Social Determinants of Outcomes in African Americans with Rheumatoid Arthritis

非洲裔美国人类风湿关节炎预后的社会决定因素

• 批准号: 8119656
• 负责人: LEIGH Fleming CALLAHAN
• 金额: $ 19.18万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8119656
• 关键词: Abbreviations; Adult; African American; Alabama; American; Anti-Inflammatory Agents; Anti-inflammatory; Antibodies; Antirheumatic Agents; Arthritis; Articular Range of Motion; Attitude; Autoimmune Diseases; Body mass index; C-reactive protein; Censuses; Childhood; Chronic Disease; Clinical; Clinical Research; Communities; Cross-Sectional Studies; Data; Data Set; Degenerative polyarthritis; Disadvantaged; Discrimination; Disease; Disease Outcome; Disease-Modifying Second-Line Drugs; Elderly; Enrollment; Environment; Environmental Exposure; Ethnic group; Evaluation; Exposure to; FPS-FES Oncogene; Family Practice; Foundations; Goals; Health; Health Services Accessibility; Health Status; Individual; Institutes; Intervention; Joints; Laboratories; Life; Life Cycle Stages; Measures; Mediating; Mediator of activation protein; Metatarsal bone structure; Methotrexate; Missouri; Modeling; Morbidity - disease rate; Motion; Musculoskeletal Diseases; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Neighborhoods; Non-Steroidal Anti-Inflammatory Agents; North Carolina; Outcome; Participant; Patient Self-Report; Perception; Pharmaceutical Preparations; Physical environment; Policies; Population; Positioning Attribute; Proteins; Psyche structure; Questionnaires; Registries; Research; Resources; Rheumatoid Arthritis; Rheumatoid Factor; Rheumatology; Risk; Risk Factors; Role; Severity of illness; Social Environment; Socioeconomic Status; Sorting - Cell Movement; South Carolina; System; Systemic Lupus Erythematosus; Tennessee; Testing; United States National Institutes of Health; Universities; Visual; analog; clinical research site; college; design; disorder risk; health related quality of life; high school; illness length; indexing; mortality; public health relevance; racial and ethnic; segregation; skin disorder; social; socioeconomics

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.

描述（由申请人提供）：类风湿关节炎（RA）是一种多系统自身免疫性疾病，与全球的发病率和死亡率相关。在RA研究中，非裔美国人（AAS）的代表性明显不足。较低的个人社会经济地位（SES）与RA中健康状况较差之间的密切联系在白人中已经建立了良好的联系，但在AAS中却较少。最近的数据表明，社区社会决定因素，例如个人社区和环境暴露的社会经济环境，在这方面也可能是运营者。此外，种族隔离将可比较的SE的个体与近不同的社区环境分类。 AA通常与白人人口隔离，这可能会导致社区影响与AA和白人不同。该提案的长期目标是检查整个生命的社会决定因素与AAS与RA的健康成果的关系。该项目将是第一个研究RA的AA人群中个人和社区级别的社会决定因素，通过检查社会地位（童年，当前和生命力的个人SES）和社会背景（社区级别的SES，环境暴露，服务和种族居民隔离）。这也将是第一个检查可能充当RA结果介体的看法（对照，歧视和邻里）的人。拟议的项目将使用广泛的人口统计，社会经济，环境，临床和放射学数据通过联盟收集，以对具有早期RA（清晰）注册表和网络的非洲裔美国人进行纵向评估，该评估由阿拉巴马大学（UAB）（UAB）和UAB和其他4个Southerties的临床现场的协调中心组成。 Clear有两个组成部分：Clear I与350名AA参与者患有<2年的疾病持续时间，他们已经入学，并且将遵循其疾病的第五年；和Clear II，预计有600名AA RA参与者目前正在参加一次横断面检查。具体目的包括：1）评估整个生命的社会地位与与RA的AAS中的疾病严重程度之间的社会地位之间的关联，2）确定在AAS中，社会环境与社会地位与AAS中的疾病严重程度之间是否存在独立的关联，以测试与RA的疾病严重程度，以测试与RA的社交位置（跨越生命的社会位置）之间关系中的假设中介者，以及与RA的社交位置之间的关系。 公共卫生相关性：在类风湿关节炎（RA）的研究中，非洲裔美国人的代表性明显不足，因此在这个种族/族裔群体中，有关该疾病的重要问题有许多重要的问题。该项目旨在阐明社会决定因素在患有RA的非裔美国人中具有健康结果的作用，并且是第一个研究社会经济地位问题的人，特别是在具有RA的非洲裔美国人群中。对这些问题的更好理解将为设计临床干预措施并制定减少这些差距的政策提供宝贵的基础。