REasons for Geographic And Racial Differences in Stroke-Myocardial Infarction-4 (REGARDS-MI-4)

黑白冠状动脉心脏病（CHD）和心力衰竭 (HF)尽管美国进行了几十年的研究和全国性的公共卫生运动，但这种差距仍然存在。 健康的社会决定因素（SDH），如结构性种族主义在健康差距中的作用， 仅在1%的已发表作品中进行了研究。很少有关于SDH的研究从生命过程的角度进行， CHD和HF的风险。在急性健康事件的压力后恢复的能力，或恢复力， 这是一个重要的以患者为中心的结果，但SDH对恢复力的影响尚不清楚。几个过去 在世界卫生组织（WHO）的研究中， 卫生组织可持续发展问题委员会（世卫组织可持续发展问题委员会）的概念框架， 严格裁定的CHD和HF终点，这是本申请的目的之一。我们提出 一系列研究填补了这些空白，同时也提供了严格裁定的CHD和HF事件 和死亡原因的研究人员有兴趣使用这些数据（到目前为止，超过500人 使用这些数据）。我们建立在指导的跟踪记录，提出一个正式的一年的职业生涯 早期研究者发展计划（ESI），特别是代表性不足的少数民族 （URM）。本申请的具体目的是：（目的1）进行研究， 在卫生组织可持续发展委员会概念框架的指导下， 包括：a）CHD的发生率和复发率; B）HF的发生率和复发率， 射血分数和射血分数降低的HF; c）事件后的储备和恢复力，或 复发性CHD或HF事件。(Aim 2）继续裁定CHD事件、HF住院，以及 死亡原因，以支持我们小组以外的研究人员进行的广泛研究，并将死亡原因联系起来。 队列与医疗保险数据，以支持调查人员进行卫生服务利用研究。(Aim第三章 通过一项新的计划，支持心血管疾病健康公平性研究人员的发展，特别是URMs， 指导研究计划的早期阶段的研究人员队列，包括分析和统计 支持和为期2天的年度健康公平研究暑期研究所的演示，培训，模拟 学习和网络。早期研究人员将毕业于特定的能力， CVD健康公平研究。拟议的赠款将为政策，宣传和设计提供信息， 通过产生新的证据，说明SDH和卫生服务的差异导致了干预措施， 冠心病和心力衰竭的发病率和复发率的人群水平差异，以及 CHD或HF事件。我们的多学科团队包括流行病学家，社会学家，卫生服务 研究人员、生物统计学家、临床医生和参与者咨询委员会，确保严谨性和相关性 的拟议研究。继续为REGARDS-MI基础设施提供资金将支持一系列 由一个不断扩大的研究小组领导的额外研究。资金还将扩大研究人员的队伍，致力于发现实现所有美国成年人健康公平的战略， 由NHLBI，国家科学院，CDC，美国心脏协会， 以及美国所有主要的专业协会。

Black-White coronary heart disease (CHD) and heart failure (HF) disparities persist in the US despite decades of research and national public health campaigns. The role of social determinants of health (SDH) like structural racism in health disparities has been studied in only 1% of published work. Few studies of SDH have taken a life course perspective related to risk of CHD and HF. The ability to recover after the stress of an acute health event, or resilience, is an important patient-centered outcome, but the influence of SDH on resilience is unknown. Few past studies have examined both structural and intermediary SDH in the World Health Organization's (WHO) Commission on SDH (WHOCSD) conceptual framework in a longitudinal national sample with rigorously adjudicated CHD and HF endpoints, which is one of the aims of this application. We propose a series of studies to fill these gaps, while also providing rigorously adjudicated CHD and HF events and causes of death to a host of investigators interested in using these data (to date, over 500 have used these data). We build on a track record of mentoring to propose a formal year-long career development program for early-stage investigators (ESI), especially underrepresented minorities (URM). The specific aims of this application are to: (Aim 1) conduct studies examining underlying mechanisms of health disparities, guided by the WHOCSD conceptual framework, in three thematic areas: a) the incidence and recurrence of CHD; b) the incidence and recurrence of HF with preserved ejection fraction and HF with reduced ejection fraction; c) reserve and resilience after an incident or recurrent CHD or HF event. (Aim 2) To continue to adjudicate CHD events, HF hospitalizations, and causes of death to support a wide range of studies by investigators beyond our group, and to link the cohort with Medicare data to support investigators conducting health services utilization studies. (Aim 3) To support the development of researchers in CVD health equity, especially URMs, through a new mentored research program for a cohort of early stage investigators, including analytic and statistical support and an annual 2-day Health Equity Research Summer Institute of presentations, training, mock study section, and networking. Early stage investigators will graduate with specific competencies in CVD health equity research. The proposed grant will inform policy, advocacy, and the design of interventions by generating new evidence on which SDH and disparities in health services lead to population-level disparities in incident and recurrent CHD and HF, and on resilience in recovery after a CHD or HF event. Our multidisciplinary team includes epidemiologists, sociologists, health services researchers, biostatisticians, clinicians, and a participant Advisory Board, assuring rigor and relevance of the proposed research. Continued funding for the REGARDS-MI infrastructure will support a host of additional studies led by an expanding group of investigators. Funding will also expand the cadre of researchers dedicated to discovering strategies to achieve health equity for all US adults, a goal supported by NHLBI, the National Academy of Sciences, the CDC, the American Heart Association, and all major professional societies in the US.