Upstream Contributors to Downstream Disparities in Type 2 Diabetes

描述（由主要研究者提供）：2型糖尿病（T2DM）折磨着大约2100万美国成年人，每年可归因于的费用超过1320亿美元。美国少数民族人口承担了不成比例的2型糖尿病负担。与白人相比，黑人和西班牙裔美国人T2DM患病率较高，疾病控制较差，T2DM并发症患病率较高。当地环境不利、缺乏获得适当保健的机会、行为风险因素和其他影响的共同作用可能导致这些负担的增加。此应用程序响应NIH项目公告PA-07-027（“NIDDK疾病的健康差异”），通过调查导致T2DM风险“下游”差异的“上游”前因因素。该研究旨在衡量社会、环境、行为和生物生理等多层次因素对前驱糖尿病患病率的种族和民族异质性的相对贡献。前驱糖尿病将被定义为空腹血糖受损，或代谢综合征的患病率。该项目将从一个独特的新人群队列中获得3000名受试者的数据- NIDDK支持的波士顿地区社区健康（BACH）样本（DK 56842；主要研究者：John McKinlay博士）。因此，它将经济有效地利用我们之前的工作，以获得这个庞大的，随机选择的，具有代表性的人群。巴赫队列- 5506名社区居民-具有社会人口学多样性，包括2301名男性和3205名女性（1780名黑人，1858名西班牙裔和1868名白人），年龄范围广泛（30-79岁）。该队列在总体健康状况、当前生活环境和获得计划研究所需的医疗保健方面表现出广泛的差异。重要的是，使用该样本将允许在临床环境中通常未被观察到的受试者中进行健康和疾病研究。广泛的初步研究支持这一努力的可行性。当有针对性的干预措施可能在预防向T2DM过渡方面取得巨大影响时，上游对糖尿病前期的关注代表了一个独特的机会，可以检查T2DM诊断前健康差异的多层次贡献者的影响。衡量多层次因素的动机是考虑到它们在社会和环境层面（健康的公共政策和社区行动）或行为和生物生理层面（一级和二级预防）为此类干预提供信息的潜力。多层次、跨学科的方法建立在现有文献的基础上，并允许对不同因素的独立和相对贡献进行平衡估计。在每个层面纳入合理的措施将有助于了解其社会和环境背景下的疾病途径，从而增加临床提供者和决策者的装备，并提高他们预防和治疗2型糖尿病的能力。公共卫生相关性：该项目将获得3000名受试者的数据，这些样本按性别和种族/族裔（黑人、西班牙裔和白人男性和女性）平均划分，以便了解黑人和西班牙裔美国人中2型糖尿病比白人同胞更常见和更严重的原因。为此，研究小组将检查在糖尿病诊断之前经常发生的生理影响和健康状况，以确定它们是否在种族和民族之间存在差异，如果存在差异，哪些解释因素（如环境、家族史或社会经济地位）导致了这些差异。如果成功，该项目将确定在弱势人群中观察到的过量2型糖尿病风险可以降低的方法。

DESCRIPTION (provided by principal investigator): Type 2 diabetes mellitus (T2DM) afflicts some 21 million US adults, with annual attributable costs exceeding $132 billion. A disproportionate burden of T2DM is borne by US minority populations. Black and Hispanic Americans have higher prevalence of T2DM, achieve poorer disease control, and have greater prevalence of T2DM complications than do their white counterparts. The confluence of local environmental disadvantages, lack of access to adequate health care, behavioral risk factors, and other influences likely contribute to these increased burdens in a synergistic fashion. This application responds to NIH program announcement PA-07-027 ("Health Disparities in NIDDK Diseases") by investigating "upstream," antecedent factors contributing to "downstream" disparities in T2DM risk. It is specifically intended to measure the relative contributions of multilevel social, environmental, behavioral, and biophysiologic factors to racial and ethnic heterogeneity in the prevalence of prediabetes. Prediabetes will be defined either as impaired fasting glucose, or the prevalence of the metabolic syndrome. This project will obtain data on 3000 subjects from a unique and newly available population-based cohort - the NIDDK supported Boston Area Community Health (BACH) sample (DK 56842; principal investigator: John McKinlay, PhD). It will therefore cost-effectively capitalize on our previous work in obtaining this large, randomly-chosen, and representative population. The BACH cohort - 5,506 community- dwelling subjects - is socio-demographically diverse, consisting of 2,301 men and 3,205 women (1,780 black, 1,858 Hispanic, and 1,868 white) across a broad age-range (30-79 years). This cohort exhibits the wide variability in overall health status, current life circumstances and access to health care that is required for the planned study. Importantly, use of this sample will permit the study of health and disease among subjects who typically go unobserved in a clinical setting. Extensive preliminary studies support the feasibility of this effort. The upstream focus on prediabetes represents a unique opportunity to examine the influence of the multilevel contributors to health differences antecedent to T2DM diagnosis, when targeted interventions might achieve tremendous impact in preventing transition to T2DM. The measurement of multilevel contributors is motivated by their potential to inform such interventions, either at the social and the environmental levels (healthy public policy and community action), or the behavioral and biophysiologic levels (primary and secondary prevention). The multi-level, interdisciplinary approach builds upon existing literature and permits balanced estimation of the independent and relative contribution of different factors. The inclusion of well justified measures at each level will facilitate understanding of disease pathways within their social and environmental contexts, thus adding to the armamentarium of both clinical providers and policy makers, and enhancing their ability to prevent and treat T2DM. PUBLIC HEALTH RELEVANCE: This project will obtain data on 3000 subjects, a sample equally divided by gender and race/ethnicity (black, Hispanic, and white men and women), in order to understand the reasons that among black and Hispanic Americans, type 2 diabetes is more common, and more severe, than among their white compatriots. To do so, the study team will examine physiologic influences and health conditions that often occur before diabetes is diagnosed, to determine if they are different across race and ethnicity, and if so, what explanatory factors (such as environment, family history, or socioeconomic status) contribute to those differences. If successful, this project will identify ways that the excess risk of type 2 diabetes observed among vulnerable populations can be reduced.