Biology or Management: Understanding Racial Differences in Post Fracture Outcomes

生物学或管理学：了解骨折后结果的种族差异

• 批准号: 9769512
• 负责人: Nicole C Wright
• 金额: $ 12.71万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9769512
• 关键词: Address; African American; Age; Area; Biological; Biology; Characteristics; Clinical; Clinical Trials Design; Data; Data Set; Death Rate; Discipline of Nursing; Enrollment; Evaluation; Femur; Financial Support; Fracture; Gait speed; Goals; Health; Healthcare; Hip Fractures; Hip region structure; Hospitals; Knowledge; Life; Logistics; Measures; Mediating; Mediation; Mediator of activation protein; Medicaid; Medical; Medicare; Mentored Research Scientist Development Award; Mentors; Methods; Minority Groups; Modeling; Morbidity - disease rate; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Nursing Homes; One-Step dentin bonding system; Osteoporosis; Outcome; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Pelvis; Persons; Pharmaceutical Preparations; Pilot Projects; Postmenopausal Osteoporosis; Pragmatic clinical trial; Psychosocial Factor; Public Health; Quality Indicator; Questionnaires; Race; Reporting; Research; Research Design; Research Personnel; Rotation; Telephone; Time; Training; Training Activity; Training Programs; United States; Vertebral column; Woman; Wrist; beneficiary; bone health; career; career development; cohort; disparity reduction; experience; fragility fracture; health care service utilization; health disparity; humerus; interest; lifestyle factors; mortality; mortality disparity; multidisciplinary; multiple chronic conditions; prevent; primary outcome; psychosocial; racial difference; racial disparity; racial minority; recruit; repaired; screening; social; therapy development

ABSTRACT Fragility fractures related to osteoporosis are associated with high rates of morbidity and mortality. Up to a third of patients die in the year after sustaining a hip fracture, 20% require extended time nursing facilities, and one in ten require additional financial assistance from Medicaid post fracture. Preliminary data among Medicare beneficiaries indicate that there are significant racial differences in hip fracture mortality; specifically, a higher mortality rate among Black women, suggesting either biological differences in bone health, disparities in osteoporosis and post fracture management, or both. A current evaluation of racial differences in post fracture outcomes has not been performed. Similarly, there has not been a comprehensive evaluation of factors that if intervened upon, could reduce the disparity in these post-fracture outcomes. Many factors that prevent and/or reduce the adverse sequelae of fractures have been reported from large national osteoporosis cohorts. However, these cohorts had a relatively small proportion of Blacks, and these factors may have different associations in the Black population. Currently, Blacks comprise the largest racial minority group in the United States, thus highlighting the need to evaluate factors potentially mediating these disparities and designing studies targeting these factors to reducing the mortality disparity in the Black population. To further my journey as an independent osteoporosis outcomes and disparities researcher, I propose a project titled “Biology or Management: Understanding Racial Differences in Post-Fracture Outcomes.” The specific aims for this study are: 1) To determine current racial differences in post fracture outcomes, 2) To identify the patient, health care utilization, and hospital-related factors that mediate the association between race and post- fracture outcomes, and 3) To examine if psychosocial, cultural, and lifestyle factors mediate the association between race and mobility among patients with hip fracture. To achieve these aims, I have proposed training and career development activities around health disparities research, mediation analysis, and pragmatic clinical trial design and intervention development with complementary osteoporosis and hip fracture clinical rotations. With completion of my training activities and research aims, I will successfully transition into an independent researcher, and be one step closer to my overall goal of reducing the racial disparity in fracture outcomes.

摘要 与骨质疏松症相关的脆性骨折与高发病率和死亡率有关。高达三分之一 20%的患者在髋部骨折后的一年内死亡，20%的患者需要延长护理设施的时间，其中 十分之一的人需要医疗补助骨折后的额外经济援助。医疗保险中的初步数据 受益人指出，髋部骨折死亡率存在显著的种族差异；具体地说，较高的 黑人女性的死亡率，这表明要么是骨骼健康的生物学差异，要么是 骨质疏松症和骨折后治疗，或两者兼而有之。骨折后种族差异的最新评估 结果尚未执行。同样，还没有全面评估如果 进行干预，可以减少这些骨折后结果的差异。许多因素阻碍和/或 减少骨折的不良后遗症已有来自大型国家骨质疏松队列的报道。 然而，这些队列中黑人的比例相对较小，这些因素可能会有所不同 黑人人口中的联系。目前，黑人是美国最大的少数族裔群体 各国，从而突出需要评估可能调和这些差异的因素并设计 针对这些因素的研究旨在减少黑人人口中的死亡率差距。为了让我的旅程更进一步 作为一名独立的骨质疏松症结果和差异研究人员，我提出了一个名为《生物学或 管理：了解骨折后预后的种族差异。这项研究的具体目的 是：1)确定当前骨折后预后的种族差异，2)识别患者， 卫生保健利用，以及与医院相关的因素，调解种族和后 骨折结局，以及3)检查心理社会、文化和生活方式因素是否在 髋部骨折患者的种族与活动能力之间的关系。为了实现这些目标，我有 拟开展的培训和职业发展活动围绕健康差距研究、调解分析、 与骨质疏松症和髋关节互补的实用临床试验设计和干预开发 骨折临床旋转。随着我的培训活动和研究目标的完成，我将成功 转变为一名独立的研究人员，离我减少种族歧视的总体目标又近了一步 骨折结果的差异。