Social adversities and asthma: a new phenotype?

 描述(由申请人提供)：哮喘是一种常见且具有挑战性的儿童疾病，对贫困的少数群体影响不成比例。这些人群还经历了过多的社会逆境，这是哮喘发病率的重要风险因素。然而，对这些逆境的反应是多种多样的：贫困增加了非裔美国人患哮喘的几率，但降低了墨西哥裔美国人患哮喘的几率。因此，我们在识别易受社会逆境影响并真正处于哮喘预后不良高危人群的能力方面存在知识差距。我正在寻求有导师的NIH K23职业发展奖，以获得必要的培训、实践经验和知识，以成为哮喘健康结果方面的领先、独立研究人员。为了朝着这个目标前进，我这个奖项的总体目标是识别处于不利地位的少数族裔儿童，他们有可能出现较差的哮喘结果。我的中心假设是人口、社会和环境特征的概况，加上与压力相关的生物标记物，将预测哪些人患上哮喘预后不良的高风险，并且这种概况将因种族/民族而异。这将通过以下三个目标进行测试。具体目标1：评估个人和社区一级的社会逆境与哮喘易感性和发病率之间的联系。通过对6200名患有和不患有哮喘的儿童的横断面研究，从管理的问卷和从个人住址历史中获得的地理编码人口普查数据，已经确定了社会逆境。具体目标2：检查社会逆境是否与可能影响哮喘易感性和发病率的压力生物标记物有关。将测量与压力相关的生物标记物，并将在非洲裔美国人和拉丁裔儿童中分别检查生物标记物和哮喘结果之间的联系。具体目标3：确定易受社会逆境影响的表型，并使用纵向方法研究它如何改变哮喘的病程。将确定哮喘患者中与社会逆境有关的一种表型或哮喘类型。具有确定表型的参与者将从最初的研究中招募，并进行跟踪，以了解这种哮喘类型在社会逆境中随着时间的推移是如何表现的。这项建议将导致确定一种哮喘表型，使我们能够针对与社会逆境相关的哮喘预后不良的高危人群。这一贡献与利用压力一样意义重大 相关的生物标志物可能使我们能够更好地对个体进行风险分层，并有可能在不良健康后果发生之前捕捉到他们。具有不同专业知识的多学科指导委员会：哮喘(Burchard博士、Cabana博士)、健康差距研究(Burchard博士、Bibbins-Domingo博士、Cabana博士)、生物统计学(Sen博士)和实施科学(Cattamanci博士、阿克曼博士)将指导研究议程的进展。他们的指导，以及由K23奖项推动的重点培训和研究计划，将发展我在哮喘健康差距研究方面的专业知识。

 DESCRIPTION (provided by applicant): Asthma is a common and challenging disease of childhood that disproportionately affects poor minority populations. These populations also experience an excess of social adversities, which are important risk factors for asthma morbidity. However, the response to these adversities is variable: poverty increases the odds of asthma in African Americans, yet decreases it in Mexican Americans. Thus, there is a knowledge gap in our ability to identify individuals vulnerable to social adversities and truly at high-risk for poor asthma outcomes. I am seeking a Mentored NIH K23 Career Development Award to acquire the necessary training, practical experience, and knowledge to become a leading, independent researcher in asthma health outcomes. To move towards this goal, my overall objective for this award is to identify disadvantaged minority children at risk for poor asthma outcomes. My central hypothesis is a profile of demographic, social, and environmental characteristics coupled with stress-related biomarkers will predict which individuals are at high risk for poor asthma outcomes, and that this profile will vary by race/ethnicity. This will be testd with the following three aims. Specific Aim 1: Estimate the association between social adversities at individual- and community-levels with asthma susceptibility and morbidity. Social adversities have been identified from administered questionnaire, and geocoded census data obtained from personal address history through a cross-sectional study of 6200 children with and without asthma. Specific Aim 2: Examine if social adversities are associated with biomarkers of stress that may influence asthma susceptibility and morbidity. Stress-related biomarkers will be measured and a link between the biomarkers and asthma outcomes will be examined separately in African American and Latino children. Specific Aim 3: Identify a phenotype susceptible to social adversities and examine how it modifies the course of asthma using a longitudinal approach. A phenotype, or type of asthma, associated with social adversities amongst those with asthma will be identified. Participants with the identified phenotype will be recruited from the original study and followed to understand how this asthma type behaves over time in the presence of social adversities. This proposal will result in identifying an asthma phenotype that will allows us to target individuals at high-risk for poor asthma outcomes related to social adversities. This contribution is significant as utilizing stress related biomarkers may allow us to better risk stratify individuals and, potentially, capture them prior to adverse health outcomes occurring. A multi-disciplinary mentoring committee with diverse expertise: asthma (Drs. Burchard, Cabana), health disparities research (Drs. Burchard, Bibbins-Domingo, Cabana), biostatistics (Dr. Sen), and implementation sciences (Drs. Cattamanchi, Ackerman), will guide the progress of the research agenda. Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will develop my expertise in health disparities research in asthma.