Racial Disparities in Health Outcomes Following CABG

描述（由申请人提供）：美国有超过1200万人患有冠心病（CHD），这是第二大住院原因。非裔美国人的冠心病死亡率高于其他任何有记录的种族或族裔群体。尽管冠状动脉旁路移植术（CABG）是治疗冠心病最常见的侵入性干预手段之一，但与疾病严重程度相当的白种人相比，非裔美国人接受冠状动脉旁路移植术的可能性更小，而且术后发病率和死亡率更高。我们还没有完全了解造成这些差异的复杂因素。一些人将原因归因于生理或遗传基础，而另一些人则认为种族是一种社会结构，对健康状况和获得健康有强大的经济影响。大多数先前关于冠状动脉搭桥术后结果的种族差异的研究都采用了回顾性分析，没有很好地控制混杂因素，对发病率和死亡率的结果评估有限，并且没有考虑到获得医疗保健对结果的影响。本研究的目的是采用前瞻性受试者间重复测量比较调查设计，描述非裔美国人和白种人接受孤立CABG后，冠心病可改变的危险因素、医疗保健获取和利用以及术后结果的差异。受试者将根据年龄、性别、导管血管数量和来源以及收入进行匹配。将在基线、3个月和6个月时测量可改变的风险因素、卫生保健获取和利用以及结果（并发症、与健康有关的生活质量和功能状态）的数据，并进行比较，以确定关系和影响。我的长期职业目标是发展一个独立的研究项目，以减少非裔美国人在接受侵入性心脏手术时的健康和医疗差距。为了实现这个目标，我制定了一个强化训练计划来提高我的能力：1)设计和开展前瞻性研究，以了解和减少冠心病患者的差异；2)提高我对影响少数民族健康和医疗保健差异的问题的理解，以及开展以少数民族为重点的研究的专业知识；3)管理和分析纵向数据（强调预测建模）；4)通过与专家研究人员一起参与多学科和机构间的活动来准备和管理拨款。

DESCRIPTION (provided by applicant): More than 12 million people in the U.S. have coronary heart disease (CHD), the 2nd leading cause of hospitalization. The CHD death rate is higher for African Americans than for any other racial or ethnic group for which data are recorded. Although coronary artery bypass grafting (CABG) is one of the most common invasive interventions used to treat CHD, African-Americans are less likely to undergo CABG than Caucasians with equivalent severity of disease, and experience higher post-surgical morbidity and mortality. We do not yet have a full understanding of the complex factors that cause these disparities. Some attribute the cause to physiologic or genetic underpinnings, while others contend that race is a social construct with powerful financial consequences impacting health status and health access. Most prior research examining racial disparities in post-CABG outcomes has utilized retrospective analyses, has not controlled well for confounding factors, has limited outcome assessment to morbidity and mortality, and has not accounted for the impact of health-care access upon outcomes. The purpose of the proposed research is to describe differences in CHD-modifiable risk factors, health care access and utilization, and post-surgical outcomes over time in matched African-Americans and Caucasians undergoing isolated CABG, using a prospective between-subjects repeated measures comparative survey design. Subjects will be matched by age, gender, number and source of conduit vessels, and income. Data on modifiable risk factors, health care access and utilization, and outcomes (complications, health-related quality of life and functional status) will be measured at baseline, 3 and 6 months, and compared to determine relationships and effects. My long-term career goal is to develop an independent program of research to reduce health and healthcare disparities in African-Americans undergoing invasive cardiac procedures. To meet this goal, I have developed an intensive training plan to improve my ability to: 1) design and conduct prospective research to understand and reduce disparities in patients with CHD, 2) improve my understanding of issues impacting racial minority health and health-care disparities, and expertise in conducting minority-focused studies, 3) manage and analyze longitudinal data (emphasizing prediction modeling), and 4) prepare and administer grants by participating in multidisciplinary and inter-institutional activities with expert researchers.