Effects of Neighborhood SES on CHD Burden in Communities

描述（由申请人提供）：尽管过去几十年来冠心病（CHD）死亡率大幅下降，但有证据表明CHD死亡率的种族和社会经济差异正在增加。CHD监测工作检查这些人群亚组内的趋势是量化和减少差异的重要第一步。然而，只有一项美国基于人群的CHD监测研究包括黑人人群，并且没有一项通过社会经济地位（SES）监测趋势。自1989年以来，社区动脉粥样硬化风险（ARIC）研究监测了美国四个社区35至74岁的黑人和白色成年人中经验证的住院心肌梗死和致死性CHD的发生率和趋势。拟议的研究将扩大ARIC监测的范围，通过检查SES的CHD率和时间趋势的变化，在人口普查区的水平上测量。对于已纳入ARIC监测（1992- 2002）的CHD事件，将从医疗记录和死亡证明中获取地址并进行地理编码，以便与基于人口普查的地理区域的标识符相匹配。ARIC研究将提供每年更新的抽象CHD事件和随后几年（2003-2005）的地址。每一项活动都将与1990年和2000年人口普查提供的普查区一级社会经济状况指标联系起来。这项新的努力将允许SES检查致死性CHD、住院心肌梗死、病死率、侵入性心脏手术的使用和出院时有效药物处方的发生率和趋势的差异。此外，还将探讨SES在多大程度上解释了CHD和相关治疗的种族差异。这项研究将是美国第一项基于人群的CHD监测研究，包括SES对CHD负担变化的评估，因此，将为科学文献提供有价值的贡献。此外，研究结果可用于计划旨在减少CHD差异的有针对性的公共卫生干预措施。

DESCRIPTION (provided by applicant): Despite strong decreases in coronary heart disease (CHD) mortality over past decades, there is evidence that racial and socioeconomic disparities in CHD mortality are increasing. CHD surveillance efforts that examine trends within these population subgroups are an important first step in quantifying and reducing disparities. Yet, only one U.S. population-based CHD surveillance study includes black populations and none has monitored trends by socioeconomic status (SES). The Atherosclerosis Risk in Communities (ARIC) Study has monitored rates and trends in validated hospitalized myocardial infarction and fatal CHD among black and white adults aged 35 to 74 years in four U.S. communities since 1989. The proposed study will expand the scope of ARIC surveillance by examining variations in the rates and temporal trends in CHD by SES, measured at the level of census tract. For CHD events already included in ARIC surveillance (1992- 2002), addresses will be obtained from medical records and death certificates and geocoded so that they can be matched with identifiers for census based geographical areas. The ARIC study will contribute yearly updates of abstracted CHD events and addresses for subsequent years (2003-2005). Each event will be linked with census tract level SES indicators available from the 1990 and 2000 censuses. This novel effort will permit an examination of disparities by SES in rates and trends in fatal CHD, hospitalized myocardial infarction, case fatality, use of invasive cardiac procedures and prescription of efficacious medication at time of hospital discharge. In addition, the extent to which racial disparities in CHD and associated treatments are explained by SES will also be explored. This study would be the first U.S. population-based CHD surveillance study to include an assessment of variations in the burden of CHD by SES and thus, would provide valuable contributions to the scientific literature. Furthermore, the findings could be used to plan targeted public health interventions aimed at reducing CHD disparities.