Race and Health Outcomes Associated with Obesity

描述（由申请人提供）：2010年健康人计划的两个首要目标是延长健康生活的年限和提高健康生活的质量，并消除健康差距。由于肥胖对非洲裔和西班牙裔美国人的影响尤为严重，因此了解种族对肥胖对不同健康结果的影响对于实现这些目标尤为重要。有趣的是，尽管非裔美国人的预期寿命明显低于白人，但观察性研究表明，肥胖对非裔美国人死亡率的影响可能低于白人，尽管肥胖非裔美国人的医疗支出低于肥胖的美国白人。与肥胖相关的死亡率和成本的种族差异可能反映了几个方面的差异：在AAs中，吸烟、艾滋病毒和创伤等竞争性健康风险的比率较高；在AAs中，肥胖与心血管危险因素之间的相关性降低；以及在诊断和治疗正常体重aa的危险因素方面的延误。使用来自3个国家数据库的数据-医疗保险当前受益人调查（MCBS），国家健康和营养调查（NHANES）和医疗支出小组调查（MEPS)-本研究将检查种族和体重指数（BMI）的相互作用，因为它们与4个重要结果相关：1）死亡率；2)心血管危险因素；3)心血管危险因素的诊断和治疗延误；4)医疗支出。以前研究肥胖相关死亡率的研究未能充分解决健康风险的竞争问题，以及吸烟和临床前疾病的残留混淆，这可能模糊肥胖和高死亡率之间的联系。由于MCBS数据与医疗保险索赔有纵向联系，这项研究将能够限制吸烟和临床前疾病以及相互竞争的健康风险造成的不可控制的混淆。此外，本应用程序中提出的研究将解决几个重要问题：与白人相比，肥胖与新型心血管危险因素之间的关联是否降低？较瘦的少数民族成年人患某些心血管危险因素的风险可能比他们的体重指数预测的要高，他们是否更容易在这些危险因素的诊断和治疗方面出现延误？在与肥胖相关的医疗支出中，有哪些不同类型的护理和医疗条件导致了种族差异？在澄清这些关系的过程中，我们的发现可以揭示肥胖相关风险和成本的种族差异背后的机制。我们的研究结果还可以指导公共卫生优先事项的设定和针对具体举措的目标，以减少医疗保健和死亡率方面的种族差异。

DESCRIPTION (provided by applicant): Two overarching goals of Healthy People 2010 are to increase years and quality of healthy life and to eliminate health disparities. Because obesity disproportionately affects African and Hispanic Americans, understanding the influence of race on obesity's impact on different health outcomes is especially vital to achieving these goals. Interestingly, although African Americans (AAs) continue to have substantially lower life-expectancy than whites, observational studies suggest that obesity may have a lower impact on mortality in AAs than in whites even though healthcare expenditures in obese AAs are lower than in obese white Americans. Racial differences in obesity-related mortality and cost may be a reflection of differences on several fronts: higher rates of competing health risks such as smoking, HIV, and trauma in AAs; a reduced association between obesity and cardiovascular risk factors in AAs; and delays in diagnosis and treatment of risk factors in normal-weight AAs. Using data from 3 national databases -the Medicare Current Beneficiary Survey (MCBS), National Health and Nutrition Examination Survey (NHANES), and Medical Expenditures Panel Survey (MEPS)- this study will examine the interplay of race and body mass index (BMI) as they relate to 4 important outcomes: 1) mortality; 2) cardiovascular risk factors; 3) delays in diagnosis and treatment of cardiovascular risk factors; and 4) healthcare expenditures. Previous studies examining obesity-related mortality have not been able to adequately address the issue of competing health risks and residual confounding from smoking and preclinical illness, which can obscure an association between obesity and higher mortality. Because MCBS data are linked to Medicare claims longitudinally, this study will be able to limit uncontrolled confounding from smoking and pre-clinical disease and competing health risks. Furthermore, the studies proposed in this application will address several important questions: Is the association between obesity and novel cardiovascular risk factors reduced compared to whites? Are leaner minority adults, who may be at higher risk for some cardiovascular risk factors than predicted by their body mass index, more susceptible to having delays in diagnosis and treatment of these risk factors? What are the different types of care and medical conditions that drive racial differences in obesity-related healthcare expenditures? In clarifying these relationships, our findings could shed light on mechanisms underlying racial differences in obesity-related risk and cost. Our findings could also guide the setting of public health priorities and the targeting of specific initiatives to reduce racial disparities in healthcare and mortality.