Racial Disparities in Health Outcomes Following CABG

冠状动脉搭桥术后健康结果的种族差异

• 批准号: 6676110
• 负责人: MARILYN HRAVNAK
• 金额: $ 8.95万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-01 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6676110
• 关键词: African American; atherosclerosis; behavioral /social science research tag; caucasian American; clinical research; coronary bypass; coronary disorder; diabetes mellitus; health care service availability; health care service utilization; health disparity; human subject; hyperlipidemia; hypertension; longitudinal human study; medically underserved population; nursing research; obesity; outcomes research; racial /ethnic difference

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.

描述（由申请人提供）：美国有超过1200万人患有冠心病（CHD），这是住院的第二大原因。非裔美国人的冠心病死亡率高于有数据记录的任何其他种族或族裔群体。尽管冠状动脉旁路移植术（CABG）是治疗CHD最常见的侵入性干预措施之一，但非洲裔美国人接受CABG的可能性低于疾病严重程度相同的白人，并且术后发病率和死亡率较高。我们尚未充分了解造成这些差距的复杂因素。有些人将原因归结为生理或遗传基础，而另一些人则认为，种族是一种社会结构，对健康状况和获得保健的机会具有强大的经济后果。大多数既往研究均采用回顾性分析，未很好地控制混杂因素，仅对发病率和死亡率进行了结局评估，未考虑医疗服务获取对结局的影响。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，描述在接受单独CABG的匹配的非裔美国人和白人中，CHD可改变的风险因素、医疗保健获得和利用以及术后结局随时间的差异。受试者将根据年龄、性别、管道血管的数量和来源以及收入进行匹配。将在基线、3个月和6个月时测量关于可改变的风险因素、卫生保健获得和利用以及结局（并发症、健康相关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开发一个独立的研究项目，以减少接受侵入性心脏手术的非裔美国人的健康和医疗保健差异。为了实现这一目标，我制定了一个强化培训计划，以提高我的能力：1）设计和进行前瞻性研究，以了解和减少CHD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，以及进行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），以及4）通过与专家研究人员一起参与多学科和机构间活动来准备和管理赠款。