Social Determinants of Outcomes in African Americans with Rheumatoid Arthritis

描述(申请人提供)：类风湿性关节炎(RA)是一种多系统自身免疫性疾病，在全球范围内有相当大的发病率和死亡率。在RA的研究中，非裔美国人(AA)的代表性明显不足。在白人中，较低的个人社会经济地位(SES)水平与较差的健康结果之间的强烈关联在白人中得到了很好的证实，但在AA中则较少。最近的数据表明，社区社会决定因素，例如个人所在社区的社会经济环境和环境暴露，也可能在这方面起作用。此外，种族隔离将具有相似SES的个体分类到截然不同的邻里环境中。AAS通常与白人人口隔离，这可能会导致AA和白人的社区影响不同。这项建议的长期目标是研究生活过程中的社会决定因素与类风湿关节炎患者健康结局的关系。这个项目将是第一个通过调查社会地位(童年、当前和生活中的个人层面的社会地位)和社会背景(社区层面的社会层面的社会地位、环境暴露、获得服务的机会和种族居住隔离)来检查患有类风湿关节炎的AA人群中的个人和社区层面的社会决定因素的研究。这也将是第一次检查可能作为类风湿性关节炎结果的中介的感知(控制、歧视和邻里)。拟议的项目将使用通过患有早期类风湿性关节炎(CLEAR)的非裔美国人纵向评估联盟(CLEAR)登记和网络收集的广泛的人口、社会经济、环境、临床和放射数据，该联盟由阿拉巴马大学(UAB)的协调中心和UAB和东南部其他4所大学的临床站点组成。Clear有两个组成部分：Clear I包括350名病程为两年的AA参与者，他们已经登记，并将被跟踪到他们的疾病第五年；Clear II，预计有600名任何病程的AA RA参与者，他们目前正在参加单一的横断面检查。具体目标包括：1)评估生活中社会地位与RA疾病严重程度之间的关系；2)确定生活中社会背景和社会地位与RA疾病严重程度之间是否存在独立的关联；以及3)检验社会地位(生活过程中)和社会地位与RA疾病严重程度之间关系的假设中介变量。 公共卫生相关性：非洲裔美国人在类风湿性关节炎(RA)研究中的代表性明显不足，因此在这个种族/民族群体中，关于这种疾病有许多重要的悬而未决的问题。该项目旨在阐明社会决定因素在非裔美国人类风湿性关节炎患者健康结局中的作用，并首次专门研究非裔美国类风湿性关节炎患者的社会经济地位问题。更好地了解这些问题将为设计临床干预措施和制定缩小这些差距的政策提供宝贵的基础。

DESCRIPTION (provided by applicant): Rheumatoid arthritis (RA) is a multisystem autoimmune disease associated with considerable morbidity and mortality worldwide. African Americans (AAs) have been markedly underrepresented in research on RA. The strong association between lower levels of individual socioeconomic status (SES) with poorer health outcomes in RA is well-established in whites, but less so in AAs. Recent data suggest that community social determinants, e.g., the socioeconomic environment of an individual's neighborhood and environmental exposures, may be operant in this regard, as well. In addition, racial segregation sorts individuals of comparable SES into vastly different neighborhood environments. AAs are often segregated from the white population, which may result in community influences differing for AAs and whites. The long-term goal of this proposal is to examine the relationship of social determinants across the lifecourse with health outcomes in AAs with RA. This project will be the first study to examine individual and community-level social determinants in an AA population with RA, by examining social position (childhood, current and lifecourse individual-level SES) and social context (community-level SES, environmental exposures, access to services and racial residential segregation). It will also be the first to examine perceptions (control, discrimination and neighborhood) that may act as mediators of outcomes in RA. The proposed project will be conducted using extensive demographic, socioeconomic, environmental, clinical and radiographic data collected through the Consortium for the Longitudinal Evaluation of African Americans with Early RA (CLEAR) registry and network, which consists of a Coordinating Center at the University of Alabama (UAB) and clinical sites at UAB and 4 other universities across the southeast. CLEAR has two components: CLEAR I with 350 AA participants with < 2 years of disease duration who are already enrolled and will be followed to year 5 of their disease; and CLEAR II with an anticipated 600 AA RA participants of any disease duration who are currently being enrolled for a single cross-sectional examination. Specific aims include: 1) To evaluate associations between social position across the lifecourse with disease severity in AAs with RA, 2) to determine whether there are independent associations between social context and social position across the lifecourse with disease severity in AAs with RA, and 3) to test hypothesized mediators in the relationships between social position (across the lifecourse) and social position with disease severity in AAs with RA. PUBLIC HEALTH RELEVANCE: African Americans have been markedly underrepresented in research on rheumatoid arthritis (RA), so there are many important unanswered questions regarding the disease in this racial/ethnic group. This project aims to clarify the role social determinants with health outcomes in African Americans with RA, and is the first to examine socioeconomic status issues specifically in an African American population with RA. A better understanding of these issues will provide an invaluable foundation for designing clinical interventions and creating policies to reduce these gaps.