Can a radical transformation of preventive care reduce mortality by 20% in low SES populations? Preparatory work focusing on AUD/heavy alcohol use, HIV risk, and cardiovascular risk

%20a%20radical%20transformation%20of%20preventive%20care%20reduce%20mortality%20by%2020%%20in%20low%20SES%20populations?%20Preparatory%20work%20focusing%20on%20AUD/heavy%20alcohol%20use,%20HIV

• 批准号: 10542278
• 负责人: Ronald Scott Braithwaite
• 金额: $ 20.13万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542278
• 关键词: Age; Algorithms; Appointment; Area; Australia; Behavioral; Canada; Cardiovascular system; Caring; Cessation of life; Characteristics; Chronic lung disease; Clinic; Communities; Cost Effectiveness Analysis; Country; Denmark; Depressive disorder; Diabetes Mellitus; Disease; Education; Elements; Ethnic Origin; European; Financial compensation; Finland; Frequencies; Generalized Anxiety Disorder; Goals; HIV; HIV risk; Health; Health system; Healthcare; Heavy Drinking; Hepatitis C virus; Hispanic; Hong Kong; Hour; Income; Individual; Injury; International; Intervention; Japan; Kidney Failure; Korea; Life Expectancy; Liver Failure; Liver diseases; Mental Depression; Methods; Modeling; Myocardial Infarction; New Zealand; Norway; Not Hispanic or Latino; Operations Research; Overdose; Pathway interactions; Persons; Population; Prevention; Preventive care; Primary Health Care; Primary Prevention; Process; Race; Research; Risk; Sampling; Socioeconomic Status; Specific qualifier value; Stroke; Substance Use Disorder; Suicide; Sweden; System; Target Populations; Testing; Time; To specify; Tobacco use; Training Programs; Travel; United States; Visit; Woman; Work; alcohol use disorder; base; binge drinking; black men; brief intervention; cardiovascular disorder risk; cardiovascular risk factor; cost; health disparity; health goals; low socioeconomic status; medication nonadherence; mindfulness; models and simulation; mortality; optimism; pre-exposure prophylaxis; preference; prevent; preventable death; preventive intervention; recruit; response; safety net; screening; sex; sexual risk taking; social; trend; young mother

Socioeconomic status (SES)-related health disparities are worsening substantially in the U.S. and elsewhere, including Canada, Australia, New Zealand, Japan, Korea, Hong Kong, and even egalitarian Nordic European countries with robust social safety nets (Denmark, Norway, Sweden, and Finland). Preventable mortality is difficult to mitigate for a multitude of reasons, including numerous determinants at individual, interpersonal, community, and societal levels. However, there is some cause for optimism based on the potency of action levers at the individual level. Among SES- and race/ethnicity-related health disparities in the U.S., 11 preventable conditions cause >50% of mortality. Further, our preliminary modeling work suggests that only 9 prevention goals are required to attain 40% mortality reduction from these 11 conditions, resulting in 20% mortality reduction overall, because of interdependencies and common pathways. For example, alcohol use disorder and/or heavy drinking impacts not only liver failure, but also behavioral consequences such as sexual risk-taking and medication nonadherence. However, attaining 20% mortality reduction would require a radical transformation of preventive care, such as what we propose, focused on personalization, navigation, and compensation. Personalization means maximizing individual-level benefit by modulating intensity of screening, frequency of screening; and intensity or duration of response; navigation means reducing barriers posed by fragmentation of health and social systems; and compensation means offsetting dependent care, time costs, and travel costs. The post-R34-goal is a N=15,000 5-year RCT which would have adequate power to test the hypothesis of 20% mortality reduction from personalization, navigation, and compensation. This proposed R34 is preparatory for that goal, and focuses especially on alcohol use disorder and heavy drinking, HIV risk, and risk for cardiovascular disease.

在美国和其他地方，与社会经济地位（SES）相关的健康差距正在大幅恶化， 包括加拿大、澳大利亚、新西兰、日本、韩国、香港，甚至还有平等主义的北欧 拥有健全社会安全网的国家（丹麦、挪威、瑞典和芬兰）。 由于多种原因，可预防的死亡率难以降低，其中包括许多决定因素 个人、人际、社区和社会层面。然而，有一些乐观的理由 个人层面行动杠杆的效力。社会经济地位和种族/民族相关的健康差异 在美国，11 种可预防的疾病导致 50% 以上的死亡率。此外，我们的初步建模工作表明 只需要实现 9 个预防目标即可将这 11 种情况的死亡率降低 40%，从而 由于相互依赖性和共同途径，死亡率总体降低 20%。例如，酒精 使用障碍和/或酗酒不仅会影响肝功能衰竭，还会影响行为后果，例如 性冒险和药物不依从。 然而，要实现死亡率降低 20% 需要彻底改变预防性护理，例如 我们的建议侧重于个性化、导航和补偿。个性化意味着 通过调节筛查强度、筛查频率来最大化个人利益；和强度 或响应持续时间；导航意味着减少健康和社会分散造成的障碍 系统；补偿意味着抵消家属照顾、时间成本和旅行成本。 R34 后的目标是 N=15,000 项 5 年 RCT，它有足够的功效来检验 20% 的假设 通过个性化、导航和补偿降低死亡率。这个提议的 R34 是为 该目标，并特别关注酒精使用障碍和酗酒、艾滋病毒风险和感染风险 心血管疾病。