Examining the Impact, Pathways, and Cost of County-Level Structural Racism on Hypertension Disparities in Black and White US Adults

项目总结 美国黑人的高血压(或称高血压)的发病率是世界上最高的， 黑人和白人成年人之间的种族差距持续了几十年，代价最高的是 所有心血管疾病的协会。HBP差异的根本原因尚不清楚，以前 研究主要集中在个体水平的行为、应激源和生理风险因素上。 错失了发现和解决这些差异的根本原因的机会。结构性种族主义可能是一种 因此，如果结构性种族主义得不到解决，高血压差距将持续存在。 因此，为了消除HBP差异，我们必须首先调查结构性种族主义是否是根本原因和使用 探索结构性种族主义影响高血压危险因素和高血压的纵向研究 差距。使用一种新的结构性种族主义的5领域衡量标准，我们之前的横断面研究 结果表明，结构性种族主义越严重，BMI越高，这是高血压的一个行为风险因素； 然而，这项工作在理解结构性种族主义与高血压的其他风险因素之间的关系方面留下了空白， 以及关于结构性种族主义运作的时机和地理规模的问题。我们寻求 填补这些空白，以回应RFA-MD-21-004‘S的请求，即“观察研究，以了解 结构性种族主义…在造成和维持高血压患者的健康差距方面“。我们的目标是进行多层次的 全国研究调查我国新型县级多维度测量之间的关联 结构性种族主义(CSR)和：高血压的生理、行为和结构性风险因素(目标1)，高血压 发病率、流行率和严重程度(目标2)，以及在以下情况下各县可以节省多少HBP医疗成本 消除企业社会责任(目标3)。我们利用独一无二的现有资源：(A)我们的 公布县结构性种族主义量表，(B)《美国新闻与世界报道》医疗保健医院排名 质量，以及(C)来自30,239名黑人和白人成年人的纵向行为和生物标志物HBP数据 美国在中风(方面)队列中的地理和种族差异的原因。我们的业务扩展到 以前的研究使用结构性种族主义的多领域测量，将其应用于纵向健康数据 这使我们能够评估在生命过程中多次暴露于结构性种族主义，并量化如何 结构性种族主义如果得不到解决，就会让各县在HBP的医疗支出上付出代价。我们会 将我们的发现转化为针对美国县级高管的政策简报。我们的专家团队 在心血管疾病差异、社会和临床流行病学以及卫生经济学方面， 尊敬的，霍普金斯大学的两个差异中心，霍普金斯的心血管疾病流行病学，以及前县领导，都是很好的- 准备好执行这个新的Investigator应用程序。我们的结果将为企业社会责任如何影响提供证据 HBP，有可能为最终缩小HBP差距的企业社会责任政策决策提供支持。

PROJECT SUMMARY Black Americans have the highest hypertension (or high blood pressure, HBP) rates in the world, with stark racial disparities between Black and White adults that have persisted for decades and at the highest cost to society of all cardiovascular conditions. The underlying cause of HBP disparities is unknown, and previous studies have mostly focused on individual-level behaviors, stressors, and physiologic risk factors leaving a missed opportunity to uncover and address the root causes of these disparities. Structural racism may be a root cause of HBP disparities and, as such, HBP disparities will persist if structural racism is not addressed. Thus, to eliminate HBP disparities, we must first investigate if structural racism is a fundamental cause and use longitudinal studies to explore the pathways through which structural racism influences HBP risk factors and disparities. Using a novel 5-domain measure of structural racism, our previous cross-sectional studies have demonstrated that greater structural racism is associated with higher BMI, one behavioral risk factor for HBP; however, this work has left gaps in understanding how structural racism is related to other risk factors for HBP, as well as questions about the timing and geographic scales at which structural racism operates. We seek to fill these gaps in responding to RFA-MD-21-004’s request for “observational research to understand the role of structural racism…in causing and sustaining health disparities” for HBP. Our goal is to conduct a multi-level national study to investigate associations between our novel multi-dimensional measure of county-level structural racism (CSR) and: physiologic, behavioral, and structural risk factors for HBP (Aim 1), HBP incidence, prevalence, and severity (Aim 2), and how much counties could save in HBP healthcare costs if CSR was eliminated (Aim 3). We leverage pre-existing resources that are uniquely available to us: (a) our published County Structural Racism Scale, (b) US News & World Report hospital rankings of healthcare quality, and (c) longitudinal behavioral and biomarker HBP data from 30,239 Black and White adults across the US in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We expand beyond previous studies by using a multi-domain measure of structural racism, applying it to longitudinal health data that allows us to assess exposure to structural racism at multiple times in the lifecourse, and quantifying how much structural racism costs counties in HBP healthcare spending when it goes unaddressed. We will translate our findings into policy briefs targeted toward county-level executives in the US. Our team of experts in CVD disparities, social and clinical epidemiology, and health economics, with representation from REGARDS, two Hopkins disparities centers, Hopkins’ CVD Epidemiology, and former county leaders, are well- equipped to execute this New Investigator application. Our results will offer evidence of how CSR influences HBP, with the potential to build support for policy decisions on CSR that can ultimately reduce HBP disparities.