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

项目摘要 美国黑人是世界上高血压（或高血压，HBP）发病率最高的人， 黑人和白色成年人之间的种族差异持续了几十年， 心血管疾病协会HBP差异的根本原因是未知的，以前 研究主要集中在个人层面的行为，压力源和生理风险因素， 错过了发现和解决这些差距根源的机会。结构性种族主义可能是一种 因此，如果不解决结构性种族主义问题，家庭与家庭伙伴之间的差距将继续存在。 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一个根本原因和用途， 纵向研究，探索结构性种族主义影响HBP风险因素的途径， 差距。使用一种新的结构性种族主义的5个领域的措施，我们以前的横断面研究 表明更大的结构性种族主义与更高的BMI相关，这是HBP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如何与HBP的其他风险因素， 以及关于结构性种族主义运作的时间和地理范围的问题。我们寻求 填补这些空白，以响应RFA-MD-21-004的要求“观察研究，以了解的作用， 结构性种族主义.造成和维持健康差距”。我们的目标是进行多层次的 一项全国性的研究，调查我们的新的多维度衡量县级之间的关联 结构性种族主义（CSR）和：HBP的生理、行为和结构性风险因素（目标1），HBP 发病率、患病率和严重程度（目标2），以及如果 CSR被删除（目标3）。我们利用我们独有的现有资源：（a）我们的 出版的县结构性种族主义量表，（B）《美国新闻与世界报道》医院医疗保健排名 质量，以及（c）来自30，239名黑人和白色成年人的纵向行为和生物标志物HBP数据。 卒中地理和种族差异原因（REGARDS）队列中的美国。我们扩展到 以前的研究通过使用结构性种族主义的多领域措施，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 许多结构性的种族主义成本县在HBP医疗保健支出时，它得不到解决。我们将 将我们的研究结果转化为针对美国县级行政人员的政策简报。我们的专家团队 心血管疾病的差异，社会和临床流行病学，卫生经济学，代表从 关于，两个霍普金斯差异中心，霍普金斯的心血管疾病流行病学，和前县领导，是很好的- 有能力执行新调查员申请我们的研究结果将为企业社会责任如何影响 HBP，有可能为企业社会责任的政策决定提供支持，最终减少HBP的差异。

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.