Race and Health Outcomes Associated with Obesity

描述（由申请人提供）：2010年健康人的两个首要目标是增加健康生活的年数和质量，并消除健康差距。由于肥胖不成比例地影响非洲裔和西班牙裔美国人，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（AAs）的预期寿命仍然大大低于白人，但观察性研究表明，肥胖对AAs死亡率的影响可能低于白人，即使肥胖AAs的医疗保健支出低于肥胖白色美国人。肥胖相关死亡率和成本的种族差异可能反映了几个方面的差异：AA中吸烟，HIV和创伤等竞争性健康风险的比率较高; AA中肥胖与心血管风险因素之间的关联降低;以及正常体重AA中风险因素的诊断和治疗延迟。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），国家健康和营养检查调查（NHANES）和医疗支出小组调查（MEPS）-这项研究将研究种族和体重指数（BMI）的相互作用，因为它们与4个重要结果有关：1）死亡率; 2）心血管风险因素; 3）心血管风险因素的诊断和治疗延迟;（4）医疗支出。以往研究肥胖相关死亡率的研究未能充分解决吸烟和临床前疾病的竞争性健康风险和残留混杂的问题，这可能会掩盖肥胖与较高死亡率之间的关联。由于MCBS数据与医疗保险索赔纵向相关，因此本研究将能够限制吸烟和临床前疾病以及竞争性健康风险的不受控制的混杂。此外，本申请中提出的研究将解决几个重要问题：与白人相比，肥胖与新的心血管危险因素之间的关联是否减少？较瘦的少数民族成年人，可能比他们的体重指数预测的心血管危险因素的风险更高，更容易在诊断和治疗这些危险因素的延误？哪些不同类型的护理和医疗条件导致了肥胖相关医疗支出的种族差异？在澄清这些关系时，我们的研究结果可以揭示肥胖相关风险和成本的种族差异的潜在机制。我们的研究结果还可以指导公共卫生优先事项的设定，以及减少医疗保健和死亡率方面种族差异的具体举措。

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.