Socio-environmental context in monoclonal gammopathy of undetermined significance (MGUS) disparities

摘要 与非西班牙裔白人相比，非裔美国人的多项 骨髓瘤（MM）及其无症状前驱疾病，单克隆丙种球蛋白病， 显著性（MGUS）。然而，这些种族差异背后的病因学因素尚不清楚， 流行病学资源目前可用于支持不同人群的研究。值得注意的是， 几乎没有证据表明遗传因素可以解释这些差异; MGUS和MM患病率的差异， 因此，种族可能反映了外部生活方式和社会因素。我们认为，种族差异反映在 社会经济地位（SES）和地理空间因素，如一个人生活的环境的“健康” （称为“人造环境”），这两种环境都与种族和各种健康结果有关。 黑人妇女健康研究（BWHS）和加州教师研究（CTS）， 补充的妇女群体，提供了一个独特的机会，研究SES和建筑环境因素， 具有25岁个体水平风险因素的非裔美国人和非西班牙裔白色女性的MGUS 通过重复的健康问卷调查评估的信息，以及地理编码的住宅 地址.我们提出了一项流行病学研究，汇集这两个队列的数据，以评估 个人和社区SES和建筑环境中的种族差异在MGUS。流行病例 MGUS将通过筛选8，000名队列受试者（BWHS中3，300名，CTS中4，700名）来确定， 使用金标准实验室检测方法诊断MGUS的存档血液标本;我们预计， 确定了660例MGUS病例（包括330名非洲裔美国人和330名非西班牙裔白色妇女）。我们 假设邻里不利因素和建筑环境的属性， 行为会增加风险，并导致MGUS中已知的种族差异。我们将确定 邻里剥夺和个人SES的标志，如教育成就，父母教育， 水平，收入和早期生活财务不稳定，与总体和种族MGUS有关。我们还将探索 建筑环境的特点，如城市性和邻里步行能力，以及跨 这些变量与SES的分类，与MGUS相关，可以解释观察到的差异， 按种族分列的患病率。我们提出的研究特别具有创新性，因为它超越了传统， 单水平预测模型的方法，解决个人和上下文的复杂性， 疾病的水平预测。我们研究的广泛的地理/城乡，种族和社会经济多样性 跨队列的人口使其成为询问种族，SES， 以及邻域属性对MGUS和MM风险的影响。因此，这项研究具有很大的发展潜力 目前关于MGUS病因学的知识，为研究不足的高风险患者提供降低风险的机会 人群，并缩小多发性骨髓瘤及其前驱疾病的种族差异的差距。

ABSTRACT Compared to non-Hispanic whites, African Americans have a more than 2-fold higher incidence of multiple myeloma (MM) and its asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS). However, the etiological factors underlying these racial disparities are not known and few epidemiologic resources are currently available to support research in diverse populations. Notably, there is little evidence that genetic factors explain these disparities; differences in prevalence of MGUS and MM by race may thus reflect external lifestyle and social factors. We posit that racial disparities are reflected in socioeconomic status (SES) and geospatial factors such as the “health” of the environment in which one lives (termed “built environment”), both of which are known to be linked to race and a variety of health outcomes. The Black Women's Health Study (BWHS) and the California Teachers Study (CTS), well-established complementary cohorts of women, provide a unique opportunity to study SES and built environment factors for MGUS in African American and non-Hispanic white women with up to 25 years of individual-level risk factor information, assessed through repeated health questionnaires, available as well as geocoded residential addresses. We propose an epidemiologic study pooling data from these two cohorts to evaluate the role of individual and neighborhood SES and the built environment in racial disparities in MGUS. Prevalent cases of MGUS will be identified by screening 8,000 cohort participants (3,300 in BWHS and 4,700 in CTS) with archived blood specimens using gold-standard laboratory assays for the diagnosis of MGUS; we expect to identify 660 cases of MGUS (including 330 African American and 330 non-Hispanic white women). We hypothesize that neighborhood disadvantage and attributes of the built environment that inhibit healthy behaviors increase risk and contribute to known racial disparities in MGUS. We will determine associations of neighborhood deprivation and markers of individual SES, such as educational achievement, parental education level, income, and early life financial instability, in relation to MGUS overall and by race. We will also explore how characteristics of the built environment, such as urbanicity and neighborhood walkability, and the cross- classification of these variables with SES, are associated with MGUS and may explain observed differences in prevalence by race. Our proposed study is particularly innovative because it moves beyond the traditional, single-level predictor model to an approach that addresses the complexity of both individual- and contextual- level predictors for disease. The wide geographic/rural-urban, racial, and socioeconomic diversity of our study population across cohorts makes it an ideal setting in which to interrogate the intersection between race, SES, and neighborhood attributes on MGUS and MM risk. This research therefore has great potential to advance current knowledge about MGUS etiology, to inform opportunities for risk reduction in high-risk understudied populations, and to close the gap in racial disparities in multiple myeloma and its precursor conditions.