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Health Disparities in the Development, Persistence, and Progression of Uveitis and Ocular Inflammation in the United States

美国葡萄膜炎和眼部炎症发生、持续和进展的健康差异

基本信息

批准号：
10490367
负责人：
Brian Toy
金额：
$ 16.4万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10490367
关键词：
Address Affect Age American Area Biological Biostatistical Methods Blindness Caring Case Series Cataract Chronic Disease Cicatrix Clinical Clinical Informatics Clinical Research Clinical Services Code Computerized Medical Record County Data Data Mart Data Set Databases Development Diagnosis Disease Economics Education Environment Epidemiology Ethnic Origin Formularies Foundations Future Geography Glaucoma Goals Grant Health Health Care Costs Health Policy Health Services Health Services Research Health system Healthcare Healthcare Systems Incidence Income Inflammation Inflammatory Informatics Insurance International Classification of Diseases Intervention Knowledge Leadership Logistics Longitudinal Studies Los Angeles Low Income Population Low income Manuscripts Medical Mentored Patient-Oriented Research Career Development Award Mentors Methods Modeling Morbidity - disease rate Patient Care Patients Pattern Patterns of Care Persons Pharmaceutical Preparations Pharmaceutical Services Population Heterogeneity Population Intervention Population Study Prevalence Race Rare Diseases Regression Analysis Reporting Research Risk Risk Factors Sampling Science Scleritis Smoking Smoking Status Socioeconomic Status Steroids Surgeon Target Populations Testing Training Treatment Protocols United States Uveitis Validation Vision Visual Vulnerable Populations Writing age group barrier to care base career development clinical care clinical database cohort comorbidity cost disease diagnosis economic disparity experience hazard health disparity health economics high risk immunomodulatory therapies improved indexing innovation insight interest low socioeconomic status multidisciplinary novel population based practice setting programs racial disparity risk stratification safety net sex skills socioeconomic disparity socioeconomics standardized care treatment comparison

项目摘要

PROJECT SUMMARY Uveitis is an important cause of visual morbidity, responsible for an estimated 10% of blindness in the United States with an annual associated cost of $242.6 million. Prior studies have sought to elucidate the incidence and prevalence of uveitis; however, these studies have been limited in scope by age subset, localized geography, referral practice setting, or specialized health systems environment. The primary objectives of this K23 career development proposal are: 1) to demonstrate the benefit of using multiple databases to characterize the epidemiology of uveitis across the U.S., elucidating disparities in risk factors for its development, persistence, and progression; and 2) to provide an academic uveitis and vitreoretinal surgeon with the training and mentored research experience necessary to conduct independent clinical research. Achieving these objectives will provide critical skills and experiences necessary to establish an independent research program focused on applying clinical informatics to improve the clinical care of patients with uveitis. The proposed K23 application will provide additional training in four vital areas: 1) epidemiology and mechanisms of chronic disease; 2) quantitative characterization of health economics and health disparities; 3) biostatistical methods for health services research; 4) validation and analysis of very large clinical databases. The proposed research will capitalize on the strengths of two unique databases containing large and diverse cohorts of patients, including health claims-based data from the Optum Clinformatics Data Mart and electronic medical record-derived data from the Los Angeles County Department of Health Services safety net healthcare system, to generate exploratory knowledge on health disparities in the epidemiology and treatment of ocular inflammatory diseases. After validating longitudinal samples of patients with uveitis, the prevalence of uveitis in diverse populations will be estimated, documenting race-ethnic and other disparities. Risk factors for the development of uveitis and its sequelae will be incorporated in developing and testing models to investigate to what degree risk factors might affect health disparities. The interaction between race and smoking status will be a particular factor of interest. Population-based treatment patterns and health care costs associated with non-infectious uveitis will be characterized. Socioeconomic disparities in the utilization of steroid-sparing immunomodulatory therapy will be explored. The results of the proposed research will provide the foundation for a future longitudinal study examining the benefit of targeted interventions in patients at higher risk of blindness from uveitis. The ultimate goal of my research is to develop risk-stratification and treatment protocols that guide the standardized care of patients with uveitis and decrease the incidence of ocular inflammatory disease and its associated ocular morbidity.

项目总结葡萄膜炎是视力疾病的一个重要原因，据估计，在美国有10%的失明是由葡萄膜炎引起的。这些国家每年的相关费用为2.426亿美元。此前的研究试图阐明这一发生率和葡萄膜炎的患病率；然而，这些研究的范围受到年龄子集的限制，局限于本地化地理位置、转诊实践环境或专业卫生系统环境。这项工作的主要目标是 K23职业发展建议是：1)展示使用多个数据库的好处描述美国各地葡萄膜炎的流行病学特征，阐明其风险因素的差异发展、持续和进步；以及2)提供学术葡萄膜炎和玻璃体视网膜外科医生具有进行独立临床研究所需的培训和指导研究经验。实现这些目标将提供关键的技能和经验，以建立一个独立的研究计划的重点是应用临床信息学来改善葡萄膜炎患者的临床护理。拟议的K23应用程序将在四个重要领域提供额外的培训：1)流行病学和慢性病的发病机制；2)卫生经济学和卫生差距的量化表征；3) 卫生服务研究的生物统计学方法；4)非常大的临床数据库的验证和分析。拟议的研究将利用两个独特的数据库的优势，这两个数据库包含大型和多样化的患者队列，包括来自Optom Clinformatics Data Mart和Electronics的基于健康声明的数据来自洛杉矶县卫生服务安全网医疗保健部门的病历数据系统，以产生关于眼科流行病学和治疗方面的健康差距的探索性知识炎症性疾病。在对葡萄膜炎患者的纵向样本进行验证后，将对不同的人口进行估计，记录种族、民族和其他差异。的风险因素葡萄膜炎及其后遗症的发展将纳入开发和测试模型，以调查多大程度的危险因素可能影响健康差距。种族和吸烟状况之间的相互作用将成为特别令人感兴趣的因素。以人群为基础的治疗模式和与之相关的医疗费用将以非感染性葡萄膜炎为特征。使用非类固醇药物的社会经济差异将探索免疫调节疗法。拟议的研究结果将提供基础未来的一项纵向研究，考察有针对性的干预措施对高危患者的益处葡萄膜炎导致失明。我的研究的最终目标是开发风险分层和治疗方案指导葡萄膜炎患者的规范化护理，降低眼部炎症的发生率疾病及其相关的眼部发病率。