Upstream Contributors to Downstream Disparities in Type 2 Diabetes

描述(由首席研究人员提供)：2型糖尿病(T2 DM)困扰着大约2100万美国成年人，每年的可归因性成本超过1320亿美元。美国少数民族人口承担着不成比例的T2 DM负担。与白人相比，黑人和西班牙裔美国人T2 DM的患病率更高，疾病控制更差，T2 DM并发症的患病率更高。当地的环境不利因素、缺乏充分的医疗保健、行为风险因素和其他影响因素的汇合可能以协同的方式导致这些负担的增加。该应用程序响应NIH计划公告PA-07-027(“NIDDK疾病中的健康差异”)，调查导致T2 DM风险“下游”差异的“上游”因素。其具体目的是衡量多水平的社会、环境、行为和生物生理因素对糖尿病前期患病率的种族和民族异质性的相对贡献。糖尿病前期将被定义为空腹血糖受损或代谢综合征的流行。该项目将从一个独特的、新获得的基于人群的队列中获得3,000名受试者的数据--NIDDK支持的波士顿地区社区卫生(BACH)样本(56842丹麦克朗；主要调查者：约翰·麦金莱博士)。因此，它将具有成本效益地利用我们以前在获得这一庞大的、随机选择的和有代表性的人口方面所做的工作。巴赫群体--5,506名社区居民--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名白人)，年龄范围很广(30-79岁)。这一队列显示了计划研究所需的总体健康状况、当前生活状况和获得卫生保健的机会方面的广泛差异。重要的是，使用该样本将允许在通常在临床环境中未被观察到的受试者中进行健康和疾病的研究。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是一个独特的机会，可以检查在T2 DM诊断之前多水平的健康差异贡献者的影响，当有针对性的干预可能在预防向T2 DM过渡方面取得巨大影响时。衡量多层次贡献者的动机是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)为这类干预措施提供信息的潜力。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。在每一级纳入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武器库，并增强他们预防和治疗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、西班牙裔和白人男性和女性)平均划分，以了解为什么在美国黑人和西班牙裔美国人中，2型糖尿病比他们的白人同胞更常见、更严重。为此，研究小组将检查糖尿病诊断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，哪些解释因素(如环境、家族史或社会经济状况)对这些差异有影响。如果成功，该项目将确定可以降低在脆弱人群中观察到的2型糖尿病额外风险的方法。

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.