Prioritizing county-level social determinants that contribute to the greater burden of diabetes and hypertension in the US

项目总结/摘要 在美国，心血管疾病（CVD）的死亡人数在经历了数十年的下降后开始增加。 尽管CVD死亡率增加的原因尚不清楚，但预防、检测和治疗CVD死亡的方法是非常重要的。 CVD危险因素的最佳治疗（即，糖尿病和高血压）将是必不可少的， 进一步增加CVD死亡率。目前，美国14%的成年人患有糖尿病，其中三分之一的人患有糖尿病。 29%的成年人患有高血压。然而，在CVD风险因素中存在着明显的差异， 负担，特别是健康的社会决定因素。这些决定因素是导致 糖尿病和高血压的发展。然而，它们在很大程度上被临床实践所忽略， 决策的人们日益认识到社会决定因素对健康结果的影响， 但目前尚不清楚应该评估哪些因素，以及如何将这些信息纳入当前的 实践健康的社会决定因素是广泛的，因此，重要的是要确定那些可能 对糖尿病和高血压的预防、治疗和控制影响最大，可能是 用于为制定有针对性的方案和政策提供信息。我们建议调查社区 和个人的社会决定因素，有助于更大的负担，糖尿病和高血压， 美国东南部通过利用国家数据库，医疗保险索赔管理数据库和 一项前瞻性队列研究的基础设施，NIH资助的地理和种族差异的原因， 中风（REGARDS）研究，2003-07年招募了30,239名中年和老年人。我们将依靠 这些资源用于实现以下目标：1）确定县级社会决定因素的关联 健康状况与县级糖尿病和高血压患病率和发病率的关系， 美国东南部; 2）评估县级健康社会决定因素与县级 在东南部的老年人中，糖尿病和高血压的患病率和发病率分别为 美国使用医疗保险数据库; 3）评估县级和个人级社会 健康的决定因素与个人水平的流行和事件糖尿病和高血压，分别， 在美国东南部的参与者中。这项提案将优先考虑那些社会决定因素， 与美国东南部糖尿病和高血压负担加重有关的健康问题， 帮助指导预防计划和干预措施，以减少这种过度风险。

PROJECT SUMMARY/ABSTRACT Deaths from cardiovascular disease (CVD) have begun to increase in the US after decades of decline. Although the reasons underlying this increase in CVD deaths are unclear, the prevention, detection, and optimal treatment of CVD risk factors (i.e., diabetes and hypertension) will be essential for preventing any further increases in CVD mortality. Currently, 14% of adults in the US have diabetes, of which 1 in 3 is undiagnosed, and 29% of adults have hypertension. However, stark disparities exist in the CVD risk factor burden, particularly by social determinants of health. These determinants are key contributors to the development of diabetes and hypertension. Yet, they have largely been omitted from clinical practice and decision-making. There is increasing awareness of the influence of social determinants on health outcomes, but it is not clear exactly which factors should be assessed or how to integrate this information into current practice. Social determinants of health are extensive, so it is important to characterize those that are likely to have the greatest influence on the prevention, treatment and control of diabetes and hypertension and may be used to inform the development of targeted programs and policies. We propose to investigate the community and individual social determinants that contribute to a greater burden of diabetes and hypertension in the southeastern US by leveraging national databases, the Medicare claims administrative database and the infrastructure of a prospective cohort study, the NIH-funded Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, that enrolled 30,239 middle-aged and older adults in 2003-07. We will build upon these resources to address the following aims: 1) determine the association of county-level social determinants of health with the county-level prevalence and incidence of diabetes and hypertension, separately, in the southeastern US; 2) evaluate the association of county-level social determinants of health with the county-level prevalence and incidence of diabetes and hypertension, separately, among older adults in the southeastern US using the Medicare database; and 3) evaluate the association of county-level and individual-level social determinants of health with individual-level prevalent and incident diabetes and hypertension, separately, among REGARDS participants in the southeastern US. This proposal will prioritize those social determinants of health that are associated with a greater burden of diabetes and hypertension in the southeastern US and help guide prevention programs and interventions to reduce this excess risk.