Precise Bone Density Reference Ranges to Reduce Systematic Disparities in Osteoporosis Healthcare for Hispanic Women

精确的骨密度参考范围可减少西班牙裔女性骨质疏松症医疗保健的系统性差异

• 批准号: 10372881
• 负责人: Qing Wu
• 金额: --
• 依托单位: UNIVERSITY OF NEVADA LAS VEGAS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-08 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372881
• 关键词: Address; African American; Aging; Assessment tool; Bone Density; Caucasians; Cessation of life; Characteristics; Clinical; Clinical Data; Custom; Data; Data Set; Databases; Diagnosis; Diagnostic Errors; Electronic Health Record; Ethnic Origin; Fracture; Generations; Goals; Guidelines; Healthcare; Healthcare Systems; Hispanic; Hispanic Populations; Individual Differences; Knowledge; Life Expectancy; Methodology; Methods; Minority; Minority Groups; Modeling; National Health and Nutrition Examination Survey; Normal Range; Osteoporosis; Outcome; Patients; Performance; Plant Roots; Postmenopause; Prevalence; Prevention; Public Health; Race; Reference Values; Research; Risk; Risk Assessment; Risk Management; Running; Sampling; Scoring Method; Specificity; Statistical Models; Systematic Bias; Testing; Validation; Variant; Woman; Women' s Health; base; bone; clinical care; clinical diagnosis; cohort; design; disparity elimination; epidemiology study; ethnic minority; fracture risk; fragility fracture; gradient boosting; health care disparity; improve minority health; improved; innovation; large scale data; novel; osteoporosis with pathological fracture; racial and ethnic; racial and ethnic disparities; random forest; rapid growth; screening; statistics

Project Summary / Abstract Some Caucasian-based clinical guidelines have become the systematic underpinnings of racial and ethnic dis- parities in healthcare. A prime example is the T-score osteoporosis diagnosis criteria, which the WHO initially proposed only for postmenopausal Caucasian women in epidemiological research. However, the T-score diag- nosis criteria are currently used to help with osteoporosis diagnosis for all patients. The T-score approach defines the reference range (RR) of bone mineral density (BMD). Nonetheless, Caucasians-based RRs cannot account for normal variability in race/ethnicity. As a result, applying these Caucasian-based RRs to racial/ethnic minorities often causes errors in diagnosis and risk assessment. With a growing and increasingly diverse minority popula- tion in the US, Caucasian-based clinical guidelines run the risk of exacerbating racial and ethnic healthcare disparities. The existing RRs of BMD are incredibly controversial because many patients who sustain fragility fractures have a “normal” BMD as defined by the conventional T-score approach. This clinically utilized, Cauca- sian-based approach is flawed and, as such, causes systematic healthcare disparities. There is no empirical approach specifically designed to define the RRs of BMD for racial/ethnic minorities. Subsequent race/ethnicity- adjusted T-score thresholds remain controversial because they are not empirically validated, so consequently, their performance has been unsatisfactory on racial/ethnic minorities. Hispanic women have a similarly high fracture risk as Caucasian women; however, Hispanic women, as the most heterogeneous group, have a higher osteoporosis misclassification rate with the T-score diagnosis criteria. With the rapid growth of an increasingly diverse and aging Hispanic population, osteoporotic fractures in Hispanic women are rapidly becoming a signif- icant public health issue. Hence, this application aims to create precise RRs of BMD for Hispanic women to address this pressing issue. This application's central hypothesis is that new precise RRs will classify osteopo- rosis in Hispanic women more accurately than conventional thresholds. This hypothesis will be tested by pursu- ing three specific aims: 1) developing the best-performing model for normative BMD in Hispanic women; 2) determining the precise thresholds of BMD; and 3) evaluating the new RRs in Hispanic women. By replacing the conventional Caucasian-based threshold, the novel, precise RRs will fundamentally shift the current research and clinical care paradigm in RR from one fixed range for every patient to more precise thresholds that account for many individual differences. This application will leverage large samples of Hispanic women and innovative data-driven approaches in creating race/ethnicity-specific, precise RRs of BMD, thus systematically eliminating the corresponding root cause of healthcare disparities for Hispanic women. Of increased significance, the knowledge gained herein can be utilized to generate many other types of precise RRs for various minority groups. The new generation of RRs will directly contribute to improving minority health and reducing healthcare dispari- ties by eliminating such systematic bias in the healthcare system.

项目摘要/摘要 一些以高加索人为基础的临床指南已经成为种族和民族差异的系统基础。 医疗保健中的平价。一个最好的例子是T-Score骨质疏松症诊断标准，世界卫生组织最初是这样做的 建议在流行病学研究中仅针对绝经后的高加索妇女。然而，T-SCORE诊断- NOSIS标准目前用于帮助所有患者诊断骨质疏松症。T-Score方法定义了 骨密度的参考范围(RR)。尽管如此，高加索人的RRS不能解释 种族/民族的正常变异性。因此，将这些以高加索人为基础的RRS应用于种族/少数民族 经常导致诊断和风险评估中的错误。随着少数民族人口的不断增长和日益多样化- 在美国，基于高加索人的临床指南存在加剧种族和民族医疗保健的风险 差距。现有的BMD RRS极具争议性，因为许多患有骨质疏松症的患者 根据传统的T评分方法，骨折有一个“正常”的骨密度。这一临床应用，考卡- 以西安为基础的方法是有缺陷的，因此导致了系统性的医疗差距。没有经验的证据 专门为确定种族/族裔少数群体的BMD的RRS而设计的方法。随后的种族/民族- 调整后的T-Score阈值仍然存在争议，因为它们没有得到经验验证，因此， 他们在种族/少数民族问题上的表现并不令人满意。西班牙裔女性也有类似的快感 高加索女性的骨折风险；然而，西班牙裔女性作为最不同种族的群体，有更高的 骨质疏松症的误分率采用T-Score诊断标准。随着越来越多的人快速增长 随着西班牙裔人口的多样化和老龄化，西班牙裔女性的骨质疏松性骨折正在迅速成为一个标志- 尖锐的公共卫生问题。因此，该应用程序旨在为西班牙裔女性创建精确的BMD RRS 解决这个紧迫的问题。这个应用程序的中心假设是，新的精确RRS将对骨质疏松症进行分类- 与传统的阈值相比，西班牙裔妇女的黑素症更准确。这一假说将由Pursu验证- ING的三个具体目标：1)开发西班牙裔妇女标准骨密度的最佳表现模型；2) 确定BMD的准确阈值；以及3)评估西班牙裔女性的新RRS。通过替换 传统的基于高加索人的阈值，新颖、精确的RRS将从根本上改变目前的研究 RR中的临床护理模式从每个患者的一个固定范围到更精确的阈值 对于许多个体差异。这一应用程序将利用大量西班牙裔女性样本和创新 以数据驱动的方法创建特定种族/族裔的准确的BMD RR，从而系统地消除 拉美裔女性医疗保健差距的相应根本原因。更重要的是， 在此获得的知识可用于为各种少数群体生成许多其他类型的精确RR。 新一代RRS将直接为改善少数群体健康和减少医疗差异做出贡献- 通过消除医疗体系中的这种系统性偏见来建立联系。