asian-Pacific Islanders) and SES groups. It also spans the full spectrum of disease severity (from compensated to advanced decompensated disease), rather than focusing on a few groups. We will uncover the relative contributions of established (hepatitis C virus, hepatitis B virus) and emerging (obesity, diabetes) etiological risk factors as well as risk behaviors (alcohol use) to cirrhosis prognosis disparities. We will also characterize pathways that contribute to cirrhosis disparities among the high order determinants at the individual (e.g., medical mistrust), interpersonal (e.g., bias), and community (e.g., access to transportation) levels either directly or by affecting etiological or behavioral risk factors. Identification of these root cause mechanisms will identify actionable targets for intervention and policy change. We will also examine a set of genetic single nucleotide polymorphisms using stored sera in a subset of the cohort to understand the role of genetic differences, if any, in explaining racial/ethnic disparities.

抽象的 肝硬化 - 慢性肝病的终阶段结果 - 是一种发病率高的疾病 死亡率变得越来越普遍。所有肝硬化患者中几乎有一半 包括肝癌（HCC）在内的肝功能补偿，经常住院 肝硬化诊断的5年内。几项研究表明这些肝硬化并发症 不成比例地影响种族/族裔少数民族和低社会经济地位（SES）的人。 但是，鉴于只有很少的研究调查了，但基本问题仍然没有得到答案 这些差异的基础的机制。这里提出的研究旨在提供 可行的信息有关降低肝硬化预后差异的目标。我们将 对假设在 在三个关键的肝硬化预后措施中引起种族/种族和SES差异：a） 肝功能不全，包括HCC，b）与现场相关的住院以及c）总体生存。 我们提出了一项大型，多中心，种族和社会经济多样性的队列研究 肝硬化患者来自四个医疗保健系统；该项目将结合信息 来自现有的临床数据库，基因组数据和与患者和患者的地理空间分析 临床调查以提供有关个人际交往的作用的无与伦比的信息， 以及肝硬化预后中种族/种族和SES差异的社区级因素。 拟议的队列包括来自所有种族/种族的代表团体（黑人，西班牙裔， 亚洲太平洋岛民）和SES群体。它还跨越了各种疾病的严重程度 （从补偿到晚期代偿性疾病），而不是专注于少数 组。我们将发现已建立的相对贡献（乙型肝炎病毒，乙型肝炎 病毒）和新兴（肥胖，糖尿病）病因学风险因素以及风险行为（酒精 使用）到肝硬化预后差异。我们还将表征有助于 高级决定者（例如，医学不信任）之间的cirhosis差异， 人际关系（例如偏见）和社区（例如，访问运输）级别或直接 通过影响病因或行为风险因素。识别这些根本原因机制 将确定可行的目标进行干预和政策变更。我们还将检查一组 遗传单核苷酸多态性使用储存的血清在同一组的子集中 了解遗传差异（如果有的话）在解释种族/种族差异中的作用。