Upstream Contributors to Downstream Disparities in Type 2 Diabetes

描述（由主要研究者提供）：2型糖尿病（T2 DM）困扰着大约2100万美国成年人，每年的可归因成本超过1320亿美元。美国少数民族人群承担了不成比例的T2 DM负担。与白色美国人相比，黑人和西班牙裔美国人的T2 DM患病率更高，疾病控制较差，T2 DM并发症患病率更高。当地环境不利因素、缺乏获得适当保健的机会、行为风险因素和其他影响的汇合可能以协同方式促成这些增加的负担。本申请通过调查导致T2 DM风险“下游”差异的“上游”、前因因素来响应NIH项目公告PA-07-027（“NIDDK疾病中的健康差异”）。它特别旨在衡量多层次的社会，环境，行为和生物生理因素的相对贡献，种族和民族异质性的糖尿病前期的患病率。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。本项目将从一个独特的、新获得的基于人群的队列中获得3000例受试者的数据-NIDDK支持的波士顿地区社区卫生（BACH）样本（DK 56842;主要研究者：John McKinlay，PhD）。因此，它将经济有效地利用我们以前的工作，以获得这个大的，随机选择的，和代表性的人口。BACH队列-5，506名社区居民受试者-在社会人口统计学上是多样化的，包括2，301名男性和3，205名女性（1，780名黑人，1，858名西班牙裔和1，868名白色），年龄范围很广（30-79岁）。该队列在总体健康状况、当前生活环境和计划研究所需的医疗保健获取方面表现出广泛的变异性。重要的是，使用该样本将允许在临床环境中通常未观察到的受试者中研究健康和疾病。广泛的初步研究支持这一努力的可行性。上游对前驱糖尿病的关注代表了一个独特的机会，可以检查T2 DM诊断前健康差异的多层次贡献者的影响，此时有针对性的干预措施可能会在预防转变为T2 DM方面产生巨大影响。多层次贡献者的测量是出于他们的潜力，告知这种干预措施，无论是在社会和环境层面（健康的公共政策和社区行动），或行为和生物生理水平（初级和二级预防）。多层次，跨学科的方法建立在现有的文献，并允许平衡估计的独立和相对的不同因素的贡献。在每一级纳入充分合理的措施将有助于在其社会和环境背景下了解疾病途径，从而增加临床提供者和政策制定者的医疗设备，并提高他们预防和治疗T2 DM的能力。公共卫生相关性：该项目将获得3000名受试者的数据，样本按性别和种族/民族（黑人、西班牙裔和白色男性和女性）平均划分，以了解黑人和西班牙裔美国人中2型糖尿病比他们的白色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，如果是，则解释因素（如环境，家族史或社会经济地位）有助于这些差异。如果成功的话，该项目将确定如何减少在弱势群体中观察到的2型糖尿病的过度风险。

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.